This Service Survey is a part of a Quality improvement project which aims to :1- To assess the extent of the problem regarding accessing Adult ADHD assessment and treatment by getting the views of clinicians.2- Evaluate negative impact on care coordinators of the delay in accessing timely and effective diagnosis and treatment of ADHD; This will: a-Increase understanding of the care needed by this patient group. b-Clarify current practice and any difficulties staff face in condition management when diagnosis not confirmed i.e. outline training needs. c-Determine if waiting time for diagnosis results in iatrogenic harm (deterioration driven by ‘unmet need’). 3-Inform the development of an alternative pathway of care; thus: a-Reduce inequality of healthcare access for those with this neurodevelopmental condition. b-Reduce stigma. c-Improve service user health and well-being. d-Support families and carers. e-Reduce social costs to individual and community. f-Support community staff and increase knowledge and effectiveness.

Methods of the service survey part:

1. 1. Service survey: Sent to 21 consultants who are working in Adult CMHT.

2. 2. Service Satisfaction survey for all of the Redcar & Cleveland Affective disorder team's clinical staff members (18).

11 consultants responded out of 21 (52%)

Approximate number of the diagnosed ADHD patients / team varied between 7–80 patients.

Wait time for an ADHD assessment varied between 12 -30 months.

Number of patients/ team waiting for assessments by the specialist team 2- 27 patients.

50% of the consultants reported significant delays between referral to the services and initiation of treatment 6–36 months.

All consultants reported commencing treatment of ADHD, if a patient already had the diagnosis.

9/11 (82%) consultants reported making the initial diagnosis and treating ADHD patients in CMHTs. However, all consultant reported the need for further training in assessment and management of ADHD patients.

6/11 (55%) consultants stated that ADHD patients should be managed in CMHTs provided they are care coordinated by another clinician.

All 3 staffs responded out of 18 staff, reported un satisfaction with the current service provision.

1. 1. The current service model is not able to meet the increasing demand for the services and leading to significant delay in accessing appropriate treatment.

2. 2. There is a need to improve competencies of community mental health teams to manage these patients.

3. 3. This survey will be used to model a new care pathway.

Development of an eating disorder in childhood has been shown to predict sleep disturbance in adulthood. Both the National Institute of Health and Care Excellence (NICE) and the wider scientific literature support interventions to help support patients with their sleep. The aim of this project was to evaluate the perceived benefits of the Sleep and Dreams Group to adult patients with anorexia nervosa (AN) on a specialist eating disorders unit.

Adult patients with severe AN on an inpatient specialist eating disorders unit attended a 6 session, once weekly group on a voluntary basis. The therapeutic group included psychoeducation around sleep hygiene, and an experiential component focusing on sleep/dreaming context of inpatient treatment of severe AN.

All participants(n = 6) either agreed or strongly agreed that their understanding of sleep and dreams had improved. Quality of sleep strongly improved in 20% of participants, however, the remainder reported no significant change in this domain. Despite this, 80% of participants agreed or strongly agreed they got what they wanted from the group, finding the content of the psychoeducation material slightly positive or very positive. The total program length was thought to be appropriate, with 80% describing this as very positive.

The impact of the group on quality of sleep was variable, these results indicate that the value of the group to participants was found in the intergroup processes as evidenced by positive evaluation. This is of particular relevance to severe AN, where interpersonal deficits are often seen and from a treatment perspective in addressing the isolating nature of the disorder. Suggestions for improvement included bolstering the interactive component, and assessing participants regarding eligibility for dream discussion to aid formulation work of the unit.

Balint groups were initially set up to meet the needs of GPs in better understanding the emotional aspects of complex doctor-patient relationships. They have since been taken up in the training of psychiatrists, GPs, and medical students, having been shown to improve communication skills and sensitise participants to their own psychological processes. Working as a Care Coordinator in a Forensic Community team is a highly challenging role where, by definition, there is the spectre of risk of harm to others. There is very little published data on the use of Balint groups in nursing populations, even less so in the Forensic mental health setting. The aim of this project was to evaluate a longitudinal Balint group for mental health professionals in the Forensic service of Cambridge and Peterborough NHS Foundation Trust, and to report on the perceived benefits to attending in terms of personal and professional development.

The evaluation used a standardised mixed methods approach, with the sample consisting of members of the Forensic South Community Service Balint group n = 5. For the evaluation period the job roles were solely clinical nurse specialists, taking a snapshot of the group between September 2020 and January 2022. The group met monthly for one hour virtually, led by Dr Arends, a specialist registrar in psychiatry with appropriate training in Balint leadership. The format in sessions was in keeping with the Balint method, as per The Balint Society, emphasising confidentiality. Data were gathered via survey tool, adapted from the literature using Likert scales and white space questions to identify barriers and facilitators.

Participants scored the group highly across the board in terms of acceptability, clinical impact, and fidelity measures. Notably 60% strongly agreed and 40% agreed the group was a safe place to express and process anxieties and frustrations about their work. All participants either agreed or strongly agreed the group had changed the way they think and practice, and that they felt able to consider their clinical encounters in a new light.

Facilitators identified were of increased team working through cohesion and notably of increased appreciation for the functional and symbolic elements of the symptoms their patients presented with, suggesting that the value of the group existed in its providing of space to metabolise the often intense demands of Forensic patients, together and as a team. The main theme within barriers to the group processes were external in terms of other clinical demands requiring prioritisation.

The worldwide prevalence of Attention Deficit and Hyperactivity Disorder (ADHD) in the adult population is estimated to be 2.5%. Prevalence studies have shown rates to be consistently around ten times higher in the prison population, but there is less known about secure psychiatric hospital populations. ADHD has relevance as a predictor for offending, for challenging behaviours when incarcerated, for lower quality of life and high costs for both the NHS and prison systems. This service evaluation aimed to establish estimated prevalence of ADHD within one male medium secure unit.

A cross sectional review of computerised medical records for all service users on the male medium secure forensic unit took place, to identify those who met inclusion criteria. Service users who were too acutely unwell or had an established or pending diagnosis of ADHD were excluded.

The Brief Barkley Adult ADHD Rating Scale (B-BAARS), a 5 minute screening questionnaire, was given to service users to complete. Anonymised responses were converted to electronic format and the compiled results analysed.

There were 125 service users at the time of information gathering, with 112 eligible according to inclusion and exclusion criteria. 2 of the excluded service users already had an ADHD diagnosis. 70 service users out of those approached, agreed to take part in the screening (62.5%). 2 out of 70 (2.9%) service users met criteria for a possible diagnosis of ADHD.

Using the B-BAARS, 2.9% of service users on the male medium secure forensic unit reported clinically significant symptoms suggestive of a diagnosis of ADHD. This estimate is significantly lower than other studies in prison settings. When combined with the figure for service users with a pre-existing diagnosis, however, the figure is still higher than in the general population (5.5% compared to 2.5%), and illustrates that screening tools can have a useful function in forensic settings.

There may have been methodological issues with this evaluation, including the self-reported nature of symptoms, the comparatively high level of functioning required to complete the questionnaire and the low response rate amongst the service users.

This evaluation serves to increase awareness about ADHD in the forensic population in general. It also highlights the value of this simple screening tool, or one similar, to clinical teams on the forensic wards. The screening tool could be further utilised in low secure and women's services to establish if results are similar amongst these populations.

Whilst the majority of age groups are seeing a decline in numbers in prison custody, the older male population continues to rise year on year. This unexpected trend has led researchers to investigate the needs of this particular cohort in more detail and start to question if the prison estate is able to care for the specific needs of the ageing population. This primary research specifically, looks to investigate what relationship, if any knowledge and attitudes to dementia have on how the confidence in practice levels of non-healthcare prison staff

This research, in a specific, applied context considers the relationship between attitudes toward the prison estate alongside knowledge and attitudes toward dementia in general and the potential relationship these may have on confidence levels. To do this, the research scored individuals’ responses against the dementia knowledge assessment scale, attitudes to the prison estate and general attitudes toward dementia. These three independent variables were measured both overall and individually against individual confidence in practices scores. 50 individuals participated with differing roles and length of service in the prison estate

The results of the study found that the overall model was significant. Of the three independent variables, it was found that positive attitudes to dementia were the most influential predictor of confidence. Knowledge of the condition and attitudes to the prison estate, the second and third independent variable however were not significant predictors of confidence in practice levels. Overall, the results indicate that there is a relationship between knowledge, attitudes, and confidence in delivery of dementia care in the prison estate as an overall model.

The main objective of this study was to determine the knowledge and attitudes to dementia of non-healthcare prison staff and if that knowledge and those attitudes had an impact on confidence in practice levels. It could be argued that this research has fulfilled its primary aim, reporting that knowledge about and attitudes toward dementia scores are a significant predictor of knowledge of the condition in non-healthcare-based staff.

To determine the utilization of mental health (MH) services, antipsychotic use and weight gain 3 years after discharge from an Early Intervention Service (EIS).

A retrospective anonymized survey was conducted of the trust electronic records of patients discharged from Barnet EIS in April to May 2018. 25 case records were identified of which 4 were excluded due to relocation out of area. Information was reviewed from the time of referral to 3 years post discharge. Data included patient demographics, number of referrals to home treatment team (HTT), inpatient admissions, medication and cardiometabolic parameters (weight and HbA1c) during this period.

21 records were analysed - 13 males, 3 females, average age of 24 years. 12 patients had been discharged to primary care of which 5 were re-referred to community mental health team (CMHT) during the 3 year follow-up. 9 patients were discharged to the CMHT of which 4 were later discharged to primary care.

There was no significant difference in the number of referrals to HTT and hospital admissions in the GP and CMHT follow-up groups (50% and 33%; 56% and 44% respectively). At the time of discharge from EIS 67% were on antipsychotic medication. At 3 year follow-up 90% in CMHT group continued antipsychotics. There was an average of 15.6 kg weight gain while under EIS with further 11.7 kg gain over the next 3 years under CMHT care. According to available data for those still in contact with MH services, no patients newly met criteria for pre-diabetes or diabetes. No records were available on our system pertaining to GP discharges.

We discuss the impact of EIS on affecting future MH service contact. There were a similar number of future MH referrals regardless of initial discharge destination. We consider whether there may be a different quality of these contacts that need further inspection.

The majority discharged continued taking antipsychotic medication and experienced considerable weight gain. This significant ongoing weight gain in a group of young people only starting to use MH services is of great concern due to negative cardiometabolic impact. It highlights the need for urgent proactive attention to ensure the best physical and mental health for these patients.

During the COVID-19 pandemic most clinical services changed to remote consultation and management to minimise virus transmission by direct contact. As the social distancing and restrictions have eased with greater control of the pandemic, the nature of consultations is going to change. At this juncture we intended to understand the perception and satisfaction of patients and clinicians on remote consultations and management during COVID-19 and to determine their preference about clinical engagement in the future.

This was a trust-wide anonymous survey conducted through surveymonkey. It involved both patients and mental healthcare staff (MHS) and explored about the quality and satisfaction in remote consultations, option to patients, and use of remote consultations in future. Clinicians were sent the online link to complete, with a reminder two weeks later. The patients were explained during their appointments about the survey, those who agreed to participate and gave informed consent, their responses to the questions were recorded.

The sample consisted of 78 patients and 107 MHS representing adult, old age, children and adolescent and intellectual disability subspecialties. Most (92.4%) participants had participated in remote consultations and understood the reason behind it. Around a third (32.7%) of MHS and 46.2% of patients felt strongly satisfied in remote consultations, and together with satisfaction these were 56.1% v 71.8% respectively (p < 0.05). The quality of the remote consultations were considered somewhat (11.2% v 23.1%) or a lot better (8.4% v 15.4%) by MHS and patients respectively (p < 0.05). Majority (82.7%) felt that an option should be given to patients for the type of consultation, face to face or remote. After the pandemic, the preference for psychiatric consultations were primarily face to face (30.3%), primarily remote (8.6%) and a mixture of the two (61.1%); there were no difference between patients and MHS. However while 71.4% doctors, 70.8% other clinicians (occupational therapists and psychologists) and 75.0% of clinical managers opted for mixture of face to face and remote, 26.9% of nurses opted for that. Background subspecialty, age group, ethnicity, experience of remote consultation with GP or hospital doctors, attendance or admission to general or psychiatric hospitals during pandemic, disabilities, or having COVID-19 did not influence the suggestion for the future consultation type.

Following the pandemic, both clinicians and patients express a preference for a mixture of face to face and remote consultations; and an option regarding that should be given to the patients.

Developing psychotherapeutic competencies is an essential part of psychiatric training. All core trainees in LYPFT until 2021 saw a patient for Psychodynamic Psychotherapy. The pandemic led to unprecedented changes to clinical practice and medical education. In LYPFT all face-to-face appointments in the Medical Psychotherapy Service were paused in March 2020. Patients were offered the choice to continue therapy remotely or postpone therapy. Supervision was also moved to a remote format. Face-to-face psychotherapy sessions resumed from August 2020, with new departmental procedures around infection control and the use of PPE. This project aimed to establish the junior doctors’ experience of delivering psychodynamic psychotherapy in LYPFT during the COVID-19 pandemic.

The project was carried out via a two-step methodology: Firstly with an online survey which included a quantitative analysis of the impact of the pandemic; and secondly via semi-structured interviews with a resultant thematic analysis.

22 junior doctors who were invited to participate, 15 completing the survey (68%). Four patients had deferred therapy; the mean length of deferral was 2 months. Ten respondents had sessions cancelled due to infection or self-isolation. Face-to-face delivery was experienced by 13 respondents, 5 respondents had delivered therapy via phone and 6 had delivered therapy with PPE. Thirteen were concerned about attaining their psychotherapy competencies. Seven preferred face-to-face supervision, and 4 preferred remote working.

Thematic Analysis of the semi-structured interviews identified three themes regarding the impact of the COVID-19 pandemic on Junior Doctors experience of Psychodynamic Psychotherapy, with sub-themes detailed below. Throughout the themes, the challenges and difficulties with delivering therapy in the COVID-19 pandemic, as well as areas of good practice and opportunities were identified.

The Work of Therapy (Remote Therapy, PPE and Therapy, COVID-19-related)

1. 1. The Structure of Therapy (COVID-19 Guidance, Setting/Frame of Therapy, Boundaries of Therapy)

2. 2. The Therapist's Training (Supervision, Attaining Competencies, Loss of Training Experience)

Recommendations:

1. 1. To create a short guide for junior doctors delivering Psychodynamic Psychotherapy during a pandemic.

2. 2. To consider the types of supervision delivery within the Medical Psychotherapy Service

3. 3. To ensure there is space for junior doctors within the Medical Psychotherapy department or a private space within their base placement, should remote therapy be required.

4. 4. To ensure future plans related to possible pandemic restrictions address the need for good quality and strong internet connections/WIFI

1. To evaluate clinicians’ experiences of the newly implemented remote ASD assessment process (due to COVID-19), including the long-term sustainability and potential standardisation of this approach; 2. To establish areas for improvement in this process and make further recommendations.

Members of the Neurodevelopmental MDT completed an online survey, whereby feedback was collected regarding the use of the Child Observation of Social Communication (COSC), which had been adapted for online use from the standardised Autism Diagnostic Observation (ADOS) Schedule by a senior Psychologist[.Participants also responded to questions on other assessment domains, including the Developmental, Dimensional and Diagnostic interview, feedback and formulation meetings. Questions included their comfort with performing the assessment, theirs views on the quality of care provided and any difficulties they faced. Survey data were collected on two occasions: between November and December 2020 and between July and August 2021.

Positive Experiences

63% of respondents in November-December 2020 reported that COSC was a good alternative whilst standardised ADOS was unavailable. This increased to 100% in July-August 2021. Quality of care delivered by COSC was rated to be the same as ADOS in 70% of participants November-December 2020; 25% felt quality of care delivered by COSC was better than ADOS in July-August 2021. 73% of participants reported they would continue to use the remote assessment in the November-December 2020 survey. This increased to 88% in July-August 2021. 33% of the clinicians were very comfortable with administering the COSC in July-August 2021, 56% were somewhat comfortable.

Negative Experiences

27% of the clinicians reported being somewhat uncomfortable with administering the COSC assessment in November-December 2020; 11% remained somewhat uncomfortable in July-August 2021. 30% of the participants rated the quality of care delivered by COSC worse than ADOS in November-December 2020. 37.5% rated this to be worse in July-August 2021. 77% of the respondents had technical or organisational difficulties, which could result in missing non-verbal cues during the assessment.

Clinicians’ experiences improved over time and with practice (34% had delivered over 10 COSC assessments in July-Aug 2021). A hybrid model may increase the quality of care of the approach, as well as careful selection of cases which would be suitable for an online assessment. There is scope for the continued use of the remote ASD pathway, taking into account patient and clinician preferences, however patient feedback will be necessary as a next step in this evaluation.

Identification of a psychosis risk syndrome to aid reduction of transition to a FEP is an important focus of worldwide research. ARMS for psychosis was defined by Yung and McGorry in 1996. UK EIP services were mandated to identify and ‘treat’ ARMS in the ‘Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance' 2016. Sussex EIP services developed such an ARMS service with a 1-year pathway of assessment, intervention as indicated, and monitoring from 2017. Sussex serves a population of approximately 1.4 million, including areas with both low and high social deprivation indices. Transition rates from ARMS to FEP in recent studies have suggested widely varying rates of 8–17% of transition in a two-year period, notably less than initially identified by Yung et al. We aimed to establish the rate of transition to FEP within 12 months from identification of ARMS in Sussex EIP services.

A retrospective study was conducted on all patients on the ARMS pathway, across five EIP services in Sussex, between Jan 2017-Oct 2021. The primary outcome measure was operationally defined transition to FEP; secondary outcome measures included clinical features and use of clinical services.

71 cases were identified as meeting ARMS criteria, with mean age 21.4yo; range 14–35, from a total new caseload of 447 over this period.

ARMS subcategories identified 4 state/trait, 55 attenuated psychosis and 12 BLIPS. Comorbidity was more common than not; mood disorders were identified in 17 cases. 23 cases met not in education, employment or training (NEET) criteria.

All cases received full care coordination by lead practitioners. 19 cases were prescribed atypical antipsychotics. 18 cases received formal CBT.

4 of the 71 cases transitioned to FEP within 12 months at mean time 35 weeks; range 28–45 weeks. 2 had attenuated symptoms and 2 experienced BLIPS. 3 were initially NEET.

We report a very low transition rate to FEP of 6% in this service, consistent with other such UK services. Whilst the ARMS sample is low in number, a clear impact on EIP service case management is identified. Risk saturation is arguably required to justify continuing this ARMS pathway, achievable by primary focus on the BLIPS subgroup. Wider review of UK ARMS services is required to reduce dilution of EIP service models and reduction of their well evidenced effectiveness.

The NHS Long-Term Plan includes the perinatal mental health objective: by 2023/24 ‘Maternal Mental Health Services’ will be available across the country to provide psychological therapy for those who experience mental health difficulties directly arising from birth trauma and or/perinatal loss. We achieved early implementer status via application to NHS England and, using transformation funding received, ‘Thrive’ was piloted in East Kent. A gap in service provision was identified: some existing primary care services provide intervention for this cohort, however some people remain in psychological distress but do not meet the criteria for specialist perinatal mental health secondary care services; these secondary care services are not commissioned to support those who have experienced perinatal loss. Thrive is co-delivered by a mental health trust and acute healthcare trust; NICE recommended psychological interventions are provided by Psychological Therapists, Specialist Mental Health Midwives and a Peer Support Worker. The aim of this project was to evaluate the effectiveness of the Thrive pilot in reducing PTSD symptomology whilst also collating feedback from patients, their families and healthcare staff across the maternity system, in order to adapt the service offer for full county rollout.

40 people who received care from Thrive from 11th January 2021 to 31st December 2021 were included in this evaluation.

Data were collected retrospectively at the end of each period of care via:

Clinical outcomes measures (quantitative):

• • PCL-5: a 20-item self-report measure assessing the 20 DSM-5 symptoms of PTSD.

• • CORE-34: a universal method of establishing well-being and risk.

• • HoNOS (Health of the Nation Outcomes Scales): a measure of the health and social functioning of people with severe mental illness.

• • 100% of patients improved following Thrive intervention: PCL-5 (significant change = a reduction in score by 10–20 points has been met) / CORE-34 (clinically significant change =score above 10 initially and below 10 after intervention).

• • Clinical improvement: HoNOS = 100% of patients improved following Thrive intervention.

Evaluation has evidenced the effectiveness of Thrive in successfully treating those with PTSD symptomology arising from their maternity experience. Post-treatment measures indicate that the level of trauma symptomology and the impact of psychological distress on the functioning of patients who have received intervention from Thrive has reduced to a sub-clinical level in all cases.

As more emphasis is placed on a move from the traditional hospital-based practice to care in the community, CMHTs are becoming the main channel for delivering specialist care in England. Access to most CMHTs occurs via written referrals, which vary significantly in content and quality. Such variability and inconsistency with the information provided can impact on the triage process and delay access to treatment for patients, making the process unnecessarily protracted and time consuming. One key factor that would drive the success and survival of CMHTs is how they gate-keep their service. This starts by adopting formal strategies when vetting and screening referrals. The aims were to determine if NW CMHT is responding to referrals appropriately, to consider if service users received good quality correspondence about referral decisions and if the outcomes of such meetings were properly documented.

The NW CMHT consists of 4 pods (A to D) and the audit included all GP referrals assessed by pod B over a month. A sample size of 28 referrals was included in the audit and the referrals were from 16 different GP practices. Data were obtained from patient electronic records and entered onto a SmartSurvey form for ease of collection prior to results being analysed.

32% of referrals came from two GP surgeries. Areas of good practice included all referrals being discussed within 4 days of receipt, and 50% reviewed by the next day. For referrals identified as needing further information and discussion, this was also done quickly between 2–5 days of receiving the referral. Also 68% of service users (SU) had a letter sent out to them within 2–5 days. It was unclear in 75% of referrals whether the SU was aware of the referral to NW CMHT and the reasons for the referral were only ‘fully’ documented in 57%.

The vast majority of GP referrals were treated in a timely manner, even if additional data gathering was needed and multiple referral discussions had. Recommendations included addressing the lack of consistency in documentation of referral discussions, developing effective ways to cut back on clinical time lost gathering what should be standard information, and education of GP practices around making good quality referrals. It was felt that a review of the referral forms would be beneficial, however a barrier to this change was that this is a trust wide form and there would need to be consensus across all CMHT localities.

The aim was to create and deliver support sessions with the psychiatry consultant's dog, Rupert, to improve the emotional health of both patients and staff. It was hypothesised that having time with a calm and affectionate dog would reduce both young person and adult anxiety, improve their mood, and help them communicate. Since the start of the COVID-19 outbreak, there has been a gradual increase in demand from children and adolescent mental health services (CAMHS), and consequent pressure on NHS staff. On June 2021, Rupert was registered as an emotional support dog with the Trust and began weekly visits to the Darwin Hospital, Stoke-On-Trent. This is a 12 bedded CAMHS hospital, which has seen an increase in patient illness and increasing staff absence due to COVID-19. Informal reports from staff and patients suggested multiple mental health benefits from spending time with Rupert. To quantify the impact of an emotional support dog on the unit, it was agreed to perform a service evaluation on mood, communication and anxiety of both patients and staff.

A questionnaire, using a Likert-type rating scale, was given to staff and patients before and after spending time with Rupert. Questions asked for ratings of mood, anxiety, and comfort in communicating on a scale from ‘very low’ to ‘very high’. The data collection took place in the last 3 months of 2021. In all, 19 people completed the questionnaire. Because of the small sample size, non-parametric bootstrap resampling methods were used to test before-and-after paired differences for individual participants.

Because the rating scale is ordinal, care needs to be exercised in interpreting differences, but in broad terms a unit increase is equivalent to an improvement, for example, from ‘low’ to ‘neutral’. On average, patients reported statistically significant improvements in mood (mean diff: 1.14, 95% CI: [0.43, 1.71]), anxiety (mean diff: 2.00, 95% CI: [1.43, 2.57]), and communication (mean diff: 1.00, 95% CI: [0.43, 1.86]). Results for staff were similar with improvements in mood (mean diff: 1.08, 95% CI: [0.83, 1.58]) and anxiety (mean diff: 0.83, 95% CI: [0.50, 1.25]) but smaller in communication (mean diff: 0.33, 95% CI: [0.08, 0.67]).

Taking an emotional support dog into a CAMHS Hospital produced clear benefits, with consistently positive feedback from sessions and no negative effects. Such was the improvement in both patient and staff well-being, staff have since been encouraged to register their dogs too.

This is a cross-sectional service evaluation study of the vaccination programme within the high secure setting of Broadmoor hospital with a view of improving the quality of it's delivery. We aimed to establish patients views about COVID-19 vaccinations particularly if there are any themes as to why the patients choose/did not choose to receive the vaccine. This information will be used to help us understand how to overcome vaccine hesitancy and anti-vaccine beliefs.

Patients across Eight wards were asked to participate in the study. 56 patients agreed to be administered the following semi-structured questionnaire by the doctors.

1. 1. Have you had a COVID-19 vaccine?

2. 2. Do you think there any advantages to taking a COVID-19 vaccine? Yes/No. If you think there are any advantages, please write these

3. 3. Do you have any fears or worries about the COVID-19 vaccine? Yes/No. If you do have any fears or worries, please write these.

14 patients had no vaccination, 2 had one, 38 had two or more.

34 patients said there were advantages, 13 said no advantages and 9 did not know. The themes of the advantages were established: Protects you from bad infection and symptoms (48), stops you from passing it on to others (3), blank (13), others (13) which included “Important to follow government guidelines, proven through history to work, it was offered, I'm more concerned with hepatitis, The doctor would have my best interests.”

30 patients stated that they did have fears and 26 did not. Common themes established were; side effects (17), Not tested correctly/given too quickly (5), Blood clots (2), positive comments (2), blank (22), others (10), which included, “Interaction with medications, more fear about face masks, injecting humanity with something could kill them, infertile generation, Control the public, don't like injections and alter the DNA genome.” The common side effects of concern were “painful arm, fever and headache.”

68% of patients had 2 or more vaccinations across the 8 wards studied. The commonest advantages cited by 86% of patients was to protect themselves from serious illness. The commonest fears or worries were of side-effects that result from the vaccine, although 46% patients had no worries and 39% gave no explanation for fears or worries. The fears and worries appeared mainly related to vaccine hesitancy rather than fixed generalised anti- vaccine views.

COVID-19 resulted in dramatic shifts in how interventions are provided within mental health services, creating the opportunity to virtually deliver JRS groups to parents of young people attending Belfast CAMHS. This is a sensory attachment intervention that facilitates the process of self-regulation and co-regulation through the use of food, sensory activities and an enriched environment provision. It is currently facilitated by CAMHS clinicians via video calls over 4 consecutive weeks.

1. 1. Evaluate the effectiveness of the virtual JRS intervention

2. 2. Measure discharge rates after JRS intervention to examine if attendance at JRS at the point of entry into CAMHS can lead to more timely discharge due to targeted early intervention

3. 3. To capture parent and clinician feedback focusing on the challenges and improvements that have occurred due to this adapted delivery of services

A systematic database search was conducted examining number of parents who have attended overall; weekly attendance; Did Not Attend rate; length of time between CAMHS initial assessment and JRS intervention; number of families discharged after JRS and number of families allocated to partnership/medic after JRS.

CAMHS clinicians (not directly involved in facilitating JRS intervention) gathered qualitative feedback from families (via phone calls with parents who provided consent).

132 parents were invited between March-December 2020. 41 families have been discharged, 60 families have been allocated to partnership or medic and 31 are awaiting future JRS groups due to non-engagement, or a further review by JRS facilitators or a CAMHS clinician that they are already allocated to.

Five parents provided positive qualitative feedback.

As JRS has engaged a high number of parents in a relatively short time -period, it would be helpful to further explore its effectiveness as a first line intervention in CAMHS, thereby informing service delivery moving forward.

A Fitness and Lifestyle Intervention Programme (FLIP IT) is a healthy lifestyle programme, developed for patients identified by their multi-disciplinary team that focusses on helping patients improve their understanding of the benefits of living a healthier life and supporting them to live a healthier life. We evaluate the effectiveness of the FLIP IT programme in tackling obesity and managing the weight of inpatients in a medium secure mental health unit.

Patients requiring support in managing their physical health from different secure wards were enrolled into the FLIP IT programme following identification by the Multidisciplinary team. Each cycle of the programme was completed over an eleven-week period. Data were collected for a total of seven cohorts of the FLIP IT program. Descriptive analysis was conducted with SPSS. Descriptive statistics, including means, frequencies and proportions were generated. Comparison was done between participants measurements at the start and end of the programme.

A total of 55 participant records from seven cohorts of the FLIP IT program were analysed; 33 (60%) male and 22 (40%) female. Ten participants did not complete the program; discontinuation rate of 18.2%, 7(70%) of which were females and 3(30%) of which were males. There was not much changes in BMI category from start to end (34.10 to 34.14) and in Waist to hip ratio only (0.951 to 0.949) subsequently.

Although, it showed only marginal number of improvement in some categories and no improvement in BMI category, also some patient did withdraw from the project. However, this does not mean that project FLIP IT was not useful at all, as it encouraged some participants to make small everyday changes in secure unit to gain understanding into the importance of their physical health.

Care in the community psychiatric setting involves regular monitoring of both mental and physical health. Patients with mental illness worldwide have higher rates of morbidity and earlier mortality, often due to physical disease, most commonly of metabolic or cardiovascular origin. The reasons for these findings are numerous, though a significant contributor is the underperformance of lifestyle screening and subsequent underutilisation of interventions. As standard, it is recommended that practitioners of all grades should, at each appropriate opportunity, assess their patient's current physical status and screen for lifestyle factors that increase risk of morbidity. These include: weekly physical activity, weight/BMI, diet, smoking status and alcohol intake. Our aim was to investigate if our Community Team was meeting both trust-set standards and national standards.

A list of all outpatient appointments, including all clinic types, and all grades of staff, was generated from 1/11/21 to 19/11/21 giving a total of 48 appointments. A list of questions were then answered using data taken from notes available on an electronic system. This allowed analysis of the frequency of assessment for each lifestyle factor and frequency of offered interventions, where appropriate. Further analysis across all grades of staff, both outpatient appointment clinics and medication monitoring clinics, and across specific mental health disorders was performed.

Each lifestyle factor should have been checked at each appointment and interventions offered where appropriate. In each assessment an intervention could have been offered following identification of a modifiable factor. No factor was assessed at every opportunity. Only 2 interventions (4%) were offered. Targeted Medication Monitoring Clinics (MMC) did not perform better than Outpatient Follow-up Clinics (OPA), OPA offered more interventions. These findings were consistent across all grades of practitioner and diagnoses.

Assessment of modifiable risk factors was not performed at each assessment, and where interventions were appropriate, they were rarely offered. This was a universal issue across the team, and in spite of specialised clinics, or high risk disorders, there was substandard physical health management. Therefore, opportunities to modify risk of physical disease, or improve treatment of the underlying psychiatric disorder are being missed. This is troublesome as community psychiatry often has the space, time, and rapport with patients to explore these issues, furthermore, many psychiatric treatments carry the burden of increased risk of morbidity and mortality. Consequently, the onus should be upon us to manage these risks and improve patient health through simple, short interventions and timely signposting and referrals.

To continue to monitor trends in detentions under the Mental Health Act based on race, age, gender, and sexuality during the COVID-19 Pandemic to consider if there were any specific areas that would need to be addressed.

We investigated available mental health detention documents stored in mental health legislative office, Birmingham and Solihull mental health foundation NHS Trust.

We found that detentions under Section 3 of the Mental Health Act have increased very gradually over the last three years (2018 to2021). However, there has been gradual reduction in detentions under Section 3 within the white population beginning in 2019 and continuing with a marked acceleration in reduction during the two peaks of the pandemic. This is marked in the 66yrs plus age group. As the pandemic has eased this reduction has stopped and reversed with increased section 3 admissions in last few months in this population. The detentions in the black and Asian population have followed a reverse pattern, with marked increase during the pandemic peaks in 2020/2021 and a marked fall as the pandemic has eased.

1. 1. Mental health act detention data during the Pandemic shows that the pandemic has disproportionality impacted black and Asian population of all ages and Elderly white population.

2. 2. During the pandemic there has been a marked increase in detentions under Section 3 of the Mental Health Act (for treatment) in the Black and Asian population with a marked reduction in the white population. This difference is stark in the working age population.

3. 3. This highlights:

   1. a. The need for a well-functioning community based health and social care offer to reduce detentions in the black and Asian population.

   2. b. Return of admissions under the mental health act of white elderly post vaccination (which are vast majority white) shows a reversal of the trend of this group not accessing inpatient treatment fully during the pandemic.

4. 4. Community Treatment Order (CTO) detentions in the Black and Asian population continue to increase through the pandemic disproportionately

5. 5. There is no material change during the pandemic, in short term detentions (section 2, 5(2)) or other inpatient detentions under the Mental health act

6. 6. There are no significant trend changes noted based on gender or sexuality or age during the pandemic in BSMHFT (Birmingham and Solihull mental health foundation NHS Trust).

High dose antipsychotic therapy (HDAT) is defined as “a total daily dose of a single antipsychotic which exceeds the upper limit stated in the SPC or BNF or a total daily dose of two or more antipsychotics exceeding the SPC or BNF maximum using the percentage method. Previous audits have looked at HDAT on both a national level (the Prescribing Observatory for Mental Health) and within Mersey Care NHS Foundation Trust. This audit aimed to identify the proportion of patients subject to HDAT and review combination antipsychotic strategies and consideration of Clozapine in patients subject to HDAT.

In August 2021, data were collected from the eight inpatient wards in Mersey Care NHS Foundation Trust. This involved using the Electronic Prescription and Administration system to identify those prescribed antipsychotics. Following this, the patient's electronic record was scrutinised for documentation of the rationale for HDAT, combination antipsychotics and consideration of Clozapine.

129 inpatients were identified as being prescribed antipsychotic medication. 21 (16.3%) patients were prescribed combination antipsychotic therapy, with four of these patients (3.1%) being prescribed HDAT. For these four HDAT patients, there was no recorded documentation of discussion of the option of Clozapine. The most common antipsychotic combination was Paliperidone depot with oral Risperidone. 38 out of 129 (29.5%) patients had been considered for Clozapine. Reasons for Clozapine being refused included the patient declining, concerns about non-concordance with oral medication, patients having had a neutropenia on an FBC, the patient being reluctant to have regular blood tests and a patient's comorbidities.

When comparing the proportion of patients subject to HDAT (3.1%) to the previous Trust audit in December 2020 (9.1%), there is a recurrent theme that antipsychotic prescribing practice in Mersey Care is safe, with minimal HDAT. Of note, the figure is significantly lower than the proportion of HDAT patients identified in the 2012 national study (28%). In this audit, none of the patients on HDAT had documented consideration of Clozapine. Three of the four patients were soon to be no longer subject to HDAT which may explain this result. Compared to the Trust's HDAT audit in 2020, the percentage of patients on combination antipsychotic therapy has stayed largely the same - 16.3% compared to 17.4%. The Trust needs to strive to continue minimal HDAT prescriptions and ensure that, in those patients subject to HDAT, there is consideration of and documentation of Clozapine being considered.

COVID-19 pandemic has a massively adverse mental health impact and people with pre-existing psychiatric illnesses are one of the most severely affected groups. We intended to study the changes in the patient profile in a psychiatric hospital during the COVID-19 pandemic, comparing it to the period just before the pandemic.

Consecutive patients (n = 210) admitted to psychiatric ward under one team during COVID-19 pandemic (February 2020 to January 2022) were compared with patients (n = 234) admitted in the immediate pre-pandemic period (January 2017 to January 2020). Demographic (age, gender, and ethnicity) and clinical variables (diagnosis, admission days, Mental Health Act status, risk to self and others) were collected from the electronic patient records and analysed.

During the pandemic monthly admission rates have gone up by 38.1% over the base rate of 6.32/month. There was no difference in the mean age at admission; or the proportion of patients aged 18–40 years or above in the pre-pandemic and pandemic groups. Similarly the gender composition of patients in the two periods was comparable. Proportion of patients from Asian background increased from 7.7% to 16.8% during pandemic period (p < 0.05). The number of hospital days decreased from 31.97 ± 45.8 days in the pre-pandemic period to 22.44 ± 25.1 days during pandemic (p < 0.05). Along with increased admission rates, it suggested a rapid flow of the admission and discharge during the pandemic. Considering diagnostic composition between pre-COVID-19 and COVID-19 periods, psychotic (27.8% v 26.7%) and mood disorders (18.8% v 23.3%) were the predominant; and substance related disorders (20.5% v 16.7%) were the most common comorbidities. Risk to self was associated with 84.3% admissions during the pandemic compared to 78.6% in the pre-pandemic period; however, risk to others was noted in 13.8% v 22.2% (p < 0.01) respectively. There was no difference in proportions getting admitted under Mental Health Act or being discharged with Community Treatment Order. Interestingly, proportions of patients getting discharged under the care of Home Treatment Team decreased from 31.1% pre-pandemic to 16.5% during pandemic period (p < 0.005).

There is an increase in admission rate and decrease in the number of admission days, suggestive of increased demand of clinical resources during pandemic. This could be reflective of the stressful situation and adverse impact on mental health in the pandemic period. As the impact on mental health is expected to continue, there is a need for greater resources both in community and inpatient psychiatric services.