The effect of menopause on mental health is increasingly well recognised. Studies assessing peri- and post-menopausal women report higher incidences of depression and anxiety. Without recognition and treatment, the negative impact on mental health during menopause can lead to long-lasting effects on quality of life. NICE and the British Menopause Society (BMS) guidelines recommend cognitive behavioural therapy (CBT) and an individualised approach, for women experiencing depression and anxiety as a result of menopause. The aim of this project was to collect data relating to the provision of mental health interventions (and how they are accessed) for women seeing menopause specialists across the UK. This data can then be used to inform and promote improvements in the delivery of care for menopause mood symptoms.

An expert panel of psychiatry, gynaecology and general practice clinicians designed an online survey which considered NICE/BMS guidance, the current evidence base and local referral/funding pathways. This was piloted on health care professionals in primary and secondary care before review by BMS Council Members. A link to the survey was distributed via email to members of the BMS on one occasion.

139 responses were received from menopause specialists across the 15 UK Deaneries. 71% worked in primary care and 29% in secondary care. 65% of clinicians offer CBT for mood symptoms but 99% reported suboptimal provision of this intervention. 43% of respondents reported over half of their patients with mood symptoms would benefit from psychological support, however 80% do not have a designated mental health wellbeing practitioner. 35% of specialists have referred complex patients to secondary mental health services. When asked what mental health resources would be most beneficial for their patients, 83% desired improved access to CBT, 65% psychological support attached to all menopause clinics, 53% guidance on managing mood symptoms in menopause and 39% an MDT clinic.

The data suggests that complex mood disorders are common in women presenting to menopause services and require non-hormonal interventions to support benefits seen with HRT. The results suggest poor provision of psychological interventions, particularly talking therapies, for women experiencing mood disorders as part of their menopause. Improved cross-specialty working and training, and improved access to CBT were identified as methods of addressing this. Locally, these results have formed the basis of a service funding bid for CBT and development of a pilot cross-speciality gynaecology/psychiatry MDT Hub.

This project evaluated the accuracy and evolution of psychiatric diagnoses in patients admitted through the Outpatient Department (OPD) and Emergency Room (ER) at Benazir Bhutto Hospital. It aimed to understand the factors contributing to diagnostic changes, especially the impact of comorbid conditions and interdisciplinary discussions.

Over an eight-month period, this study reviewed 200 patient records from the psychiatric department. It compared initial psychiatric diagnoses from OPD and ER admissions with final diagnoses at discharge. The evaluation examined the influence of ward round discussions, serial mental state examinations, and newly identified comorbid medical conditions, such as thyroid disorders and neurological issues, on diagnostic changes.

Analysis showed that 38.2% of ER admissions had a revised diagnosis by discharge, compared with 22.5% from OPD. Initial diagnoses primarily included major depressive disorder (30.1%) and bipolar disorder (27.2%). By discharge, increases were observed in personality disorders (up by 18.3%) and substance use disorders (up by 14.7%). Comorbid medical conditions were newly diagnosed in 26.8% of patients. Factors influencing diagnostic changes included ward round discussions (57.3%), serial mental state examinations (40.2%), lab findings (33.5%), and medical/interdisciplinary consultations (29.6%).

The service evaluation at Benazir Bhutto Hospital reveals significant diagnostic evolution in psychiatric care, more pronounced in ER admissions. The identification of additional disorders and comorbid medical conditions highlights the necessity for comprehensive, ongoing psychiatric assessment. Lab findings and interdisciplinary consultations played a crucial role in refining diagnoses, suggesting the importance of an integrated care approach. Recommendations include improving initial diagnostic processes in ER settings and strengthening interdisciplinary communication to enhance accuracy in psychiatric diagnosis and patient treatment outcomes.

The 2016 Junior Doctor’s contract offers guidance as to the rest periods needed during non-resident on-calls (NROCs). The Rotherham, Doncaster and South Humber (RDaSH) NHS Foundation Trust currently works on a NROC trainee rota. NROC work undertaken is monitored via a log form, returned by the trainee after their shift. A retrospective audit was completed with only a 28% return rate of log forms. Though anecdotal evidence suggested inadequate rest and high workloads during on-calls, due to low engagement in monitoring formal data was lacking. Therefore, a trainee-led prospective audit was designed to formally monitor on-call workload over a period of 4 weeks.

The main aim of this project was to review the average amount of hours worked during an NROC shift and compare achieved rest periods against agreed standards (derived from 2016 contract). These standards indicate that 90% of shifts should achieve 8 hours rest in 24 hours and 5 hours continuous rest between 22:00–07:00. In order to accomplish this we first aimed to increase the return of completed on-call log forms to 75%.

Work was predominantly concentrated around increasing return rate of the log forms including: running teaching sessions, regional promotion, and sending daily reminder emails to return the forms. These forms were then reviewed and analysed.

Across the 4 week audit period, the return rate of log forms was 95%, compared with the previous return rate of 28%. Average hours worked across all three localities exceeded the expected hours by RDaSH. When compared with the standards outlined, 1 in 3 shifts in Rotherham, 1 in 5 in Doncaster and 1 in 4 in South Humber did not achieve contractual rest periods. Out of these, not reaching 5 hours continuous rest was the most common reason for not meeting contractual rest periods.

RDaSH worked collaboratively with trainees to generate a number of interventions to mitigate the breaches in rest periods including: creation of a new clinical role to filter calls, reviewing the suitability of the NROC rota and increasing pay to reflect the increased workload. There is currently work underway to redesign the rota.

This audit highlights the importance of prioritising regular reviews of NROC work to ensure the safety of both staff and patients through achieving adequate rest periods.

We carried out a theme analysis of SAER (Significant Adverse Event) reports completed in Older Adults Mental Health Services in Greater Glasgow & Clyde. We wanted to identify common themes to bring about shared learning.

We analysed 19 SAERs from 2017 to 2023, using deductive coding. The ‘Human & Contributory Factors’ included within the SAER toolkit formed the coding system. Coding was then discussed between authors to explore the themes.

Considering the demographics of the group, patients who died by suicide demonstrated gender distribution and methods in keeping with recognised statistics. However there was an over-representation of anxiety disorders and grief reaction (64%). This may prompt clinicians to hold a lower threshold for risk management strategies in this group.

Theme #1: ‘Management & Organisation’. In the period covering the pandemic, reports reflected the need for rapid changes in practice and how in some cases this had an impact on patient care e.g. restricting the possibility for review in the patient's home.

Challenges in liaising with external agencies such as Police Scotland were also highlighted

Many reports reflected that practice could have been updated, encouraging willingness to scrutinize long-standing practice.

Theme #2: ‘Communication & Team factors’. Communication failures between staff were more common than with patients. It was more common for communication failures to occur between teams than within.

This theme also covered issues with availability of information, such as the hybrid model of working with electronic systems but also with some paper records, and the opportunity for information to be missed as a result.

Theme #3: Quality of Care. This theme referred to recommendations for more robust or formalized methods of working, or for care to be more clearly patient-centred.

Delays accessing care were also highlighted. This might refer to a delay accessing other treatments within the inpatient setting, or to missed opportunities or delays in outpatient assessment.

Factors around specific tasks were frequently identified. Most often this referred to guidelines not being followed (updating formal risk assessments, referral to Tissue Viability, etc.). In a smaller number of reports it was identified that guidance was insufficient with recommendations for these to be reviewed.

The importance of patient factors was acknowledged in all reports without this apportioning blame to them or absolving the team from identifying areas for improvement.

This theme analysis identified a number of key themes for older adult psychiatry teams to consider. Results have been disseminated locally.

High Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.

This evaluation aimed to determine prevalence of HDAT across the 16 general adult inpatient wards and the Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust.

A list of all inpatients admitted to the 16 general adult inpatient wards and to the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was subject to HDAT and, if so, whether this was due to antipsychotic monotherapy, combination of two or more antipsychotics, or due to regular and as required (PRN) antipsychotic medication.

Of the 215 inpatients on the 16 general adult wards and the PICU, a total of 29 (13.5%) patients were prescribed HDAT. Four wards had no patients on HDAT; one ward had 5 patients on HDAT. Two of the 12 patients on the PICU were on HDAT. Of the 29 HDAT patients, none were on just one regular antipsychotic, 11 were on one regular antipsychotic and one PRN, 11 on two regular antipsychotics only, 4 were on two regular antipsychotics and one PRN antipsychotic, 1 patient was on three regular antipsychotics and 2 patients on three regular antipsychotics and one PRN antipsychotic. Of the 29 HDAT patients, 14 (48%) had schizoaffective disorder, 9 (31%) had schizophrenia, 5 (17%) had bipolar disorder and 1 (4%) had emotionally unstable personality disorder.

Only a minority of inpatients on the general adult wards and the PICU are prescribed HDAT. There was variation in HDAT prescribing across the wards and this may reflect the degree of diagnostic variability of each ward's inpatients. In those patients that are subject to HDAT, there is a need for appropriate baseline physical investigations to be completed and for appropriate monitoring of ECG and relevant blood tests. There is a need to consider whether each HDAT patient has been considered for treatment with clozapine, if appropriate.

Rapid Tranquillisation (RT) is the administration of parenteral sedation to de-escalate situations where patients may harm themselves and/or others. RT is a restrictive intervention potentially breaching patients’ human rights and is reserved for situations where other measures have failed. NICE guidelines (NG10) state that once immediate risks are managed, post-RT incident debriefing of patients and staff should be conducted. This study examines concordance with NG10 at an adult inpatient psychiatric unit and explores ways to improve compliance and patient/staff experience.

Adult psychiatric inpatients (aged 18–65) who received single or multiple RT therapy during the admission study period (October 2023) were included. Data collected from Electronic Patient Records and chart review included gender, age, ward type, date of RT and drug(s) administered. Following RT, anonymised data was collected on the presence, nature and details of debriefing.

49 adult psychiatry patients were admitted during the study period and there were 32 episodes of RT use in 9 patients (18.4% of inpatients). 56.7% of these occurred on general wards and 43.8% on psychiatry intensive care, with 6 patients (66.7%) >1 episode. Intramuscular drugs used included one or more of lorazepam (78.1% of patients), haloperidol (25%), promethazine (21.9%) and aripiprazole (9.4%). After 46.9% (15/32) of RT episodes debrief was offered, and occurred in 28.1% (9/32); 40% (6/15) of those offered debrief did not participate. 52.4% (11/21) of female patients were offered debrief with 81.8% (9/11) uptake, compared with 36.3% (4/11) of male patients offered with 25% (1/4) uptake. No accounts were taken from patients’ advocate, carer or witnesses. Details of debriefs conducted were documented in 33.3% (3/9). Reasons for not conducting debriefing were documented in 43.5% (10/23). The most common reason given was “not clinically appropriate”. During debriefs, no patients were offered information leaflets about the RT medication used. Finally, staff debriefing occurred in 31.3% (10/32) of episodes.

Compliance with NG10 guidelines for debriefing inpatients following RT was low and was worse in male than female patients. Staff debriefing was poor and no witness or advocate accounts were utilised. These findings may be due to the stressful ward environment or disrupted patient-professional relationship immediately following RT administration. Understanding the reasons for the gender differences in uptake, patient, staff or environmental factors contributing to lack of debriefing will allow interventions and improve holistic patient care following RT. Information and awareness of RT therapy should be available for patients more readily on ward admission and following RT.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by the core symptoms of hyperactivity, impulsivity, and associated functional impairment. Psychostimulants are the most commonly prescribed medication for ADHD in children and adolescents. The use of psychostimulants in children and adolescents requires close supervision in a specialist clinic. The decision to commence psychostimulants should be made jointly with the young person, their parents, carers, and healthcare professionals. It is critical to provide age-appropriate information and discuss treatment's possible benefits and side effects.

This audit aimed to appraise the psychostimulant prescribing practice in children and adolescents in psychiatric outpatient clinics in Al Ain Hospital, United Arab Emirates. We analyzed compliance against the standards set out in The National Institute for Health and Clinical Excellence (NICE) Guideline 87 concerning the diagnosis and management of ADHD in children and young people.

This hospital-wide audit involved a retrospective review of case notes. A questionnaire was developed to capture the required information anonymously. The audit sample comprised 366 service users with a diagnosis of ADHD followed up in the child psychiatry clinic between January 2018 and December 2019. We chose this pre-Coronavirus Disease 2019 (COVID-19) period when services ran as usual. Data collection took place between September and November 2023.

Out of 366, 298 (85%) patients were males, with 181 (55%) being Emirati citizens. The sample age ranged between 5 and 17 years, with a mean of 9.8 years. Psychostimulants were prescribed in 327 (89%), with methylphenidate being the most commonly used medication. All but one case had documentation of discussion about medications' indications and side effects. However, only 40 (12%) cases had a discussion documented about the importance of following a healthy lifestyle, while 5% had no discussion about the right to revisit their decision about the treatment.

This audit has identified areas for improvement in practice, including the need to develop local guidance on prescribing psychostimulants in children and adolescents with a diagnosis of ADHD. We recommend enhanced staff training to improve the quality of discussion with the young person and their family before starting psychostimulant therapy, including clear documentation of the decision-making process. We suggest electronic reminders to inform the patients about the importance of following a healthy lifestyle. We will re-audit the practice after one year of implementing the above action plan.

No financial sponsorship has been received for this evaluative exercise.

Belfast Trust Addictions Service was among the first addictions teams in the UK to get their own Fibroscan® machine, in March 2021. In the two preceding years (2019–2020), only 32% of patients referred by addictions to hepatology for hepatitis C virus (HCV) attended their appointments.

Patients under the addictions service are known to access healthcare services poorly while being at increased risk, with a clear need to improve their access to appropriate care.

We aimed to review how the Fibroscan® machine has been used in the addictions service, and if there has been an impact on how the patient cohort access healthcare.

We reviewed our case records of all patients offered a Fibroscan®, and whether they attended the appointment, and reviewed indications of each scan in the three following categories. Firstly, for those with alcohol misuse. Secondly, for HCV cases in which Fibroscan® results help decide treatment choice. Thirdly, ‘other’ – for example, consultant discretion due to LFT results.

308 patients were offered Fibroscans® between March 2021 and February 2023.

238 patients attended their appointments, of which 194 were for alcohol misuse, 43 for HCV and 1 ‘other’.

70 patients did not attend their appointments, of which 67 were for alcohol misuse and 3 ‘other’.

Scans for HCV were completed ad hoc (i.e. without an arranged appointment) so are not included in attendance rates. The attendance rate for scheduled Fibroscan® appointments (for alcohol misuse and ‘other’) was 74%.

Of the 194 patients scanned for alcohol misuse, 40 were then referred to hepatology with likely cirrhosis.

238 patients underwent a Fibroscan®, leading to 40 hepatology referrals for likely cirrhosis, and 43 patients being offered appropriate HCV treatment.

Crude DNA rates appear greatly improved – 74% attendance at our Fibroscan® appointments vs 32% attendance at hepatology referral appointments.

To obtain the views of patients regarding their experience of meetings where virtual media (video conferencing) has been used during their inpatient stay in the acute female admission ward.

Data was collected via a questionnaire. Service users who met the inclusion criteria were past and current inpatients in the acute female psychiatric ward during the last six months. The sample of the service users included in the project was selected from all applicable cases via convenience sampling – those on the ward who consented and were able to engage, as well as past inpatients whom we contacted via telephone after their discharge who met these same criteria.

Verbal consent was obtained from all the patients who agreed to participate. Data was collected and analysed using Microsoft Excel.

13 patients in total completed the facilitated questionnaire which used 11 questions rated by Likert Scale as well as an open space area for further comments. Age ranges varied among participants with 39% age range 18–30, 38% aged 31–50 and 23% aged 51–65. 61% were of white British descent. Majority (38%) were admitted for schizophrenia, schizotypal and delusional disorders, 31% for disorders of adult personality, 23% for mood (affective) disorder and 8% for anxiety, dissociative, stress related, somatoform and nonpsychotic mental disorders.

Most patients rated the use of virtual consultations positively, with over ¾ of patients answering strongly agree or agree (positive response) to most questions. This included feeling able to express themselves effectively as in an in-person consultation, feeling that they received adequate care, feeling that the audio-visual quality was satisfactory and that their privacy was respected. One suggestion for improvement from the patients was to clarify the number of people in the room and how many students are present during the consultation.

Virtual consultations were overall well received among the patients interviewed. Interventions that facilitate timeliness and privacy in consultations as well as training for staff in verbal and nonverbal communication skills for virtual consultations would be beneficial. Further surveys in groups underrepresented in the survey such as men, older people, ethnic minority groups, people with visual or hearing impairment and other mental disorders not present in the sample would help to give further insight into how virtual consultations are received and barriers by different groups.

Writing clinic letters addressed and directed to the patient could be considered part of a strategy to implement a person-centred approach by giving patients more autonomy and understanding of their assessment and care plan. We carried out an audit of current practices and a survey of clinician attitudes within two community mental health teams to determine who clinic letters were being addressed to, whether they are being written in a suitable language and exploring the barriers to improving clinic letter writing.

We reviewed the first 100 initial and first 50 follow up clinic appointment encounters in two community mental health teams over a one-month period. We used a Microsoft Excel proforma to collect information on who the clinic letter was written to (patient or GP), whether the patient had been copied into the letter, and if not, if there was a recorded reason for why the patient had not been copied in. We also calculated the Flesch Readability score of each of the clinic letters to determine their reading ease using the Microsoft Word add-on tool. Following the initial audit, we carried out a survey to gain insight into clinician attitudes towards writing clinic letters directed to patients. The survey was sent out to all clinicians in the two community mental health teams where the audit was carried out.

The audit revealed that 53% of clinicians wrote their clinic letters addressed to the patient and 47% wrote them addressed to the GP. 69% of letters were classified as, according the Flesch Readability Score: fairly difficult to read, difficult to read or very difficult to read. The reading ease varied amongst different clinician types. The clinician survey had 16 respondents and revealed various reasons that clinicians did not to write to the patient – including the clinician's own opinion that letters should be addressed to the GP, current practice in their team to write to the GP, long-standing style of writing addressed to the GP and lack of training in writing to the patient.

There has been variable practice amongst clinicians for whom their clinic letters are directed to. The majority of letters in our sample were not easy to read and this could be considered suboptimal for the target population. Training in clinic letter writing directed to the patient and the development of purposefully designed clinic letter templates are ways that we could help facilitate improvement in this practice.

This retrospective cohort study using routinely collected administrative clinical data from the Cambridgeshire and Peterborough Foundation Trust (CPFT) Research Database, aims to understand how many children and young people (CYP) with attention-deficit/hyperactivity disorder (ADHD) undergo successful transition from child and adolescent mental health services (CAMHS) and community paediatric services, to adult mental health services and investigate the factors that are associated with the successful transition of care in young people with ADHD to adult services.

Many young people with ADHD, in need of service transition from child to adult services, experience serious barriers in receiving the care they need, constrained by scarce resources, low capacity in specialist services and variable awareness or training across various levels of care.

We explored the numbers and clinical and socio-demographic characteristics of CYP with ADHD who undergo successful transition from CAMHS and paediatric services, to adult mental health services. We will explore whether children with certain sociodemographic factors/treatment/service attended are more likely than others to successfully transition using multivariable logistic regression.

Note results are rounded for statistical disclosure control. We identified 24,240 unique CYP for whom a referral (age < 18) exists to CPFT between 1 Sep 2007 and 31 Aug 2019 (with follow up until 2020). Of this cohort, 2300 were referred at any time to any ADHD service, 1760 CYP had a record of ADHD medication in their clinical notes at any time of whom 1590 CYP had a record of ADHD medication under the age of 18. Of these 1590 CYP, 330 had at least 1 year follow up in the database before and after their 18th birthday and a record of ADHD prescribing during the year before they turn 18. This is a cohort of CYP who should have transitioned from child to adult services. Of these 330, 160 (48%) had been referred to any ADHD service between their 17th and 19th birthday and 190 (58%) had any record of ADHD medication in the year after they turn 18. Further analyses will explore the characteristics of CYP who successfully transition, and we will carry out a series of sensitivity analyses.

With an increase in the number of children with ADHD who are prescribed medication, we can expect an increasing cohort of emerging adults who need continued care. This study will provide evidence on the current state of care to help identify areas for improvement.

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.