The COVID-19 pandemic necessitated major changes in clinical care, including remote patient contact. Havering Older Adults Mental Health Team and Memory Service (HOAMHT&MS) patients often fell within the vulnerable category for poorer outcomes with the SARS-CoV-2 virus, so remote contact was preferable during the pandemic. Telephone assessments were offered to replace face-to-face reviews for some patients. Feedback from patients and carers was collected to compare these modes of patient contact. Remote assessment has positive impacts including; improving access to care in remote areas/when local services cannot meet demand and for disabled patients. Understanding the patient experience about remote assessments helps navigate decisions about future modes of consultation.

This evaluation was organised in HOAMHT&MS. A Rio* diary search was conducted for practitioners from 15/07/2020 to 15/10/2020. 75 questionnaires were sent from each clinic (OAMHT and Memory Service). We sent an equal number of questionnaires for telephone appointments and face-to-face reviews. Questionnaires were posted to patients with pre-paid envelopes to return responses.

*Rio is our Electronic Patient Record System

We had a total return of 23 questionnaires from the Memory Service and 24 from the OAMHT clinic. Most questions were a likert scale from Poor (1) to Excellent (5). The overall satisfaction score out of 5 (average of all the responses):

OAMHT:

Patient/telephone: 3.7 (n=13)

Patient/face-to-face: 4.1 (n=7)

Memory Service:

Carer/telephone: 4.4 (n=8)

Carer/face-to-face: 4.2 (n=9)

Some of the open ended feedback:

OAMHT:

• • Carer/telephone:

“The telephone was rushed and at the end of the meeting the person wanted to sign my husband off.”

• • Patient/face-to-face:

“Help was always there for me.”

“The clinic deserves a medal.”

Memory Service:

• • Carer/telephone:

“Very helpful - I am now contacting them for further advice. They understand my stress and give me full support.“

• • Patient/face-to-face:

“Very happy with the care and attention from the consultant, doctor and nurses at the memory service.”

OAMHT Responses:

• • Face-to-face feedback more positive

• • Patients experienced more distress - nature of illness (distress/crisis) compared to memory (usually gradual decline)

• • Telephone appointments seem less satisfactory - less likely to meet the emotional need of patient/carer

Memory Service:

• • Generally positive feedback from carers and patients in all areas - able to take a meaningful history over telephone

Amnestic Mild Cognitive Impairment (aMCI) is considered a pre-dementia (prodromal) phase of Alzheimer's disease (AD), with a higher probability in patients with positive biomarkers (temporo-parietal region, atrophy on CT/MRI imaging and hypometabolism on FDG-PET scan).We developed a pilot service development project in the North Sector of Gloucestershire Health and Care (GHC) Trust. Its’ main aim was to ease some of the pressures on the Memory Assessment Service (MAS) nurses and the medical memory clinics. The main objectives were: 1. To develop and run an aMCI Clinic service for eight months between March and November 2022 at GHC with North Sector patients to reduce waiting times compared to the preceding years. 2. In patients with aMCI and a positive biomarker, continue annual cognitive testing with early identification of conversion to dementia, thereby starting anti-dementia medication, and continue through the post-diagnosis pathway. Future plans include creating a business case for the Care Commission Group to consider commissioning a countywide aMCI service.

Patients (n=23) with the diagnosis of aMCI and a positive biomarker were selected. Data included the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) to assess patients’ daily functioning, clinical history and service satisfaction questionnaires. Different initial objective tests, including Addenbrookes Cognitive Examination (ACE-III), Repeatable Battery for the Assessment of Neuropsychological Status (R-BANS), Telephone Interview for Cognitive Status (TICS), and Rowland Universal Dementia Assessment Scale (RUDAS) were used. Data for waiting times from referral to first assessment were collected and statistically analysed using a repeated measures design across years 2020,2021,2022(March-November) and a one-way repeated measure ANOVA was performed.

Analysis of waiting time indicated a non-significant decrease in waiting times from referral to first assessment. A decrease in the waiting times from September 2022-November 2022 was noted, pointing towards a possible time lag effect. Within six to twelve months of repeat testing, 62% of patients remained with an aMCI diagnosis whereas 32% of patients progressed to dementia (Alzheimer's or Vascular). From the post-appointment patient feedback received (65%), all patients reported to be very satisfied (57%) or satisfied (9%).

It is prudent to assess the time lag effect on the results produced in subsequent months. A repeat review with a larger sample size to increase the sensitivity and specificity of the results obtained is recommended.

Lithium is an effective mood stabiliser in the management of Bipolar affective Disorder. Timing and decision to restart lithium after an episode of toxicity can be challenging. National guidelines offer advice on management of acute toxicity but little information on restarting lithium. Abrupt withdrawal of lithium can provoke relapse. Clinical experience of the authors was that patients who had Lithium stopped following toxicity often relapsed, leading to poor mental health, frequent admissions to acute and psychiatric hospitals and sometimes death. Restarting of lithium in hospital or after discharge was often variable. The aim of the evaluation was to review the outcomes of patients admitted to the University Hospitals Birmingham NHS Foundation Trust (UHB) with a lithium level over 1.2 mmol/L.

Patients were selected if recorded lithium level was over 1.2mmol/L on admission to UHB. Case note review of electronic patient records was carried out to identify demographic factors of participants alongside medical and psychiatric outcomes over the following 2 years.

84 patients were identified as having lithium levels over 1.2mmol/L. 76% Female. Mean age 61 years (range 20-95 years). 77% of patients had been prescribed lithium for more than 6 years. Mean lithium level was 1.68 mmol/L (range 1.2-3.44 mmol/L). Around 2/3 of patients admitted with lithium above therapeutic range were referred to the liaison psychiatry team. 12% of the patients died during that admission. Just over 2/3 (69%) of those discharged from hospital had been restarted on lithium. When lithium was not restarted during the acute admission, only 13% were restarted in the community within the next 2 months. Two year mortality of patients admitted with elevated lithium levels was 31%. 10% of patients were admitted to a psychiatric hospital within 1 year. The mean number of admissions to the acute hospital (UHB ) within one year was 1.6 (range 0-26).

Admission to hospital with high lithium levels appears to be associated with a number of negative outcomes. These data cannot attribute causality. Conditions predisposing to lithium toxicity such as frailty could contribute to negative outcomes. Given these high mortality figures for this group, discussions on restarting lithium following high levels may need to focus more on the priorities for the patient. Further studies looking at the outcomes of restarting and discontinuing lithium and comparing with those who have not experienced elevated levels would be helpful.

The Royal College of Psychiatrists’ Medical Training Initiative is a scheme aimed at psychiatrists from lower and middle-income countries to work and train in the National Health Service (NHS) UK for up to 2 years before returning to their home countries. They came from various countries and cultural backgrounds, however, there is a lack of study being done on how these cultural differences and experiences are impacting the newly recruited MTI fellows while working in the UK at a CT3 level. In this study, we distributed a brief questionnaire to the 2022 Rcpsych MTI trainees cohort to explore the sociocultural differences between working in the NHS and their home countries and surveyed the things that could be improved within the MTI scheme.

Royal College of Psychiatrists MTI Fellows from various backgrounds and countries participated in a survey between December 2022 and January 2023. The survey consisted of open-ended and closed-ended questions about the differences in psychiatric practices from their home countries alongside cross cultural differences while working in the NHS.

The response rate was 55% from five different countries; Egypt, Malaysia, Nigeria, Sudan, and Turkey. The majority of the participants have worked in the UK under the MTI scheme for more than 3 months and reported that English is not a widely spoken language in their countries of origin. 72.8% of respondents find it easy to incorporate their skills and knowledge in the UK despite the linguistic, cultural and mental health act differences while 72.7% of the fellows reported that psychiatric patients' presentations are similar between their home countries and the UK. There is also a bigger mental health stigma reported in their home countries. It appears based on experiences in their home countries, culture indeed plays a major role in mental illness and treatment. Besides that, 72.8% of respondents are satisfied with the MTI scheme while 81.9% of them would recommend this scheme to others. Some of the respondents recommended for introductory course about the mental health system in the UK and the mental health act before starting the scheme.

There are cultural and linguistic differences impacting the experiences of newly recruited MTI fellows in the UK. There is room for improvement to bridge the sociocultural gaps for the MTI Fellows to improve their experience and service provision.

To demonstrate the role of psychosocial support groups in providing social capital for caregivers of children with neurodevelopmental disorders as an integral part of service delivery.

A descriptive prospective pilot study was conducted at the child neuropsychiatric joint clinic of the Komfo Anokye Teaching Hospital. A support group was initiated for caregivers of children attending the clinic, with the support of a multidisciplinary team of two psychiatrists, a paediatric neurologist, nurses, a clinical psychologist, an occupational, art, and speech therapists. Fifty (50) caregivers enrolled in the support group. A total of three face-to-face psychoeducational sessions, monthly Whatsapp discussions on topical issues of interest to caregivers and an outdoor social event were conducted over a period of one year. During sessions, healthcare providers provided psycho-education about illness management and coping skills for caregivers. Caregivers shared their experiences for the purposes of peer-peer learning and peer support. Information was gathered from caregivers on their psychosocial needs through open forum discussions and a questionnaire administered needs assessment. A retrospective evaluation of the support group intervention among caregivers was carried out using a mixed method, after a year's participation in the support group.

From pilot observations of 30 of the caregivers who completed the evaluation, 85% rated the support group as highly beneficial, 10% rated as beneficial, and more than 95% of them will recommend the service to other caregivers. Caregivers perceive support groups as providing a forum to empower providers to educate caregivers about their well-being, de-stigmatize mental health, and strengthen the trust between caregivers and providers. They may also provide increased opportunities for respite and relaxation.

There must be improved social capital for caregivers of patients with chronic illnesses, with emphasis on coping during periods of stress and change. Caregiver and peer support groups are critical to improved psycho-social well-being and smooth service delivery for children with neurodevelopmental disorders and their families.

Gain an insight into learnings/pitfalls that existing services have met whilst setting up/running intensive outpatient pathways/ services (IOS).

4 Focus Groups (FGs) were conducted virtually through MS Teams from December 2022- January 2023 of duration 90 minutes each for health professionals involved in a leadership role in IOS pathways across England. The FGs were recorded with participant consent, transcribed and analysed with an inductive approach for thematic analysis.

4 main themes emerged including (i) patient and (ii) team considerations, (iii) approach and (iv) commissioning. A key sub-theme emphasised the importance of flexible and creative approaches in IOS to supplement existing evidence base therapies as well as the importance of a well-rounded MDT approach with good communication across the board. Key set-ups include: enhanced outpatient offers, home treatments, in-reach, and hybrid.

Intensive outpatient services for EDs allows an enhanced community offer that is needs led and flexible and individualised approach.

Aims: The project aims to evaluate the referrals from prison services for admission to our PICU from June 2020 to October 2021. Hypothesis: We expect referrals to come from multiple sources with variable timeframes for assessment. For those admitted to PICU, we expect delays in transfer out of PICU with increased PICU length of stay. We believe this to be secondary to lack of an established protocol for this pathway. Background: Our single 12 bedded male PICU in the trust has seen increased demands on its beds for prisoners requiring admission to mental health services. While PICU beds can meet the low secure requirements for prison transfers, they cannot function as forensic low secure beds due to their role within Acute services. With the increased number of referrals and the lack of a clearly defined pathway for these prison transfers, there was a risk of erosion of PICU philosophy aiming for discharge at the point when intensive care was not required, i.e increased length of stay.

Data were collected for all referrals from prison services to the male PICU between June 2020 and October 2021, recording the demographics, clinical information and timeframes for assessment. For those admitted to the PICU, percentage meeting the PICU criteria, admission-discharge pathways, serious untoward incidents and delays in transfer were recorded.

There were 22 referrals from prisons, of which 11 (50%) were admitted to the male PICU. The referrals came from multiple sources with poor coordination between the PICU, forensic and prison services with delays in assessment. 100% of the admissions met criteria for PICU. There were 2 serious incidents related to security levels of the environment. The pathway out of PICU included prison, forensic services and acute wards. Over half the patients were downgraded to non-restricted detentions and stepped down to acute beds. There was a delay in transferring out of PICU in 36% of the patients leading to increased length of stay.

In conclusion, the data support our initial concerns that there is a need for a protocol guiding the transfer of prisoners to our PICU for treatment. This has led to discussions to develop such a protocol with close collaboration between prisons, forensic services and PICU. We hope this will lead to a much smoother process from having a single point of referral, timely assessments and decisions making, better defined exit pathways with less delays in transfer from PICU.

A short questionnaire with open questions was created. Thirty-two patients assessed by the service took part in semi-structured interviews by means of a short telephone discussion after consent was taken. Three independent investigators reviewed their responses and performed thematic analysis, using an inductive and recursive approach.

Theme 1: The understanding of the service and awareness of the referral affects the perception of the assessment.

Theme 2: There can be therapeutic gain in the assessment process, which appears to be mediated by the relationship with the assessors including:

• • Emotional catharsis

• • Having a wider perspective of personal issues

• • Developing new coping mechanisms

• • Regaining a sense of agency

• • Gaining a sense of hope

• • Developing a better understanding of emotions

• • Having a different experience to past encounters with mental health services

Theme 3: The relationship with the assessor plays an important role in the experience of the assessment process, and is mediated by skills of the assessor, including:

• • Active listening

• • A sense of thoroghness; not feeling rushed

• • Sensitive use of verbal and non-verbal communication

• • An empathic, non-judgmental approach

• • A warm, professional approach

• • Open, clear, collaborative communication

• • A consistent approach

• • Validation

• • Psychological containment

Patient perception of the degree of attunement in these areas appears to lend itself to a sense of psychological trust and safety in the process.

Theme 4: The outcome of the assessment can lead to various emotional responses which can play a role in how people perceive the assessment process

Theme 5: The assessment letter is considered an important part of the assessment by many, but not all, participants

Psychiatric assessment can be a therapeutic intervention in its own right and a collaborative, relational approach can help to facilitate this.

Our aim was to analyse the trend in the use of new courses of ECT in Northamptonshire Healthcare Trust from 2007 to 2022 and to compare the use of ECT, Modified ECT (MECT), TMS, Ketamine and combined TMS + Ketamine in the Treatment Centre and The Centre for Neuromodulation in Northamptonshire Healthcare Trust from 2013 to 2022.

Data for new ECT courses were collected from the Treatment Centre in Northamptonshire Healthcare Trust from 2007 to 2022. These data were then compared with new courses for TMS, MECT, ketamine and combined TMS + Ketamine from various sites across the trust from 2013 to 2022. These data have been represented as two separate graphs the first showing trend of ECT and the second comparison of the trend of ECT, MECT, TMS, Ketamine & combined TMS + Ketamine.

The data show that there has been a significant decrease in the number of ECT and MECT procedures performed in recent years, with a decrease of over 50% to 70% in new courses of ECT & MECT among various units in the trust. Regarding the data for TMS treatment vs ECT there is a gradual decrease in ECT and increase in TMS over the years, of particular note is the recent period of 2019 to 2022 during which there were 10 times more referrals for TMS compared to ECT at Northamptonshire Healthcare Trust. During this period TMS accounted for 87% of the total new treatments, while ECT accounted for 9% and Ketamine 4%.

Our findings suggest that TMS is becoming an increasingly popular treatment option for depression and may eventually replace ECT and Modified ECT as the primary treatment in the Northamptonshire Healthcare Trust. This poster provides an overview of the current state of ECT, Modified ECT, TMS, and ketamine as treatments for depression, and highlights the need for further research to better understand the relative effectiveness and safety of these treatments, especially in treatment-resistant depression cases.

We aimed to enhance the clinical governance of medical input to patients within Brighton Early Intervention in Psychosis (EIP) service. The Service Standard Operational Policy indicates that patients should be medically reviewed every 6 months as part of the Care Programme Approach (CPA) and include review of: diagnosis, service eligibility, medication positive and negative effect, clinical improvement, risk assessment and physical health.

The EIP caseload on a specific date was reviewed to explore if a medical CPA review had taken place. A detailed medical letter evidenced this. A meeting was convened between team doctors to identify from electronic records when the last medical CPA had taken place. General characteristics of the delayed review group were identified. An excel spreadsheet was used to create a system to autogenerate when a next review is required.

142 patients were identified on the EIP caseload. 21 patients had been discharged so were excluded. 121 patients were eligible for this audit, including 8 inpatients. 46 (38%) patients were identified as having an overdue CPA review.

Those with overdue CPA reviews were found to be overall clinically stable, on the caseload for over a year and those who had had a recent change in Lead Practitioner (LP) who were not aware of service operational policy due to high staff turnover linked with the COVID-19 pandemic. Some duplications of routine medical reviews were identified between team doctors within the 6 months.

This service was not achieving CPA standards of the operational policy. A spreadsheet was set up to proactively alert the LP when patients required a 6 month review. Policy information sessions were set up for the team and will be specifically included in new worker induction training. A full audit cycle will be completed by implementing the change made and re-auditing to see if there is an improvement. Duplications of routine medical reviews will be explored in more detail.

To establish if there were any significant changes in the number of referrals for psychiatric assessment or prescribing rates of psychotropic medication in the South Edinburgh tier 3 CAMHS team during the first year of the COVID-19 pandemic compared to the previous year. To explore factors that might be responsible for these changes.

Referrals to the Psychiatric Assessment Clinic were analysed between the periods of 23rd March 2019 and 22nd March 2020 and 23rd March 2020 to 22nd March 2021. Using the unique numeric patient identifier, data from these referrals was gathered retrospectively by looking at clinical documentation on the healthcare information system used across NHS Lothian. Data were gathered for 243 patients.

Data were collected on psychiatric diagnosis and, if medication was prescribed, what class of medication this was. Information on potential confounding factors was also gathered including sex, age, co-morbid psychiatric diagnoses, history of self-harming behaviours and suicide attempts, family set-up, schooling and other support services involved. Information was stored anonymously.

Data were coded. Statistical analysis was undertaken using SPSS (statistical package for the social sciences).

Referrals for psychiatric assessment almost doubled from 83 pre-pandemic to 160 during the first year of the pandemic. Referral rates for most psychiatric disorders increased. The proportion of patients prescribed psychotropic medication increased significantly during the first year of the COVID-19 pandemic compared to the year preceding (P=0.031).

Analysis of possible confounding factors was completed. Anti-depressant prescribing rates for those from non-nuclear families increased significantly in the year during the pandemic (P=0.012). Other differences were observed but these were not statistically significant. The numbers of patients who self-harmed, attempted suicide or carried out both increased from 42 to 79.

Findings add to the existing body of literature highlighting an increase in referrals to mental health services and prescribing of psychotropic medications in the first year of the pandemic in comparison to those pre-pandemic. No clear conclusions could be drawn about factors responsible for change. Continuing to monitor referrals and confounding factors over time would be useful from a public health perspective. It would allow trends to be drawn so that planning can be carried out for future pandemics.

Buvidal is being used with patients with opioid dependence. Only 35% of patients read the paper patient information leaflet, which could be improved by condensing the information, making it accessible and relevant. Therefore, the aim was to create a series of informative videos answering important questions for patients taking Buvidal and then evaluate their perceived efficacy.

Data were collected from a questionnaire taken by patients taking Buvidal and healthcare professionals (HCPs) working in Substance Misuse Psychiatry in Wales. The results and preferences were analysed and the information was used to create 5 videos addressing the questions the participants thought were the most important. A second questionnaire was sent out alongside the videos to the original participants to gauge their utility. The Patient's Guide to Buvidal can be accessed on YouTube: shorturl.at/afjl3.

All participants reported that the videos would be useful in answering their questions about Buvidal. Participants ranked the use of Buvidal, the effect of comorbidities and other substances on taking Buvidal and side effects as the most important topics to be covered in the videos. Understanding and confidence increased in a mean of 80% of the topic areas discussed. HCPs reported an increase in 9 out of the 12 topic areas, whereas patients reported an increase in 7. There was no statistically significant difference between prescriber and patient confidence (t(22) = 0.197, p=0.05). 100% of the participants stated they enjoyed the videos and preferred them to the patient information leaflet.

The digital repository could be a valuable addition to the holistic care of patients taking Buvidal to improve their understanding of important questions and topic areas. The use of one long video using YouTube's bookmark feature may be preferred by patients to easily navigate the videos. In the future, new medications and routes may benefit from videos like this targeted at HCPs as well.

Patients may be referred for out-of-area (OOA) placements for a variety of reasons, including a lack of local service provision to meet the requirements of patients with complex or longer-term needs. OOA placements can lead to patients experiencing social isolation from family and friends, as well as disjointed access to local services. In addition, placements can be costly in comparison with locally provided services. Mental health Intensive Support Team (MhIST) is a specialist community rehabilitation service within Cheshire and Wirral Partnership NHS Foundation Trust which was established in June 2021. Although the team does not have specific diagnostic inclusion criteria, patients referred will typically have a high level of complexity in addition to severe, treatment refractory symptoms and impaired social, interpersonal and occupational functioning.

We analysed routinely collected data to explore two methods by which MhIST is reducing referrals for OOA placements including i) direct diversion of patients who would otherwise have been referred for OOA placements to the community with MhIST support, and ii) facilitating discharge from local high dependency inpatient rehabilitation services in order to improve patient flow, which in turn additionally enables repatriation from pre-existing OOA placements.

We identified a cohort of 33 patients who had been supported by MhIST for ≥3 months. This cohort includes seven patients who would otherwise have been referred for an OOA placement. Further analysis for this group showed that initial referrals to MhIST were received from community mental health teams (CMHT) (n=1), acute inpatient wards (n=4) and high dependency inpatient rehabilitation services (n=2). Two patients (29%) were discharged to supported accommodation, and five (71%) were discharged to independent accommodation. Within the wider patient cohort identified (n=33), 66% of patients are living independently in the community.

In total, 13 patients have been discharged from high dependency inpatient rehabilitation services to MhIST during the review period.

MhIST uses a multi-disciplinary model which offers an intensive level of support and a high frequency of interventions. The team includes support workers, nurses, doctors, occupational therapists, psychologists and social workers, and in addition links with other community services involved in housing, employment and social projects. A bespoke and flexible approach allows complex needs to be addressed within local services, and here we highlight the role of MhIST in reducing referrals to OOA placements.

Voting is an intrinsic part of being a member of society and promotes social inclusion. The vast majority of mental health service users have the same right to vote as the general population but are a disenfranchised group and inpatients are half as likely to vote. Service users experience many barriers to voting including knowledge of their eligibility and the accessibility of the registration and voting process. Mental health staff need to understand service users’ voting rights so they can offer appropriate support. This project aimed to explore staff knowledge of service users’ voting rights.

77 multidisciplinary team members from inpatient and community settings in Haringey were surveyed about voting rights.

Questions focussed on staff knowledge of service users’ right to vote (whether or not subject to various civil or forensic sections), if capacity to vote was required and if those with certain diagnoses were legally disenfranchised.

27 Care Coordinators were asked if they discussed voting with service users and whether support around voting and registration was in care plans.

The response rate was 96%. No respondents answered completely correctly. Staff knowledge was similar across all groups and settings.

The majority of staff believed community service users (89%) and informal inpatients (93%) were able to vote.

63% of respondents knew inpatients on civil sections could vote. 81% knew those on a Community Treatment Order could vote. 40% of responses regarding the forensic sections were correct.

56% believed service users needed to have capacity in order to vote.

Certain diagnoses were believed to legally prevent service users from voting, including dementia (19%) and schizophrenia (13%).

44% of Care Coordinators discussed voting with service users and 26% included voting in care plans.

Despite a national campaign, the level of staff knowledge is disappointingly low throughout all groups and settings, risking service users being given wrong information. This further disenfranchises a group that already experiences significant barriers to vote.

It is of particular concern that a significant minority of staff believed certain diagnoses legally prevent voting.

It was poorly understood that capacity is not relevant to the right to vote.

Voting rights and available support is not widely discussed by care coordinators with service users.

Clearly, education and training on voting rights is necessary for mental health professionals. We are planning staff education sessions and service user workshops as a quality improvement project.

Assessment of the capacity to consent to admission is an important legal and ethical issue in daily medical practice. Mental Capacity Assessment (MCA) should be carried out thoroughly based on all the domains mentioned in the Mental Capacity Act (2005) and be recorded in the patient's notes or admission. This audit evaluated the documentation available on the electronic database (Paris) in order to ascertain what information was and wasn't documented. The standard used: “Decision–making and mental capacity”. NICE guideline NH108 (2018) recommendations 1.4 Assessment of mental capacity were used as a standard for this audit. 100% of all admitted patients should have MCA completed during the admission clerking.

The data were examined retrospectively from the MCA on admission, available on the electronic health record database (Paris). The audit tool focuses on quantitative data collection on Mental capacity documentation.

A random sample was selected of 15 patients admitted in May, June, September, and October 2022 to the Peter Bruff MH Assessment Unit (male and female). Total 60 patients.

All data were anonymised. Results were tabulated and presented in statistical form back to the clinical teams.

All patients who were admitted to the assessment unit were subjected to capacity assessment, consenting to informal admission and acceptance of treatment.

MCA was completed and patients had capacity both on clerking and during the ward review in 85% of cases, (n=61). MCA was completed and 3 % of all patients were found to lack capacity on clerking (n=2). MCA was completed, and patients had the capacity on admission, however, they had no capacity during the review in 5% of cases (n=3). MCA was not completed, or the information was unavailable, for 7% of the cohort (n=4).

Capacity to consent is specific to a decision and can vary over time; a patient is therefore competent or not with respect to a specific decision and for a given moment in time.

We found that after the clerking assessment, when patients were reviewed by the unit doctor and the consultant, whether on the day of admission or shortly after (in a matter of hours), on several occasions some patients were lacking the capacity to consent to the admission.

The missing link to be identified between the MCA capacity assessment that was carried out by the clerking doctor, compared to the MCA that was conducted by the unit doctor and consultant. This could be a restrictive environment on the unit or less attention paid to the quality of capacity assessment and further training is needed for professionals.

The Kent and Medway Partnership Trust (KMPT) Rehabilitation service strategy 2020-2025 in line with NICE guidance for Complex Psychosis 2020, sets out to deliver a complete mental health rehabilitation pathway with local provision of high dependency rehabilitation units (HDRU), open rehabilitation units and community rehabilitation provision across the county. There is a lack of HDRU provision in Kent and Medway in its rehabilitation pathway. All HDRU provision is by external providers, often out of area, dislocating people from family support and local resources essential for their recovery and integration. Kent has a relatively high number of out of area (OAT) placements based on national benchmark data (GIRFT). The proposal to develop a HDRU locally led to a review of local population needs for HDRU. The review with the existing OAT data provided information on the number of HDRU beds required in Kent and Medway.

We identified 564 patients who had had 5 or more Mental Health Act assessments, in cluster 16 and 17, more than 3 admissions to psychiatric inpatient units and with CTO recalls. Two senior clinicians reviewed these patients against the HDRU eligibility criteria. Demographics, diagnosis and comorbidities were also recorded.

119/564 patients met the threshold for HDRU assessment. Using our conversation rate from referral to admission in our open rehab, it means about 20% (24) of this cohort would require treatment in a HDRU. Demographics, diagnosis and comorbidities were reviewed which gave important information about service provision requirements. This was compared with NICE guidance recommendations of 1 high dependency unit per 600,000 - 1,000,000. Therefore, based on this, we would be expected to have between 23 and 38 patients requiring HDRU treatment.

A high level of unmet need for HDRU exists in Kent and there is a need for further recognition of the relevance within the rehabilitation pathway. Lack of local provision of HDRUs means the use of longer, expensive and variable quality out of area or private placements. These can be not only detrimental for patients due to a loss of connection to an area and social network but a drain on resources. These results support the case for x2 12 bedded HDRUs. The lack of provision of HDRU impacts on the wider system and patient's timely access to appropriate treatment pathways.

Most patients on the old age psychiatry ward have dementia so they would need extra care from the ward team regarding their rights for a better quality of life. Therefore, the purpose is to ensure that inpatients under MHA on the ward are not deprived from their liberty to time off the hospital grounds in accordance with the leave granted by the responsible clinician. Additionally, to ensure that the appropriate steps are followed before the patient leave the ward, to ensure safety for the patient and accompanied staff if escorted.

1. 1. Data were collected with approval of the ward consultant and the ward manger from RIO records.

2. 2. Data included checking the forms for S17 on RIO, and answering the audit questions after checking the records for each patient.

3. 3. Patients included admissions within the last 6 months on the ward under the MHA weather section 2 or 3 which included 28 patients.

4. 4. Checked data were:

   • • Presence of Section 17 form uploaded to Rio

   • • Documentation of any discussion with the patient or the carer about the leave

   • • Documentations of facilitation of the leave for the patient with accordance to the guaranteed leave by the clinician.

   • • Presence of updated risk assessment before patients go to leave documented on RIO.

Sample size: 28 patients, (all patients who were admitted on the ward in the period from August 2022 till December 2022 under mental health Act section 2or section 3)

Source: RIO

1. 1. 25% of the sample (7 patients) didn`t have Section 17 leave uploaded to RIO, though it was mentioned in the ward round documentation that arrangements for leave are according to S17.

2. 2. 46.42% of the sample (13 patients), there was no evidence of any discussion with the patient or the care about the section 17 leave on RIO.

3. 3. 3.5% OF THE SAMPLE( 1 patient) , there was no discussion about the S17 leave because of the deteriorated mental state of the patient.

4. 4. 25% of the sample ( 7 patients), there was no evidence on Rio if the leave was facilitated or why it was not. 7.1% (2 patient) refused to leave their bedroom. 39% (11 patients) were ward based and only guaranteed leave off the hospital grounds for medical and physical health appointments.

5. 5. 42% of patients who had been granted leave off the hospital grounds (6 patients), has their leave facilitated.

6. 6. 83% of patients (5 patients) out of 6 patients who had leave facilitated, there was no updated risk assessment on RIO before going to leave.

7. 7. 5 out of the 6 patients who had their leave facilitated were in accordance with the time, and frequency stated by the responsible clinician, and one patient had no specification about the time and frequency he had.

8. 8. 100% of patients who had their leave facilitated has been escorted by staff in accordance with what is specified on their leave form by the responsible clinician.

Senior Psychiatric Patients are physically and mentally exhausted and frail, and it is our duty of care to help them for better recovery. Many of them have no family or friends left, and we are their only chance to get over their time of crisis. Therefore,it requires vigilance and extra care when it comes to keeping good quality of life for patients. The results concluded that patients have not had a chance to have time outside the hospital grounds as granted by the responsible clinician, and when granted there was no updated proper risk assessment before the leave. which could be changed by:

1. 1. Ward doctors should discuss leave form updates with the patient during the ward rounds.

2. 2. Ward staff should use one to one session with patients to bring up the updates in the leave form, and use that as an incentive for the patient to engage with the ward team for better recovery of their mental health.

3. 3. Ward staff should ensure documentation of their risk assessment before the patient leave the ward weather escorted or not on Rio.

4. 4. Ward staff should use the pre leave form available on the ward and upload it on RIO as a reference to their risk assessment and in which state the patient was when leaving the ward.

5. 5. Reaudit after 12 months after changing practices.

The aim was to evaluate the quality of clinic letters sent to GP following outpatient appointments by CAMHS Consultants. The audit was based on the guidance of the Royal College of psychiatrist on writing clinic letters .

Initial Audit was a retrospective audit of 40 randomly selected clinic letters sent to the GP following outpatient appointments in the previous 1 year between June 2021 and Janauary 2022. The Re-AUDIT was with 60 clinic letters sent to the GP following outpatient appointments between June 2022 and December 2022.

Information was then collected about whether the following were included in the letters;

inclusion of diagnosis with ICD code, current medication, indications for medications, allergies, physical measurements, mental state examination, risk assessment, care plan and useful links where relevant.

Overall changes were seen in quality of the GP letter in some specific areas, while some areas showed a decline or no significant changes

In including ICD 10 diagnosis to the GP letters, 100% of letters as compared to 80% in initial audit

Indications for medications were discussed/noted in 56.6% of letters when compared to 32.5% initial audit. Physical measurements were also well documented in 80% of letters. This increased from the previous 55%. Mental state examination and risk assessment also increased from 88.3% from 60%, and 86.6% from 70% respectively.

There was a drop in figures in including Current medication in letters.(100% to 90%) and also in copying patients /carers into letters(from 100% in previous audit to 86.6% in re-audit)

Little of no changes were seen in the quality of letters when observing useful links and allergies. The numbers were very low: allergy status infact dropped from 27.5% to 3.3%. Including useful links and resources in the GP letters only showed a growth from 7.5% to 13.3%.

• • Significance of allergy status and continuous reminder that allergy can start at any age in any service user. Drug interaction also important

• • Clearly stating all treatment including pharmacotherapy and psychological therapies

• • Continuous emphasis of indications for medications and psychoeducation including about commencing, stopping medications and side effects

• • QI project to bring together all useful links and make accessible to clinicians and patients

• • Ensure compliance with seclusion trust policy and guidelines by the mental health team (goal of 100 percent).

• • Confirm that proper documentation of commencement, periodic reviews, and termination is always maintained (goal: 100 percent).

Retrospective collection of data from one adult male Psychiatric Intensive Care unit and one adult female mental health ward.

Our sample consisted of patients who were secluded between the time period of September 2021 and June 2022. 33 seclusion episodes met this inclusion criteria. Data were collected from OpenRio progress notes and OpenRio seclusion section.

We developed a tool for monitoring of seclusion reviews included different data about patients demographics and other variables in seclusion reviews.

We found out the following:

• • In regard to patients demographics, the predominant age groups are between 20 and 40 years old, although there is also an increase in the number of people between 50 and 70 years old and the predominant ethnicity was white British.

• • The rationale for seclusion start and continuity was documented in 100% of the cases in our sample of 33 episodes.

• • The initial medical review was completed in the first hour was completed in 81.82% (27) , In 18.18% (6) of cases, it was not completed within the hour window.

In 4 cases, the doctor was not contacted in time to meet the one-hour limit.

In 2 episodes, the reasons for being late were not documented.

• • 2 hourly nursing review completed in 93.94% (31).

• There were 6.06 % (2 episodes) were the 2 hourly reviews were not completed. No specific reason found in the documentation for the missed episodes.

• • The 4 hourly medical review (before MDT / consultant reviews) were completed within time in 24 episodes.

There were 9 episodes when the reviews were not completed within the time window of 4 hourly.

In 5 of the episodes the patient was sleeping, so the nursing team didn't contact the doctor.

There was 4 episodes with no documentation for the reason of the delay. However, the review was completed within extra 1-2 hours duration of time.

• • The 8 hour MDT reviews with consultant were completed in 26 episodes (78.79%).

There was 7 episodes were it was not completed within the 8 hours window.

The primary reason was that the seclusion episode started on a weekend afternoon or early evening after normal working day and the consultant review was conducted on next day.

• • Two medical reviews daily – at least one by responsible clinician (following initial MDT review) completed : In 3 of the episodes (9.09%), one of the two reviews was missed without specific reason or documentation.

• • Rational to continue/ end seclusion documented at each review completed:

In 32 of the episodes the Rational to continue or end seclusion was documented.

There is one episode where seclusion was ended without documentation from the nursing team or doctors.

• • Physical health observations record :100% compliance with physical health observations record.

Recommendations:

• • Increase awareness of the importance of completing the initial reviews on time by conducting teaching sessions in the local academic program and informal teaching sessions with nursing staff.

• • Adding the seclusion review guidelines to the junior doctors handbook and discuss the guidelines during induction meetings.

• • Allocate different flyers and posters with information about seclusion reviews in the nursing stations and doctors office.

• • Completing the re-audit cycle after that to gauge the scope of change.

We conducted this audit in patients attending the Community Mental Health Team (CMHT) at St Davnet's hospital in Monaghan, County Monaghan, Ireland. The British Association for Psychopharmacology (BAP) guidelines were used for this audit to assess our service compliance with standard guidelines and to consider implementing measures to enhance the service's compliance with guidelines and maintain improvement. Metabolic syndrome (MetS) is common in patients who are prescribed depot antipsychotics. Worldwide the prevalence of MetS in Schizophrenia patients is between 30 and 40%, and MetS increases the risk of CVD and mortality. Research showed that patients with severe mental illness die 10–30 years earlier due to physical illness.

The audit cycle was from the 15th of February to the 15th of June 2022. Demographic and therapeutic variables were collected from participants within the CMHT. The action plan which included psychoeducation for nursing staff regarding guidelines for monitoring and documentation was implemented following completion of the initial audit, and then re-audited.

During initial audit the sample size was 48 patients; 77% were females and 23% were males. The mean age was 54.3 years, ranging from 24 to 90 years. 39.6% of patients had MetS monitoring charts in their files, and 29.2% had completed documentation of their MetS charts. Blood pressure, lipids, and glucose were documented in 31.3%, while BMI/girth was documented in 29.2%. Paliperidone was the most common used antipsychotic (43.8%), followed by Flupentixol (31.3%), and Aripiprazole (14.6%). In re-audit the sample size was 46 patients; 76% were females and 24% were males. The mean age was 53.7 years, with the same age range as in the audit sample. MetS monitoring charts were 100% completed in all files. Glucose documentation was 95.7%, blood pressure was documented in 91.3%, BMI/girth, and lipids were documented in 87% of files. Paliperidone, Flupenthixol, and Aripiprazole were the commonly prescribed antipsychotics.

The implementation of the action plan resulted in recognizable improvement in MetS monitoring and documentation. To maintain this level of improvement it is essential for the CMHT to continue educating the nursing staff and other team members about the importance of MetS monitoring and documentation. Defining documentation roles and responsibilities among team members will facilitate monitoring. Identification of files that require MetS monitoring can be improved by placing colour code stickers. A MetS Clinic can be considered as a long-term plan.