Pro re nata (PRN) medications are commonly prescribed for psychiatric patients on admission, often at maximum daily dose (MaxD). We intended to evaluate prescribing patterns for PRN medications, their MaxD, and rationale, specifically in the first seven days in the hospital, along with any concerns of associated physical illnesses.

All the inpatients on a specific date, admitted to adult and old age wards of a general psychiatric hospital, for at least 7 days, were recruited for this service evaluation. Data regarding the prescribing of promethazine, lorazepam, zopiclone as PRN, patient demographics, and psychiatric and physical diagnoses were collected using inpatient drug cards and electronic patient notes.

Out of 52 inpatients, 14 were excluded (4 admitted for < 7 days, and 10 had missing data), leading to a sample size of 38 patients. On admission, a considerable proportion of patients were prescribed promethazine (82%), lorazepam (76%), and zopiclone (50%). More than half (63%) of patients on promethazine were started on 100 mg MaxD, of which 13% had reasons for prescription, and 33% had reasons for the MaxD were noted. None of the old-age patients was prescribed 100 mg of promethazine. During first 7 days, patients used on average 15%, 14% and 29% of the total prescribed dose of PRN promethazine, lorazepam and zopiclone; and 35%, 45% and 47% of patients did not use any PRN drugs. Only one patient used 100% of the available PRN lorazepam and zopiclone. Patients with current illicit substance misuse, used PRN slightly more frequently; promethazine (16% v 12%), lorazepam (20% v 14%) and zopiclone (46% v 24%) compared with those with no misuse. With a current risk of aggression or agitation, all female patients were prescribed PRN promethazine or lorazepam, compared with 86% of male patients.

In regards to British National Formulary (BNF) cautions of associated physical illness, one patient with glaucoma, and one epilepsy was prescribed promethazine; three patients with respiratory condition were prescribed PRN lorazepam; and six patients with depression and four with current drug user were prescribed PRN zopiclone.

Considering diagnoses, promethazine, lorazepam and zopiclone were used by varying proportions of the patients: schizophrenia (10%, 3%, 0%), bipolar affective disorder (0%, 14%, 57%), depression (27%, 11%, 38%), personality disorder (15%, 28%, 48%) respectively.

Psychiatric inpatients were prescribed MaxD of PRN medications more than what is being administered. Documentation of rationale for prescribing PRN medications and dose is needed.

In South Korea, to care for patients with dementia, a new dementia-specific nursing institution has been established that, unlike general nursing institutions, uses shared living rooms and provides customized programs for dementia. This study aims to investigate the effectiveness of dementia-specific nursing institutions. For this purpose, whether psychotropic drugs (antipsychotics, antidepressants, sedatives, mood stabilizers) used to treat behavioral and psychological symptoms of dementia (BPSD) are prescribed, and the mortality and morbidity rates mentioned as side effects of psychotropic drugs (cerebrovascular disease, fall-related fractures, pneumonia, pressure ulcers) varied depending on the use of a dementia-specific nursing institution.

Using the National Health Insurance Service's customized and Long-Term Care Insurance databases for older people, we collected data over the four years since the introduction of dementia-specific nursing institutions. Among patients with dementia aged 65 years or older, those who used dementia-specific nursing institutions and those who used general nursing institutions were matched for gender, age, history of cerebrovascular disease, disability, comorbidities, and history of taking psychotropic drugs. Thus, 835 users of dementia-specific nursing institutions and 2,505 users of general nursing institutions were analyzed. During the study period, the subjects' use of psychotropic drugs, mortality, and morbidity (cerebrovascular disease, fall-related fractures, pneumonia, and pressure ulcers) were determined. After controlling for variables such as Activities of Daily Living (ADL) scores, the effect of using a dementia-specific nursing institution on mortality and morbidity was analyzed using a logistic regression model.

Users of dementia-specific nursing institutions were more likely to be prescribed antipsychotics, antidepressants, and sedatives during the study period compared with users of general nursing institutions. Also, users of dementia-specific nursing institutions had a lower mortality rate and lower morbidity rates of pneumonia and pressure ulcers than users of general nursing institutions.

Users of dementia-specific nursing institutions had significantly lower mortality rates and morbidity rates of pneumonia and pressure ulcers. This is attributed to dementia-specific nursing institutions encouraging social interaction and physical activity by providing shared living rooms and specialized programs catered towards patients with dementia. However, since the influence of other confounding variables cannot be ruled out, more precisely designed research is needed in the future.

Helplines and crisis lines are a standard component of a public health approach which appear to be intuitively supportive and useful to a population in acute distress and prevent severely adverse outcomes i.e., suicide. These services exist in different formats throughout the world. They have the advantage of being widely accessible, approachable, and bypass the waiting times and bureaucracies of referral systems for accessing secondary mental health services. The authors set out to study the range of outcomes used to evaluate mental health helplines and crisis lines. The focus was not simply to explore whether mental health helplines were effective or not. Rather the authors wanted to investigate what outcomes were being considered as evidence.

The authors aimed to conduct a systematic review of evidence for mental health outcomes of service users of helplines and crisis lines.

The research question was, ‘What outcomes are evidenced in published literature for mental health helplines and/or crisis lines in terms of efficacy, effectiveness or efficiency?’

This was a systematic review of literature using the PRISMA-2020 statement. Literature searches of Web of Science, Ovid (PsycINFO, Medline, EMBASE), PubMed and Scopus were conducted in December 2022. Relevant information from eligible studies was extracted by using a structured data extraction form. Mixed Methods Appraisal Tool (MMAT) was used to assess quality of the included studies. While the heterogeneity of studies prevented a meta-analysis, it provided a rich landscape for exploring the topic through a thematic analysis.

Eighteen studies finally met the inclusion and exclusion criteria. The projects studied used both trained professionals and volunteers trained to offer crisis intervention. Both qualitative and quantitative outcomes were evaluated across the studies. Outcomes were frequently subjective assessments of service users and/or the personnel delivering the intervention. Studies evaluated outcomes in various ways. Anonymity of the callers made long-term follow-up difficult in most cases, though it is understandable that anonymity might have contributed to the helpline being more accessible and less intimidating to the callers. MMAT scores showed the papers have a range of methodological soundness.

There is lack of consensus and uniformity regarding what outcomes can evidence the efficacy, efficiency, and effectiveness of mental health helplines. Before more investment in helplines, there needs to be discussion, planning and understanding among policy makers and service developers in deciding what they want to achieve from a mental health helpline. This will help researchers focus on relevant outcomes to evaluate mental health helplines. Services need clarity regarding what difference they are trying to make when such helplines are set up.

In January 2023, the rota for psychiatry SHOs within Cardiff and Vale UHB changed from 24-hour off-site on-call to 12-hour on-site shifts. This change occurred after rota gaps from sickness, increasing clinical pressures, and poor GMC survey feedback. We hypothesised that this would likely be received positively by SHOs, senior psychiatrists and other staff who work with the on-call SHO, and surveyed attitudes to the new rota. Our aim was to inform decisions about the rota going forward, and gather a baseline set of data for future comparison.

Data were collected retrospectively, via three questionnaires created on Microsoft Forms and distributed by email to: junior doctors on the on-call rota (“SHOs”), registrars and consultant psychiatrists (“seniors”), and nurses and allied healthcare professionals (“AHPs”). We used a mixture of Likert scales and free-answer sections, surveying staff attitudes of the impact of the change in rota on Patient Safety, Workload, Training Impact, Working Relationships and Welfare. Questions were altered to suit the group being surveyed (e.g. AHPs were not asked to comment on welfare of SHOs).

Data were collected between the dates of 23/3/23 and 5/5/23.

A total of 63 respondents (17 SHOs, 12 seniors, 34 AHPs) completed the questionnaire.

Overall results were very positive in favour of the new rota, with a final overall question concluding that 100% SHOs preferred the new rota, as did 92% seniors and 92% AHPs. Other highlights include:

• • 92% of all staff felt the on-call SHO could provide safer patient care, particularly at night.

• • 82% SHOs and 83% seniors felt workload had improved or stayed the same.

• • 71% SHOs had more training opportunities on-call (e.g. observing MHA assessments).

• • 82% AHPs felt working relationships with SHOs had improved.

• • 88% SHOs felt positive impact on their mental or physical wellbeing.

The new rota was near-unanimously positively welcomed by each group of staff surveyed, in all domains studied.

These findings were presented to members of the clinical board, and used to justify continuing the rota in future. It has remained in-person since.

With baseline data gathered, we will repeat the survey in February 2024 to gain more data on current attitudes to the new rota, one year on from its implementation.

This poster will:

1. 1. Describe the establishment of an acute crisis management service within a Child and Adolescent Mental Health Service (CAMHS) in the Republic of Ireland.

2. 2. Summarise clinical activity during the first six months of the service and qualitative feedback from service users and clinicians on their experience of the service.

In December 2021 the Republic of Ireland Health Service Executive approved the roll out of acute crisis management services for CAMHS – known as Hubs, with a remit to provide intensive brief interventions to support young people experiencing acute Psychiatric crises. Multiple weekly appointments are provided in clinic, at home or via telehealth.

The Lucena Clinic CAMHS – based in Counties Dublin and Wicklow, was chosen as a pilot site. Staff were recruited in January 2023 consisting of:

1. 1 FTE Consultant Child and Adolescent Psychiatrist

2. 1 Candidate Advance Nurse Practitioner

3. 1 Senior Social Worker

4. 1 Senior Occupation Therapist

5. 1 Administrator

A multi-disciplinary Steering Group was established with a view to planning clinical programs, ensuring safety and governance, procuring resources and embedding service evaluation.

The service went live in May 2023. Clinical data was gained from data entry to the service Electronic Patient Record.

Qualitative feedback was gained from service users using post-discharge questionnaires and from clinicians using semi-structured interview.

1. 1. Between May and December 2023 the Hub received 61 referrals and accepted 35.

2. 2. 27 of those accepted were new referrals to the service.

3. 3. Patients received an average of 27.1 hours of clinical intervention during their admission.

4. 4. Shortest admission was 10 hrs, the longest 66.5 hrs.

5. 5. 6 young people were seen at home, totalling 41 visits.

6. 6. 24 young people were discharged to CAMHS, 2 to GP, 2 to the clinic's Day Program, 3 required in-patient admission.

Service user feedback was positive with families highlighting ease of access to the service, intensity of intervention and a friendly environment as positives.

One parent remarked that they did not feel the Hub was the right setting for their child's care.

Clinician feedback highlighted the Hub as a positive support for community CAMHS with rapid access to intervention and communication from the Hub team mentioned as positives. One drawback identified was the intensity of intervention setting an unrealistic expectation for ongoing care.

The Hub appears a welcome addition to CAMHS with positive feedback from service users and clinicians. Ongoing development phase and evaluation is required.

Psychiatric illnesses are common in the perinatal period and many women are treated with psychotropic medications. Prescribing psychotropic medications often raises concern among patients and clinicians, because of a lack of information and no license to prescribe during pregnancy. This project aimed to evaluate the interventions offered in a perinatal clinic against the Perinatal College Centre for Quality Improvement standards. This included evaluating medications prescribed in the antenatal and postnatal periods; counselling regarding medication risks and benefits, provision of verbal and written information and psychosocial interventions.

Data of 60 patients (30 antenatal and 30 postnatal) attending perinatal outpatient clinics covering two cities in Midlands, England, consecutively from November 1st 2023 were collected from electronic clinical notes and clinic letters. Patients who did not attend their appointment were excluded.

The mean age of the sample was 30.3 ± 5.2 (range 19–41). Average gestational age was 6.5 ± 2.1 months (range 2.0–9.5) for antenatal women, and average postnatal duration was 6.5 ± 5.0 months (range 0.1–22.0) at the time of review. All women had psychiatric diagnosis, except one who was discharged back to primary care. The most common diagnoses were mixed anxiety and depression (38.3%), emotionally unstable personality disorder (38.3%), and postnatal depression (20%). The majority (75.0%) were prescribed psychotropic drugs. Antidepressants were prescribed in 66.7% of antenatal and 76.7% postnatal patients; most commonly prescribed overall were sertraline (33.3%) and citalopram (23.3%). Antipsychotics were prescribed in 30.0% of antenatal and 46.7% of postnatal patients. Aripiprazole and quetiapine were most commonly prescribed in the antenatal (both 13.3%) and postnatal (both 20%) periods. A larger proportion (40.0%) of women had as required medications; promethazine (20.0% vs 30.0%), diazepam (6.7% vs 13.3%) and zopiclone (3.3% vs 13.3%) were most frequently prescribed, with figures indicating prescription rates in the ante- versus postnatal period. None of the medications were prescribed above licensed limits nor met criteria for high dose antipsychotic monitoring. Verbal and written information about medications was provided in 78.3% and 35.0% of all cases respectively. Most (65.0%) women were offered psychological therapies, and of these, 69.2% received it.

Most women in the perinatal period were prescribed psychotropic drugs, with higher proportions in the postnatal period. The findings suggested areas of improvement, such as offering written information, documenting the discussion of medication counselling, and to increase the psychotherapeutic support. It also suggests developing manualised educational interventions to improve information sharing with patients, and perinatal care.

Opioid dependence is associated with adverse physical health, mental health and social consequences. Daily oral opiate substitutes offer some treatment gains but several negative associations including daily dosage fluctuations, long-term reliance on services and negative impact on ability to work.

Long-acting injectable buprenorphine (LAIB) is a new treatment option, extensively used in Wales since 2020. We have shown the many gains, including increased treatment retention, reduced service reliance, improved patient satisfaction and increased capacity for people to move on in their recoveries, are likely to be due to LAIBs unique combination of allostatic μ-opioid receptor agonism (craving reduction) and sustained κ-receptor antagonism (anxiolysis). However, ~50% experience resurfacing of mental health and/or trauma symptoms on LAIB that impedes recovery. The Buvidal Psychological Support Service, commissioned by Welsh Government, seeks to develop the evidence base for provision of rapidly accessible, tiered psychological support alongside LAIB to address this. Here we present initial 9-month findings.

Tier 1 of the service offers 8 weekly individual therapy sessions, delivered flexibly over 2–6 months, with an experienced trained therapist focused on psychoeducation, co-production of a trauma and compassioned based formulation, and the development of skills to manage current mental health or trauma symptoms.

Pre- and post-evaluation programme assessed efficacy including: EQ5D-5L, Work and Social Adjustment Scale (WSAS), Clinical Global Impressions (CGI), PRO Severity and Clinical Outcomes in Routine Evaluation –10 (CORE-10).

The service launched in March 2023 with 100 referrals in the first 9 months.

35 patients have completed Tier 1, taking between 2 and 6 months to complete.

Patients who completed Tier 1 showed clinically significant reductions in psychological distress and improvements in global functioning, quality of life and perceived mental health difficulties.

These were statistically significant at p < 0.001 for all measures (EQ5D, ICECAPS, WSAS, CGI, PRO, CORE-10) (28< = n <=34).

Rates of retention in treatment are greater than expected amongst this complex client group and the significant global improvements support the notion that those on LAIB present with increased stability and ability to engage in therapy, and that a tiered flexible approach to therapy can promote psychological safety and engagement and sustained recovery.

We propose that a tiered trauma-focused psychology service is well placed to meet the needs of people on LAIB and should be a core component of LAIB treatment in the UK.

Long-acting injectable buprenorphine (LAIB) is an opiate substitution therapy which controls cravings and other symptoms for at least 28 days. Using this medication eliminates daily visits to the pharmacy, the risk of deviation or overdose from OST and death from overdosing with opiates. Many of those on LAIB return to the lives they left before they became addicted to opiates, but some require additional support from a new bespoke psychological service.

The new service with funds for two years opened in March 2023. An evaluation of the service is required before funding ends to ensure renewal. Here we discuss the costs, benefits and assumptions we have used to demonstrate cost effectiveness.

Patients referred to the service are asked questionnaires and clinical outcomes at the start and end of the programme. We have used the EQ5D throughout as from this we can calculate the QALYs that NICE uses to value cost effectiveness. We have extrapolated that the benefit will last 4 years based on the COBALT study (Wiles 2016). We will be following the patients up at 12 months to test this but have no funds to follow up to 4 years. We have assumed that patients would have remained the same without this therapy.

The service has a budget of £23,812 a month and 5.17 patients a month (n = 31 July to December 2023) completed treatment. The average gain in EQ5D utility score per patient (n = 33) at discharge was 0.234 [0.140, 0.328]. If the quality-of-life score (EQ5D) at discharge is maintained in the same way as that for CBT in the COBALT study, the total number of QALYs gained from referral to 4 years would be 0.876. The cost-effectiveness ratio is therefore £5,261 per QALY gain. If the assumptions are correct and the patients retain this benefit this could be easily offset by savings elsewhere that have not been estimated in this evaluation.

Our analysis shows we are cost effective, but we may be cost neutral due to the potential savings accrued due to less substance misuse – currently costed at £58K per user per year (Home Office). The use of additional questionnaires for assessing NHS resource use or criminal activity could derail the success by overburdening participants. Evaluating roll out to other sites needs to be costed and proportional.

With thanks to all who have helped with an infectious enthusiasm – we may be cost-effective.

Crisis Resolution Home Treatment Team (CRHT) provides short-term treatment for psychiatric patients in the place of residence, dealing with mental health crises, risks, deterioration, and preventing hospital admissions. This team works round the clock, seven days a week. This study aimed to analyze the clinical outcomes of the service provided by the CRHT in Wolverhampton.

In a retrospective, observational, explorative study design, data was collected from the electronic medical records of 100 (54 female and 46 male) consecutive patients who were treated under the general adult (age range 18–65 years) CRHT from 1st December 2022. We collected outcome variables such as symptomatic improvement, change in risk status, days of treatment under CRHT, and discharge destination.

In the sample, 76% had one psychiatric diagnosis, and co-morbidities were present in 20%, with 4% of patients having no syndromal diagnoses. The most common primary diagnosis was personality disorder (24%), followed by psychotic disorders (22%), anxiety disorders 21%, and depression (20%). Overall risk status of red changed from 87% at admission to 17%, at discharge; risk to self from 43% to 17% (p < 0.01), risk to others from 11% to 1% (p < 0.01), respectively. The mean length under care of CRHT was highest with anxiety disorder (27.7 ± 18.2 days), followed by personality disorders 23.7 ± 17.9 days. Age and number of days under CRHT were negatively correlated, suggesting younger age was linked to higher number of days (p < 0.05). Most (71%) patients showed an improvement in their mental health, 15% deteriorated and got admitted to the psychiatric hospital, 9% did not engage and 5% were considered not suitable for care under CRHT for various reasons such as having no fixed abode. Most (80%) patients were discharged back to the community following the CRHT period.

Despite the limitation of subjective clinical assessments, the results suggested that the CRHT was effective in considerable proportions of patients with symptomatic improvement and a decrease in risk level, with a small proportion being admitted to a psychiatric ward. There is a need for objective evaluation of risk and symptomatic change using validated instruments and assessing patient experiences about the services.

Psychiatric services are under increasing pressure to provide effective patient care with diminishing resources. In NHS Lothian, there is a sector-based model and chronic issues with lack of inpatient beds.

We aim to examine the admission to discharge process at the Royal Edinburgh Hospital (REH) for patients within the North-West sector of Edinburgh (NW) to identify areas for improvement.

We collected data for NW admissions and discharges from the five General Adult Psychiatry wards in REH in 2023, two of which are allocated NW wards.

Admissions to the Intensive Psychiatric Care Unit were excluded as they indicated differing severity, and discharges via the ‘long-stay’ ward were excluded due to other factors delaying discharge.

Data was collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.

Qualitative data was collected anonymously from staff within NHS Lothian in the form of an online questionnaire to identify strengths and weaknesses of the current processes.

In 2023 there were 133 discharges of NW patients in REH. The average age was 39 years old and most common diagnosis was a psychotic illness (36%).

Qualitative data identified that admitting patients to hospital is increasingly challenging due to capacity issues and the lack of a community transfer plan.

53% of NW patients were admitted to NW wards. 27% of patients were moved between wards during their admission.

Length of stay (LOS) and readmission rates were used as proxy measures to examine patient outcomes. Patients who remained on the same ward during their admission had an average LOS of 28 days. 22% were re-admitted within the calendar year. Outcomes were no better when patients remained on their sector ward.

Patients who moved ward during their admission to hospital had an average LOS of 47 days. 45% were re-admitted.

A lack of bed capacity is having a negative impact on patient care in NHS Lothian. Staff expressed concerns about the admission process and patients are moving wards during acute episodes of care to accommodate a sector-based model and chronic lack of capacity. Lack of continuity during admissions may be contributing to longer admissions and more re-admissions, further impacting on capacity.

A review of the strategic planning of NHS Lothian Psychiatric care is required, including capacity planning, admission protocols and policies on boarding patients. We will disseminate these results to support this process and any future work into this topic.

In conditions such as schizophrenia insight may be limited, leading to partial adherence to antipsychotic medication. This can result in lower remission rates in this group and increased disease burden. Depot injections allow close monitoring of treatment adherence and early intervention where needed.

We aimed to determine the treatment adherence of patients attending the outpatient depot clinic at the South Sefton Neighbourhood Centre (SSNC) for antipsychotic injections and compare adherence between depot medication administered at 1, 2, 3 and 4 weekly intervals.

We identified patients attending the depot clinic at the SSNC using depot cards. The RIO patient electronic record was used to find previous depot cards and to record the number of doses given each month and calculate the number of failed encounters over a twelve-month period.

We excluded patients receiving the injection at home and those where 12 months of data could not be collected.

42 (12 female, 30 male) patients were included. 18 had full adherence and 24 had partial adherence. Average adherence was 93%; 90% in the female group and 94% in the male group. We compared adherence to weekly (7 patients), 2 weekly (15 patients), 3 weekly (8 patients) and 4 weekly (12 patients) depot injections. Weekly and 2 weekly had an average adherence of 89%, while 3 and 4 weekly had an average adherence of 96% and 99% respectively. The average number of failed encounters was highest with the 2 weekly group and lowest in the 3 and 4 weekly group.

Adherence to antipsychotic depot treatment at SSNC is good with nearly half of the patients included having full adherence. 4 weekly depot injections showed the best adherence with an average of 99%. Following on from this study we would like to explore the reasons for partial adherence in the two weekly group as well as the impact this has had on this group of patients, looking specifically at relapse and readmission rates.

This study focuses on the North Central London Child and Adolescent Mental Health Services (NCL CAMHS) Co-production workstream, initiated to establish co-production as a foundational method for service planning and delivery in the NCL region.

To understand what the CAMHS experts by experience members found useful and did not find useful in co-production projects within Barnet Enfield and Haringey Mental Health NHS Trust and NCL wide co-production.

Semi-structured interviews conducted with experts by experience within the Barnet Enfield and Haringey (BEH) NHS Trust aimed to explore their co-production experiences, identifying facilitators and barriers. The study employed an inductive thematic analysis, grounded in a constructionist epistemological position, to analyse qualitative responses from semi-structured interviews. Braun and Clarke's (2006) methodology guided the analysis, consisting of six phases. The researchers emphasized reflexivity, reflection, and maintaining coherence, consistency, and flexibility throughout the recursive process. The voices of the lived experience co-production members played a central role in the research, influencing the entire report.

Two members of the NCL CAMHS lived experience group served as “Lived Experience Researchers” and received training on coding reliability based on Braun and Clarke's (2006) guidance.

Thematic analysis revealed several key findings. Recognition of co-production values within the group highlighted the importance of giving voice to service users, valuing their individual experiences, and promoting power-sharing. Facilitators included good team working, valuing diversity, accessible online sessions, and promoting equality through interactions. Conversely, barriers included inconsistent meeting timings, power imbalances, and a consultation-style dominance. Participants expressed the need for more involved projects and recommended a transformation of BEH's co-production strategy.

Recommendations for BEH include a comprehensive evaluation of their co-production projects on the ladder of participation, emphasizing the importance of higher-level collaborations. Training for staff on co-production principles is crucial for fostering a mindset shift, and the establishment of a dedicated co-production team, including a co-production lead, is advised by service-users who co-produce. These roles can drive co-production projects, provide organizational structure, and facilitate stakeholder engagement.

During the perinatal period women are at increased risk for mental health illness. It is estimated that around 0.5 in 1000 deliveries will result in admission to the mother and baby unit (MBU). Recovery is achieved by combining pharmacological treatment with holistic approaches. The majority of MBU settings will offer a variety of sessions that aid relaxation, reflection, and bonding. We have chosen to trial an additional service – Yoga class. It is known that Yoga is beneficial not only for strength, flexibility, and chronic pain but also for improved concentration, relaxation, and anxiety reduction.

Service evaluation took place in 8 bed, inpatient MBU. Selection criteria included non-pregnant women who had 4–6 weeks postnatal health check, were interested in trialling the class and were willing to complete pre- and post-class selected questions from the Dialog scale. The total number of Yoga classes conducted was 9 but there was no set number of classes for patients to commit to. Sessions were run between October 2023 and February 2024. Dialog scale was selected as a well-established outcome measure within the ward. We measured 3 areas by a Dialog scale (physical health, mental health, and leisure). The rating range was 1–7 with 1 being totally dissatisfied and 7 totally satisfied. Questions were completed before and after the class.

In total 7 patients attended at least 1 Yoga class. We have calculated pre- and post-class average scores to measure change in selected outcomes. Physical health self-reported evaluation improved from 4.09 (SD = 0.79) to 4.48 (SD = 0.71). Mental health score improved from 3.61 (SD = 0.96) to 4.29 (SD = 0.99). Leisure score rose from 3.67 (SD = 1.3) to 4.34 (SD = 0.55). From the class record it was noted that overall, the uptake of the class was encouraging with 85% of patients returning to the Yoga with on average completion of 3 classes. 6 out of 7 patients did not attend further classes due to discharge or other commitments rather than withdrawing from classes.

From the collected data we can see that Yoga classes appear to be associated with moderate improvements in mothers’ mental and physical health, at least immediately post-class. Whether this translates into long-term benefits remains unknown. Our service evaluation indicates that Yoga can be a beneficial part of holistic management for mothers in the MBU setting. In the future, this study could also involve pregnant mothers, who are an important population within the MBU setting.

1. - To strengthen shared decision making between psychiatrists and general practitioners (GPs) while avoiding needless outpatient activity.

2. - To promote a seamless partnership between GPs and psychiatrists that will improve efficiency and effectiveness for better patient health outcomes.

3. - To improve patient journey whilst responding to operational pressures.

4. - To test GPs engagement and satisfaction.

Following GPs engagement sessions, a 12 weeks pilot was conducted with the Bath and North East Somerset (BaNES) Primary Care Liaison Service (PCLS) and the 6 Primary Care Networks (PCNs) in BaNES. 22 GP surgeries were allowed access to Advice and Guidance (A&G) system using a digital platform. The pilot ran from 3rd April to 25th June 2023, focussing on answering non-urgent queries related to: psychotropic medications, mental health presentations, and the wider mental health system signposting and awareness.

One Consultant Psychiatrist and One Associate Specialist in Psychiatry were involved. The asynchronous system (eOpinion) with an expected response time of 3–5 working days was used.

To allay any governance risks and to act as a backup should the A&G system process fail to record appropriately, a dual recording of the A&G given – both in the A&G digital platform and the patient electronic record was implemented. Further governance structures were built into the project to establish that actions undertaken by the psychiatrists were effective and justifiable.

82 requests received over the 12 weeks period.

20 out of 22 surgeries took part.

The Psychiatrists spent on average of 3.5 hours per week answering A&G requests. The administrative team spent on average one hour and three quarter per week processing A&G responses.

Although no significant impact on total referrals was noted, there was indication that demand was moving from the referral to A&G request.

All requests were responded within 2 working days.

Requests from GPs were largely appropriate with 88% resulting in advice and guidance, indicating an improved patient journey.

Minimal impact on the operational processes.

Positive feedback from GPs with 91% finding the A&G system useful or very useful. They were keen for the offer to continue.

Effective inter-professional collaboration between GPs and psychiatrists is essential in enhancing patients' overall health outcomes and experiences. For mental health services, this transformational approach should continue to enhance the existing offer. However, we should remain mindful of the potential risk of increased workload burden in General Practices, and the implications of this new clinical model on staff based in specialist services.

To examine whether the rate of clinical and non-clinical complaints towards a mental health service (MHS) in the west of Ireland has changed over the preceding seven years. We aim to clarify the pathways for managing clinical and non-clinical complaints locally and compare with other MHS nationally. We aim to capture the nature of complaints, potential factors in any change in rate and quantify associated workloads via survey of senior clinicians involved in managing complaints.

We obtained anonymous data from a local database maintained by administrative staff regarding annual complaint numbers for the previous seven years (2016–2022). Data separating clinical and non-clinical complaints were available for the previous four years only due to previous recording practices. Current complaint pathways were captured via administrative staff. A survey via telephone or email of Executive Clinical Directors (ECDs) typically involved in complaint management was conducted.

Annual rates of complaints have increased in the past four years, with these representing higher totals than any of the three previous years (2019–2022, n = 27,23,23,46 v. 2016–2018, n = 21,12,14). A significant increase in rate is noted in 2022 (n = 46) representing at least double the rate of five of the preceding six years. Clinical complaints are more predominant than non-clinical across a four year period (mean = 59% annual total) but no significant change in rate was noted. Rates of complaints are perceived to have increased in the previous five years by ECDs (n = 4). Repeat complainants are perceived to be common (n = 4). Workload regarding complaints is reported to be variable between services (n = 2, 0–4 hrs/week v. n = 2, 4–8 hrs/week). A clear appeals pathway is unavailable regarding clinical complaints across MHS (n = 4). A disparity between MHS around clinical complaints structures and recording practices between services is noted.

Overall rates of complaints towards MHS have broadly increased in the last four years, with a significant increase in 2022. There appears to be a significant disparity in structures between both clinical and non-clinical complaints pathways and between individual MHS. Further research in this area and a standardised national framework for management of clinical complaints is needed.

Addiction services in Essex are provided as a collaborative by NHS run Essex STaRS, Open Roads, SHARP and ARC provide psychosocial care. YPDAS supports the young people.

Observed gap: Pregnant women with addiction problems were running from pillar to post to receive care and support needed during this challenging phase of their life.

The one stop clinic provided an all-encompassing care pathway to fill the above need and improving outcomes for mothers and babies.

Description:

The new pathway was setup in 2019 on a hub & spoke model. The one stop clinic was at centre, comprising Substance Misuse, Midwifery and Obstetrics. The spokes included Perinatal-mental health, Neonatal, Adult, Child Social services, CMHTS, Police, Criminal Justice and primary care.

Simple entry criteria: 1. Substance Dependence 2. Positive pregnancy test with referral taken from any service. Patients receive comprehensive initial assessment covering addictions, mental health, social circumstances, obstetric history and physical health evaluation including foetal US scanning. Led by a team of psychiatrist, midwife, obstetrician and substance worker.

Evaluation identifies risks from mental, physical health, safeguarding, support needs and formulates an initial engagement and management plan. Referral into all necessary organisations. A staggered follow up plan per every trimester agreed.

Commencement or planned reduction of Opiate Substitution Therapy (OST), medication rationalisation, nutritional advice, enhanced antenatal monitoring. The regular follow-up via fortnightly midwife, drugs worker review. Monthly medial review in the clinic.

The support from perinatal psychiatry teams, CMHTS, Social services, Criminal Justice safeguarding teams is roped in when needed. Child protection, safeguarding issues are addressed. Clear multi-directional communication is maintained at all times. A safe delivery plan along good neonatal management ensured with appropriate outcomes for mother & baby are achieved.

Since 2019, this initiated 16 patients with various complexities. 12 women left hospital with their baby in their care. 1 left the area during the pregnancy. 2 babies were removed into care. 1 had a miscarriage, 1 had a false positive test. All women received contraceptive advice, one got tubectomy and many on long-term contraception. No significant mental health relapses or admissions. All managed to stabilize or reduce their opiates issues.

This One Stop Clinic has effectively addressed the complex needs of perinatal addiction patients. Centralised provision of care, duplication avoided, clear communication was a welcome relief for patients. Clinic has won a quality award.

Since 2020, there has been an increase in children with mental health presentations ending up on general paediatric wards. Hospitals are identified as a place of safety for young people in crisis, though admission to a paediatric ward is not without risk for the child and staff involved in their care. Stays are often prolonged and classed as delayed discharges. This evaluation looks at 22 admissions to general paediatric wards within an acute health trust in Greater Manchester.

Local CAMHS teams identified 22 patients with a mental health presentation who had been admitted to paediatric wards and had delayed discharges between September 2021 and December 2023. Their electronic notes were analysed to identify number of bed days and CAMHS contacts, legal status, and discharge destination. Incident reports of each admission were analysed, and categorised into ‘Restraint/Rapid Tranquilisation’, ‘Assault on staff’ ‘Self harm’ ‘Abscondence’ and ‘Other’.

Of the 22 cases analyses, total bed days were 1469. The average number of bed days was 66.7. 6 admissions were over 100 days with the longest being 186 days. The majority (19) of the presenting complaints were categorised as ‘self-harm’ and /or ‘suicidal ideation’. The average number of core CAMHS contacts was 23 per admission, with an average of 9 consultant contacts, 5 Junior doctor out of hour contacts, and 32 meetings (e.g. discharge meeting, strategy meeting) requiring CAMHS attendance. 11 admissions involved assault on staff, with the highest number of assaults 48 during a single admission. 18 of the admissions required additional staffing (clinical support worker, security). Three patients required police to be called to the ward due to assault on staff. 9 of the patients were discharged to a social care placement, 8 were discharged home. The remaining were discharged to inpatient unit, day unit or to a family member.

Mental health admissions to paediatric wards are associated with a high level of CAMHS contacts provided by Tier 3 staff, which creates a previously unseen burden on the service. Admissions can be prolonged. Patients are cared for in an environment which is not designed to meet their needs. This is demonstrated by high level of patients absconding from the ward and increased restrictive measures such as restraint and 1:1 observation. Admissions are also associated with high levels or assault on staff. Further work is needed to evaluate the economic impact of additional staffing on paediatric wards, as well as the impact on paediatric nursing and security staff.

Accurately and comprehensively assessing physical health risk for people with intellectual disability (ID) is paramount in improving health outcomes, reducing the need for acute hospital admissions and preventing mortality. We aimed to compare the existing approach to assessing physical health risk with the use of a novel standardised risk stratification tool, the Decision Support Tool for Physical Health [DST-PH]. We hypothesise that DST-PH will be useful in improving and streamlining the assessment of physical health risk factors in people with ID.

People with ID are more likely to have poorer physical health outcomes and are at increased risk of premature and preventable death. Annual data from LeDeR (Learning from lives and deaths – People with a learning disability and autistic people) consistently underlines the need for developing strategies that reduce the risk of people with ID developing conditions associated with high causes of morbidity and mortality.

The DST-PH is an online tool that helps clinicians to identify people with ID who are at increased risk of early and preventable death. The tool captures key patient data about underlying health issues and risk factors that can contribute to poor health outcomes. Patients are then stratified according to their overall level of risk using a ‘RAG’ (red, green, amber) system. This allows targeted intervention and monitoring for those patients in need.

All patient-facing staff in the Wandsworth Learning Disability Service were surveyed about their confidence levels in assessing physical health risk factors independently. We then asked each member of staff to assess physical health risk and assign a RAG rating for 2 randomly selected patients using their usual methods (clinical judgement). We then assessed the same patients using the DST-PH tool. Results were then compared to determine the degree of correlation between clinicians' existing risk assessment methods and the risk ratings assigned using the DST-PH.

Survey results showed that staff would welcome the introduction of a risk stratification tool. Comparison of risk assessment data showed a significant correlation between clinicians’ assessment and the results from the tool.

Results evidenced the drive for ID clinicians to be observant of the physical health care needs of their patients. Introduction of the DST-PH may help to streamline the risk assessment process and increase confidence levels of clinicians.

The project aims to evaluate the referrals from North Kent for admission to our PICU from April to November 2021.

Hypothesis:

There are very few surveys of PICU referrals. We expect more referrals for younger men with psychotic illnesses and comorbid diagnoses; to be for aggressive behaviours; and most will be admitted to acute wards with ongoing support from the PICU liaison team.

Our PICU services in the trust include one 12-bedded male PICU, 5 contracted female PICU beds and the PICU liaison service. PICU liaison team ‘gatekeep’ the PICU beds for patients meeting the admission criteria and supporting the other referrals’ admissions to non-PICU acute beds by working closely with the staff and patients on these wards.

Data was collected for all referrals for PICU admission made to one of the three PICU Liaison practitioners in North Kent from April to November 2021, recording the demographics, clinical information and outcomes.

There were 126 referrals in this time period, of which 68% were males. 38% were aged 18–30 and 25% were 31–40 years old.

43% of referrals were from inpatient acute wards, 21% from community, 21% from other settings and 7% from Places of Safety. 75% of the referrals were detained under the Mental Health Act.

The primary diagnosis was Schizophrenia in 25%, Bipolar Affective Disorder in 25%, Schizoaffective Disorder in 13%, Personality Disorders and Substance misuse related disorders were 7% each. 32% of the referrals had a comorbid diagnosis; 43% of which was substance use related, 23% had personality disorder and 34% had other conditions including neurodevelopmental disorders.

42% had previous admissions to PICU and 52% had forensic history.

Reason for referral was aggression in 76%; 10% did not have any indications for PICU and 18% was for current or recent prison stay.

30% of the referrals were admitted to PICU and 58% were either admitted to or remained on the acute wards with support from PICU Liaison Team. While 5% were diverted to the forensic pathway, 7% remained in the community.

In conclusion, the data shows patients referred for PICU admission were more likely to be young men with aggressive behaviour and a primary psychotic illness, using illicit substances. Most referrals came from the inpatient wards as is to be expected. They were also more likely to have previous PICU admissions and a significant forensic history.

The project aims to reduce the delays in transferring prisoners back to prison after they have completed the treatment of their mental health disorder in our male PICU.

Hypothesis:

When prisoners are admitted to our PICU for treatment of their mental health condition, there is a delay in transfer to prison after completion of their treatment due to lack of clear protocol between the services. We expect this project to significantly reduce these delays by agreeing treatment goals and exit pathways prior to admission.

Our 12 bed male PICU accepts admissions from prison for patients meeting our admission criteria. With increased number of admissions from prison since 2020, we were experiencing delays in transferring the patients back to prison after completing their hospital treatment.

Data was collected for all admissions from prison services to the male PICU ward since June 2020 to April 2023. We introduced a PICU-Prison Transfer Agreement form in October 2021 which had to be signed by the mental health team and the governor of the prison before the admission. The form asked for details of any pending court appearances, solicitors’ details, release date, list of staff to be invited for CPA and agreement to accept the patient back to their prison after completion of treatment.

There were 44 referrals in this time period of which 24 were admitted to PICU. Prior to introducing the PICU-Prison Transfer Agreement, there was an average of 22.5 days (range 19–30 days) delay in patients being transferred to prison after being deemed ready for transfer. After the intervention, the delay in transfer reduced to an average of 10 days (range 5–11 days). The number of patients experiencing delay in transfer to prison of more than 2 weeks decreased from 100% to 0%.

In conclusion, the project shows that a simple intervention of introducing an agreement form prior to admission has reduced the delays in patients being discharged from PICU to prison. It has also improved the quality of care with additional information provided in the form. When we accepted an admission from prison outside our county, prior to admission, the out of area prison arranged for a local prison to sign the agreement to accept the patient on discharge from PICU. This has led to a closer working and effective communication between the PICU and the prison services.