After COVID-19 was declared as a pandemic, different countries have enforced lockdowns, and shielding to mitigate the spread of the virus as preventing loss of lives was the priority.

Our aim is to look for possible explanations for increased rates of visual hallucinations presented to Community Mental Health Teams for Older People during the period of lockdown.

A review of clinical cases presenting with new onset visual hallucinations to the Community Mental Health Teams for Older People during the lockdown period in 2020 was summarised in two case scenarios. One scenario represents cases with known background of dementia, while the other scenario represents new referrals during the lockdown period with no known psychiatric background. In those cases, the visual hallucinations started during lockdown with no clear cause, did not respond to psychotropic medications, physical health investigations were all normal and hallucinations improved markedly with the end of the lockdown and social isolation.

From clinical practice point of view, during the period of lockdown in the COVID-19 pandemic, visual hallucinations has been one of the commonest presentations reported to the Community Mental Health Teams for Older People. Families were calling frequently reporting that their loved ones were “seeing things”. Possible underlying causes include: social isolation, sensory and perceptual deprivation, visual impairment and Charles Bonnet syndrome, lack of cognitive stimulation activities with progress of dementia, superimposed delirium, in addition to depression secondary to loneliness, reduction in community support, increased alcohol consumption and negative effects of repeated media consumption.

There has been a marked increase in reporting visual hallucinations in the shielding older people population in the community during the period of lockdown in the COVID-19 pandemic. This shielded population was not exposed to COVID-19, so it didn't give an explanation to this new phenomenon. Though there are multiple possible causative factors, the effect of the lockdown itself with its resultant social isolation and sensory deprivation remains to be the most significant. Shielding the older people population throughout the COVID-19 pandemic came as an essential measure as the physical safety and preventing loss of lives was the priority; however the lockdown had significant negative effects on the mental health of the shielding population. It remains unclear if those negative effects are going to be reversible in the future, resulting in poor quality of life.

Hypnic Headache are is a very rare primary headaches that affect the elderly, with an average age of 60 years. Research in the areas of neurophysiology and treatment options for Hypnic Headache are necessary in order to better understand, and improve outcomes for this rare headache disorder.

Mr. X is a 70-year-old patient, has been presenting with the complaints of headache during sleep at night for the last 1 year. The Headache started after 3 to 4 hours after falling asleep. Due to headache, he wakes up from sleep around 03:00 to 04:00 am almost every night and his headache persist for 30 to 40 minutes. After waking up from sleep he keeps himself busy with religious activity and the headache gradually resolves. He then goes back to bed again.

Mr. X also informed that, the headache is dull in nature and located in left temporo occipital region. It is not associated with photophobia, phonophobia, nausea, vomiting, tearing or discomfort in the leg. He gives no history of early morning headache or day time headache, sleep disorder, snoring or sleep apnea. He has no past history of trauma to the head, fainting attack, unconsciousness, weakness or paralysis of limbs, seizures or non-epileptic seizures. He is an non-smoker, non-alcoholic, non-hypertensive & non-diabetic person.

On general examination, his heart rate is 70 beats/min, blood pressure 138/68 mm of Hg. There are no anemia, jaundice or oedema present in him. His both lung fields are clear. On neurological examinations there are nothing abnormality detected. His Serological investigations, CBC (Complete Blood Count) FBS (Fasting Blood Glucose), lipid profile are within normal limit. CT scan of the brain is normal. There are no cerebral atrophy or volume loss compatible with age.

Mr. X was treated by several general practitioners with paracetamol, diclofenac sodium, mefenamic acid, tramadol hydrochloride. He used these drugs either singly or in combinations. But with this treatment there were no significant improvement occurs. Mr. X is scared and depressed for his sleep time headache.

Hypnic headache is a very rare headache disorder. It occurs in age groups over 60 years. It is occur at night during in sleep and waking the patient up, hence the name of it “alarm clock headache”. It is commonly unilateral and lasts for 15 minutes to 4 hours. Hypnic headache commonly dull or throbbing in character and does not make the patient restless, unlike in Cluster Headache. After waking up from sleep, most patients engage in some activity. Hypnic headache is not associated with rhinorrhea, tearing and ptosis. Diagnosis is mainly clinical. Secondary causes headache must be excluded. International Classification of Headache Disorders 3rd Edition (ICHD-3)-beta provides diagnostic criteria for hypnic headache. Pathophysiology of hypnic headache is not clearly identified. Usual treatment options of Hypnic headache includes bed time coffee, lithium carbonate, indomethacin. Our patient fulfil all the criteria of Hypnic headache and he fells improvement with Indomethacin 50 mg in devided doses.

Hypnic Headache is a very rare type of primary headache. It should be diagnosed only after other secondary causes of headache have been excluded. Caffeine, lithium carbonate, flunarizine, indomethacin, used to treat the patient of Hypnic Headache. Lack of study and awareness about these disorders can lead to delays in diagnosis and treatment. Clinical trials are needed to find out proper treatment, but it will be difficult to perform because of the rareness of this disorder.

A growing body of research evidence shows that individuals with Obsessive Compulsive Disorder (OCD) have been negatively affected by the COVID-19 pandemic including deterioration of OCD symptoms plus relapse from previously well-controlled OCD. The impact of the COVID-19 pandemic is discussed in a single case study of a patient with OCD consisting of contamination concerns. In addition, the effectiveness of providing Exposure and Response Prevention (ERP) virtually is evaluated with regards to the treatment outcome in COVID-19 related OCD.

This study describes a 41-year-old, single, employed female with OCD consisting of concerns of contamination and infecting others thereby causing harm. The total duration of the disorder is 32 years with the most recent presentation being of three years duration. Relapse during the pandemic resulted in OCD symptoms being solely concerned with COVID-related contamination. The questionnaires routinely completed at the time of assessment and treatment were the Obsessive Compulsive Inventory (OCI); Yale Brown Obsessive Compulsive Scale (YBOCS); Beck Depression Inventory (BDI). Clinical data were collated and analysed prior to and during the pandemic. Treatment consisted of ERP and was adapted for provision via a virtual platform. ERP involved exposure to a graded hierarchy of COVID-specific anxiety-provoking situations modified to take government guidelines into consideration.

Prior to the COVID-19 pandemic the patient's response to treatment with cognitive behavioural therapy (CBT) including ERP indicated a 79% improvement in OCD symptoms on self -rated measures. The impact of the pandemic led to a significant 65% deterioration in OCD symptoms, regarding COVID-19 contamination concerns. Intervention with ERP resulted in 73% improvement over a three-month period. Measures of depression symptoms indicated an 80% improvement pre-COVID, with a 78% deterioration at relapse. Following treatment, the patient also showed a 65% improvement in depression symptoms. Improvements have been maintained at one month follow-up.

The case study supports literature indicating the exacerbation of OCD symptoms due to the COVID-19 pandemic for patients with contamination fears and washing compulsions. The promising results support the use of ERP as an effective treatment for COVID-related OCD symptoms. It also validates the provision of CBT interventions virtually to ensure accessibility of treatment to OCD sufferers.

To investigate a unique brief intervention, which offers a combination of neuro-linguistic programming and practical graded exposure therapy, to overcome a fear of heights.

A fear of heights or acrophobia is common and often deters people from perusing activities like climbing. It can also interfere with routine activities of daily living.

This two-day intervention is set in the Peak District (Derbyshire, UK) and works with a maximum of eight individuals to four instructors. The first half-day involves working with a psychotherapist using neurolinguistic programing techniques. The next 1.5 days involves graded exposure using abseiling over gradually increasing heights, to a final height of approximately 40 feet.

All eight individuals on the two-day course felt their fear of highs had significantly decreased. All eight individuals would recommend this intervention to others suffering from a fear of heights.

It is noteworthy that the group undergoing this intervention were self-selected and highly motivated to overcome their fear of heights. The sample size was small and outcome measures were subjective. However, this is a novel and effective approach to helping people overcome their fear of heights. Further research with larger sample sizes would be beneficial in further assessing the impact of this intervention.

Declaration: Permission was granted by the organizers of this intervention to submit an abstract to conference. There are no conflicts of interests. This intervention is run by a private company ‘Will4Adventure’, I have no finical or other interests in this company. I privately funded my own place on this course.

Increase awareness of the risk associated with access to firearms in clinical practice.

A 57-year-old man, with a 30 year history of schizophrenia, was reviewed routinely at home. His illness is predominantly characterised by chronic delusions of a grandiose nature. He believes he has been offered various senior employment positions and has acted on these beliefs by presenting at workplaces in business attire. He has no insight into his condition. At review, he described awakening a week earlier in a panic and seizing hold of his legally held shotgun. He planned to shoot out the window as he believed people were breaking in. His wife prevented him from doing so by taking the gun and hiding it. A few days later he found the gun and intended to frighten off potential pursuers by pretending to shoot birds. He was persuaded to surrender the gun and it was taken to the local Garda (Police). A short time later, he presented to Garda Headquarters, over an hour away, seeking the return of his gun. At review, he had limited insight into the potential seriousness of the situation. The team immediately liaised with Gardaí, a HCR- 20 risk assessment was completed and clozapine levels checked.

We had not know that our patient owned a shotgun despite very regular contact with him. During a comprehensive psychiatric history we routinely ask about risk of harm to self and others, but rarely ask specifically about access to or ownership of guns. Working on a farm, rural living or having an interest in shooting sports may raise the issue. Suicide, security breaches and homicide are the main risks conferred by firearms in mental illness. Mental illness is not necessarily prohibitive to gun ownership. Applicants for gun certificates in the UK must disclose specific medical conditions, including a psychotic illness, and an automatic medical report is sought. In the Irish Republic it is the responsibility of the applicant to declare any specific physical or mental health condition. Although a medical report may be sought, it is not automatic in all cases. Lack of insight into psychotic illness may potentially influence self-declaration upon application for a certificate.

Awareness of a persons access to firearms should be part of our routine risk assessment.

To explore Michael Kohlhaas syndrome and development of litigious paranoia.

A 50-year-old Swiss woman spent a number of weeks travelling around the UK, reporting to police that her family in Switzerland were working with their police, doctors and the mafia to kill her. She was therefore running away for her own safety, and trying to seek legal help to investigate. She had been in close contact with a woman in London who claimed to be able to give her legal aid in exchange for payment. On admission to the ward, it was felt that the legal aid was actually feeding her persecutory delusions.

We discovered that she had in fact been detained in Switzerland prior to coming to the UK, and the discharge report was obtained which diagnosed her with Michael Kohlhaas syndrome and Folie a deux.

This poster will further explore Michael Kohlhaas syndrome and litigious paranoia, with connection to this case.

This study aims to identify the techniques to improve the quality of the weekly one to one supervision for Psychiatry trainees.

An open-ended online questionnaire was prepared using principles of critical incident technique and distributed among psychiatry trainees working in various deaneries within the UK. The participants were asked to describe an example of a good and a bad supervision experience they had encountered during their training. In addition, participants were also requested to make suggestions to improve the supervision experience. All qualitative data were analysed using the thematic analysis approach, to identify common themes.

A total of 53 trainees working in various deaneries across England and Wales, responded to the questionnaire. The respondents were at a different level of training in psychiatry from CT1-ST6 level. The supervision hour was reported to be useful for clinical case discussions, reflection on difficult cases and situations, pastoral support and wider issues relating to personal and professional development. Trainees appreciated a holistic scope for supervision rather than a narrow discussion of management of cases.

Trainees reported that the supervision hour should be trainee-led and tailored according to their unique learning needs. Participants also saw supervision hour as a safe space where they can receive constructive criticism and feedback on their performance. At times, trust and genuineness were appreciated, as well as the use of an informal tone by the supervisor. An effective supervision leads to trainees feeling valued.

Trainees acknowledged that the supervision hour is an effective tool in psychiatry training. Trainees should get regular, protected and uninterrupted time with consultants for weekly supervisions. Both trainees and trainers need to develop a better understanding of how this supervision experience could be improved and tailored to the individual learning needs of the trainee.

The overarching aim of the session was to address and reduce stigma around Borderline Personality Disorder among doctors. The three main objectives were:

To increase empathy and understanding around Borderline Personality Disorder by exposing junior doctors to service user perspectives outside a clinical setting;

To address knowledge gaps identified by junior doctors in a self-reported questionnaire disseminated prior to the teaching session;

To offer junior doctors a basic psychological framework to base their assessment and formulation of service users with personality disorders.

‘Borderline Personality Disorder: The Person Behind the Label’ was the title of the first co-produced teaching session in the Leeds and York Partnership Foundation Trust (LYPFT). Prior to the teaching session, an online questionnaire was sent out to trainees. The results highlighted three key issues:

Negative attitudes towards service users with personality disorders;

Poor subjective knowledge of the psychological models of personality disorders;

Perception among trainees that they do not receive adequate training to deal with the challenges service users with personality disorders present.

A teaching session was co-produced by a team of two service users, a principal clinical psychologist within the Leeds Personality Disorder Network (PDN) and a core Psychiatry trainee. It was delivered in a 75 minute session to 40 attendees consisting of both trainee doctors and consultants.

Feedback was collected immediately after the session through the use of anonymous feedback forms. The response to the training was overwhelmingly positive with all 28 respondents rating the session as 4/5 or 5/5 on a satisfaction scale ranging from 1 (poor) to excellent (5). Key themes from the feedback included appreciation for the service user perspective and teaching on psychological theory. The fourth question in the questionnaire: “How will this teaching impact your work?” produced the highest number of responses (25/28) and provided evidence that the above listed objectives of the session were met.

Co-produced teaching has great potential to address negative attitudes around highly stigmatised conditions by bridging the gap that often exists between service users and mental health professionals.

To understand the level of training given to staff in providers of accommodation in the London Borough of Hackney across mental and physical health.

The Urgent and Emergency Care Collaborative (Health Education England) put out a call for funding bids around a number of workforce priority areas. This included upskilling care home staff to reduce admissions. We considered care home staff as those working across supported living schemes, housing with care, residential and nursing homes. Some of these settings exclusively support people with mental health needs.

We obtained a list of accommodation providers across the borough via the Local Authority. As a Community Rehabilitation team we work closely with many of the providers. We also co-facilitate the Hackney Mental Health Supported Accommodation panel and review all funded placements annually. We made contact via email and phonecall and arranged face to face meetings with 11 providers. We asked a standard set of questions about the organisation and training provision. We also asked them to identify gaps in training.

The level of training provided to staff varies vastly across different settings. There was a predominance of e-learning for some providers. Most staff in mental health settings are support worker level which limits the level of training offered/received.

Providers varied greatly in size of project and management structure and this directly impacts on access to training, often as a result of cost.

Providers were able to identify training gaps and were keen to have additional training.

Some common themes emerged – dual diagnosis, psychosis, medication – and some setting specific themes – dementia.

Based on the gaps identified we provided training sessions to a total of ~40 staff across a number of settings. Content included mental health awareness, crisis signposting and medicines management. All sessions were well received with pre and post-training questionnaires demonstrating an improvement in knowledge and confidence.

There is potential for knowledge sharing across accommodation settings and for stronger links between accommodation providers and healthcare providers. We plan to explore the possibility of quantitative data on the number of Emergency Department presentations from accommodation settings locally.

To review the existent literature base regarding Black and Minority Ethnic (BAME) groups care pathway into and experience of care and treatment within secure services. This includes any differences (between BAME and majority ethnic groups) in rates of sentencing, sectioning, length of stay, received treatment and use of restrictive practice. Our overarching aim is to highlight the severe lack of research in this area and the corresponding need for increased research to both consolidate and progress the existing evidence base in order to inform and improve culturally competent service provision.

Research suggests that BAME groups have an increased risk of involuntary psychiatric care, longer-stays within services and higher rates of re-admission. Several explanations have been proposed for this observed disparity, however few of these proposed explanations have provided sufficient or consistent supporting evidence.

A review of both quantitative and qualitative research regarding BAME groups within secure services was conducted. Approximately twenty journal articles, literature reviews and meta-analysis published between 1988 and 2019 were included. The current study should be considered a snapshot and not reflective of the full extent of published literature on the subject. For inclusion, studies should have been conducted in either a forensic mental health setting or a prison and differentiate a minimum of two ethnic groups

Research suggest that BAME individuals continue to experience an increased risk of involuntary psychiatric care, longer stays within secure services and higher rates of re-admission. Whilst many explanations for this disparity have been proposed, few have provided adequate supporting evidence. The ongoing lack of research within this field has led to a limited evidence base from which to inform culturally competent practice. The research which has been conducted has tended to produce inconsistent findings, in part due to the reliance on small scale studies with limited generalisability. Research within this area has been further complicated by varying definitions of culture and ethnicity across studies, leading to some suggestion that the issue of ethnic inequalities and pathways to care, has been misconceptualised. This highlights a critical need for increased research efforts to:

Understand why BAME individuals are at increased risk of involuntary psychiatric care, and how this disproportionate risk can be addressed

Explore potential disparities in the care and treatment of BAME individuals within services and how this might impact upon higher rates of re-admission

Ascertain how best to improve culturally competent service provision.

To introduce and assess the impact of balint groups on core medical trainee (CMT) doctors working within an acute medical trust.

A high rate (80%) of dissatisfaction and burnout has been reported amongst trainee doctors. This has had a significant impact on recruitment with a large proportion of foundation doctors delaying their application into core specialist training. Of those already in training, up to 50% have reported taking time, out citing burnout as a cause. Balint groups are a form of reflective practice groups looking at the doctor-patient interaction. For core psychiatric trainees these groups are a mandatory part of their training.

We piloted a total of three balint groups over a period of three months amongst CMT doctors based at an acute medical trust in London. A specialty registrar (ST6) in psychiatry facilitated the balint groups. Balint facilitators received supervision from a consultant psychiatrist in psychotherapy. CMT doctors were given questionnaires at the beginning of session one and emerging themes later explored. The questionnaires used were taken from the ‘Bristol Trainee-led Balint Group Scheme’.

The pre-questionnaires showed that all CMT doctors surveyed believed psychological factors play an important role on patient presentation and recovery. 14/19 (74%) agreed or strongly agreed that a doctor's reaction to a patient directly influenced care. All doctors agreed or strongly agreed that it was important to reflect on a patient's emotional experience, as it was crucial to their development as a doctor.

CMT doctors found balint groups useful as it provided them a space, which was not routinely offered to discuss challenging cases. Themes that emerged included a lack of support and difficulties maintaining boundaries when treating complex patients. Litigation was a recurring theme with many trainees reporting anxieties and a lack of support. Trainees reported guilt and worries that they were not doing enough for their patients. These themes appeared to have a direct impact on training experience and burnout.

With increasing burnout and dissatisfaction amongst junior doctors, balint groups provide a unique approach to supporting junior doctors within medical specialties. The current pilot has demonstrated that CMT doctors can make use of balint groups in an effective way. We recommend that balint groups should become an integral part of specialist medical training. Psychiatrists can play a central role in supporting the health and well being of medical trainees through balint group facilitation.

Reflective practice is a core component of undergraduate as well as post graduate training. Reflective practice provides an opportunity for individuals to learn through their experience as well as gaining insight into themselves and their practice. If completed effectively, it has been shown to reduce stress and improve mental well-being. Our aim therefore was to provide regular group reflective practice sessions with the aim of supporting junior doctor's mental wellbeing during the second wave of the COVID-19 pandemic.

Junior doctors within a critical care setting were offered two-weekly group reflective practice sessions focusing on ‘difficult or challenging cases and encounters.’ The sessions were offered to all junior and middle grade doctors within a critical care department in a small district general hospital. Consultants were also able to attend. The groups were facilitated by a consultant liaison psychiatrist and an accredited balint group leader. Critical care doctors were provided a feedback questionnaire assessing the impact of the sessions and the levels of stress and burnout. The themes emerging from the sessions were also explored.

A total of six reflective practice sessions were offered during a three-month period. A total of four reflective practice sessions were completed; two sessions were cancelled due to high workload on the department. Each session lasted approximately 50mins. On average a total of 3-4 junior doctors attended each session. The sessions were conducted face to face in a socially distanced manner and with all participants wearing face masks. The sessions were predominately attended by foundation doctors and SHOs. There was occasional attendance by middle grades and a consultant.

The predominant themes that emerged included: guilt, prolonged suffering, desensitisation, support and exhaustion. Despite the challenges associated with the pandemic and lockdown, many of the doctors also acknowledged the benefit of being at work during both waves of the pandemic. There was a sense of collectiveness and group belonging. The group found it beneficial to be able to share their experiences and challenges faced; this was most striking amongst the very junior members of the team.

Questionnaires were also provided to gain additional insight into the wellbeing of the critical care doctors. Worryingly the results highlighted a significant proportion of doctors were experiencing signs of burnout including fatigue (77%), lack of energy (54%), cynicism (31%), frustration and irritability (45%) and detachment (38%). Many of the issues highlighted were in response to the demand created by the pandemic and a lack of medical staffing wth 69% of doctors requesting regular feedback on staffing issues.

Burnout and low morale were already highlighted in a significant number of junior doctors prior to the pandemic. COVID-19 has identified a clear need for NHS employers and medical leaders to provide emotional and psychological support to staff. It is vital that we create an open environment where individuals can express their feelings openly without fear that they will be judged. Group reflective practice provides an avenue to build on collectiveness created during both waves of the COVID-19 pandemic. This pilot has demonstrated that if introduced as part of a wellbeing support package, junior doctors within a critical care setting are able to utilise the sessions in an effective and productive manner.

The aim of this study was to examine the factor structure of attitudes towards psychiatry among medical students by using the ‘Attitude towards psychiatry-30’ (ATP-30) scale, which is one of the most widely used psychometric tools in assessing medical students’ attitudes regarding psychiatry. We also aimed to explore the possible existence of meaningful subscales in the ATP-30 scale.

Secondary data from a survey of 743 final-year medical students from nine medical schools in Sri Lanka were subjected to factor analysis. Models based on empirical evidence were tested with Confirmatory Factor Analysis (CFA) for model fit using Comparative Fit Index (CFI), Tucker Lewis Index (TLI), root mean square error of approximation (RMSEA) and Chi square. To explore the underlying latent structure of the scale, Exploratory Factor Analysis (EFA) with oblique (i.e. Promax) rotation was employed. Horn's parallel analysis and goodness-of-fit statistics for a series of EFA models tested with different numbers of factors were used in determining the number of factors to retain. Items conceptually external to the emerging factors or with factor loadings less than 0.4 were discarded. Gender invariance of the final model was tested by configural, metric and scalar invariance. Internal consistency of subscales was assessed using McDonald's omega (ω).

Three models based on literature (one-, five-, and eight- factor) were disproved by CFA. EFA revealed a six-factor solution, encompassing 18 out of the 30 items, to be the most theoretically meaningful factor structure. This six-factor model was affirmed by a CFA (CFI = 0.94, TLI = 0.92, RMSEA = 0.036). These factors were, namely, ‘the image of psychiatrists’, ‘psychiatric patients and mental illness’, ‘efficacy of treatment’, ‘psychiatric teaching’, ‘career choice’, and ‘psychiatry as an evidence-based discipline’. This six-factor solution was invariant across gender. ‘The image of psychiatrists’ appeared to be the most salient factor, and formed the most consistent subscale (ω = 0.71). The internal consistencies of the other subscales were modest (ω = 0.55–0.67). The overall 18-item scale showed good internal consistency (ω = 0.78).

Our findings provide evidence of a multi-dimensional structure in medical students’ attitudes towards psychiatry, endorsing six meaningful subscales of the ATP-30. Future researchers and educators can utilize these subscales in identifying specific attitudinal domains which are more closely associated with students’ future choice of a career in psychiatry, and also in identifying specific areas where attitudes are more stigmatized, so that appropriate interventions can be incorporated into the undergraduate psychiatric curriculum.

The North West School of Psychiatry run a yearly structured clinical examination to help Core Psychiatry Trainees develop their training competencies and prepare for the MRCPsych Clinical Assessment of Skills and Competencies (CASC). Historically, this has been face-to-face with logistical difficulties, high cost, low trainee uptake and challenging in recruiting examiners. Following the COVID-19 pandemic and the subsequent shift to virtual consultations and examinations, the team implemented an innovative virtual Skills test. The main aims were to improve the test's quality and the trainee uptake, adapt the test delivery to a Health Education England (HEE) online platform, and establish cost-effectiveness in the post-COVID world.

A working group was formed to develop the Skills test, and in May 2019, the test was delivered face-to-face, implementing 5 cycles of 8 stations over 3 days. The same group adapted the test for online delivery, and in August 2020, 3 cycles of 8 stations were delivered. Feedback was collected, with adaptations made for a second Skills Test in December 2020.

96.4% of trainees rated their overall experience and the test organisation in the 2019 test as excellent or good (82.1% and 85.7 excellent, respectively). 93.5% of examiners rated their overall experience and the test organisation as excellent or good (45.1% excellent for both). In the August test, 95.8% of trainees rated their overall experience as excellent or good (58.3% excellent). 100% of trainees rated the test organisation and the online format as excellent or good (70.8% and 50% excellent, respectively). Although 100% of examiners rated the overall experience, the test organisation and online format as excellent or good, some felt the stations were not long enough to allow for technical issues. In the December test, higher proportions of trainees rated the overall experience (80%), organisation of the test (80%) and online format (70%) as excellent.

The virtual test is shown to be a viable and successful alternative to the face-to-face test in preparing trainees for their CASC, and trainees felt it was excellent preparation for the new online CASC format. It had some clear advantages, such as saving on consumables, reducing the financial costs of running the test, improving the test quality, and increasing the trainee uptake. It is more eco-friendly and reduces fuel emission, raising the question of how the test should be delivered after the COVID-19 pandemic.

Third year Medical students from the International Medical University, Malaysia were assessed regarding their commonly held attitudes and beliefs for the mental illness in general as well as with respect to psychiatry as a faculty through a survey monkey based survey,

Commonly held perceptions and prejudices often can be overcame by education and early exposure to facts which also holds true with medical students and their attitude as well as expectations to psychiatry. Ever growing awareness regarding the Mental illness has helped but is unable to complete address the stigma and prejudices associated with it. Also Early exposure to psychiatry in medical education can provide a positive experience to medical students including germinating an interest in psychiatry as a career choice among the students.

42 students of 3rd and 4th year medical school from International Medical University, Malaysia, some without any exposure to psychiatry, were participated in a survey created on a cloud based online survey link and responded to a questionnaire about the attitude and belief towards mental Illness as well as Psychiatry as a career choice. The results were analysed and data interpreted.

Most students (85%) though agreed that psychiatry is a rapidly expanding frontier of medicine sadly only 20% stated that it would be one of the top three career choice. Just under the 50% of the students stated that the psychiatric patients are more likely to harm others. About 95% felt that psychiatric consultations of patients with medical and surgical health problems would be helpful and 90% students shared that they would not feel embarrassed about someone from their family if diagnosed with mental illness.

Psychiatric exposure in medical education has been recognised as inadequate in general and often exposing medical students to psychiatry early helps improving the stigma and prejudices associated with mental illness. It will also give them sufficient exposure to assess the illness holistically keeping mental health in mind while treating physically ill people and also may inspire them to choose psychiatry as a career choice in a rapidly developing and conservative country such as Malaysia where mental health services are largely inadequate and is the second biggest health issue.

The BMA's survey results (Caring for the Mental Health of the Medical Workforce, 2019) and HEE's NHS Staff and Learners’ Mental Wellbeing Commission report (2019) highlighted declining staff wellbeing. The COVID-19 pandemic has sharpened focus on this and the effects of moral injury on healthcare professionals. Shielding, social distancing and redeployment led to many medical trainees being increasingly isolated at a time of heightened anxiety and adversity. Psychiatry trainees tend to have good access to reflective groups, but this is not customary in other training programmes.

Intervention

“Trainees4trainees” was set up by trainees across specialties as a HEE-TV well-being project, led by the Deanery Trainee Improvement Fellow. Peer support groups are run on Zoom, facilitated by 2 trainees with special training in peer support. Psychiatry trainees have been involved in designing and facilitating groups and training facilitators from other specialties; facilitators have regular supervision from a consultant psychiatrist in medical psychotherapy. Trainees are supported to discuss challenging experiences and think about their emotional responses in a supportive and validating group.

Feedback

We are in the process of formal data collection to assess the impact of the intervention. Informal feedback suggests the groups are a powerful support to individuals who otherwise have no avenue to think about the psychological impact of their experiences. The groups have supported trainees to feel less isolated and bolstered their resilience.

Future plans

We have faced challenges in the practicalities of establishing and maintaining groups. We are working with Training Programme Directors to move towards running the groups in protected time within working hours and advocate that reflective groups, such as our peer support groups, are a key part of future medical and surgical Training Programmes.

Involuntary commitment is a legal process through which an individual with symptoms of severe mental illness is court-ordered into inpatient or outpatient treatment. These criteria vary between nations. The goal of this presentation is to compare the governance of protecting patients among different parts of the world.

Understanding the relevance of the judicial committeemen in psychiatry is an essential part of good psychiatric practice. A majority of patients who need inpatient psychiatric treatment fall into one of the following categories: dangerous to self, dangerous to others, or gravely disabled.

In the United States, the Parens Patriate doctrine has had great application in the treatment of mentally ill persons, children, and other individuals who are legally incompetent to manage their affairs. The states, which act as parens patriae, can make decisions regarding mental health treatment. State law governs involuntary commitment, and procedures may vary among states.

One of the essential duties of St. Tammany Parish Coroner Office, Louisiana, USA is Mental Health Service, From January 2017 to October 2019, 887 Order of Protective Custody (OPC), 17,838 Physician Emergency Certificates (PEC), and 13096 Coroner Emergency Certificates (CEC) were issued. These certificates allow legal authority to transport a patient to the nearest ER for assessment by physician and mental health providers.

Patients with active Physician Certificate are examined by a coroner according to patient's mental history and clinical presentation. Coroner Certificate helps the treatment facilty detail the patient for diagnosis and treatment for fifteen days.

St. Tammany Parish Coroner Office is fulfilling its responsibility to provide proper mental health to psychiatric patients. It is necessary for each country/state/parish to have legal structure and provide proper care who are dangerous to self or others, or gravely disabled. The procedures of OPC, PEC, and CEC will be presented.

Stigma towards psychiatry feels rife within medical school and this extends from university life into clinical placements. Mental health remains an unattractive area of medicine and is frequently regarded as subpar by other specialists. Against existing literature, this study compares the authors first hand experiences over the last five years within medical school to evaluate how representative their experiences of stigma in psychiatry are for the wider community and published literature. The study aims to inform the wider discussion on this topic and offer areas where intervention may yield a better perception and hence uptake of this specialism.

Literature review relating to the topic was completed. Studies pertaining to medical students and/or educators views and experiences of psychiatric medical education and clinical placement were included for discussion. A reflection on the first author's specific experiences to date of psychiatry and his intent to pursue psychiatric career was conducted, with careful reference to existing literature. This allowed validating personal experiences in light of shared experience within the medical community in various national and international settings.

Arguably, some non-psychiatric clinicians do inadvertently set the scene early in medical school for the stigma that is to be thrust upon students. This builds upon prospective students ranking psychiatry low for satisfaction, prestige and stating it to be a ‘pseudoscience’ or words to that effect. The lack of understanding from junior medical students of the role of the psychiatrist sees them associating psychosocial education as equivalent to psychiatry. This reinforces the idea of psychiatry being grounded in sciences other than anatomy, biochemistry, physiology and pharmacology. On clinical placement, there is little cross-speciality support for those students who want to be psychiatrists and sometimes even lost opportunities for those publically aspiring towards psychiatry. Placements in psychiatry give students a better understanding of psychiatry but this does not seem to significantly change their career aspirations and this is rather defined from the admission stages.

After comparing experience with literature, stigma towards psychiatry appears to be universal. It may be important to consider the types of students who are being attracted to medical school as currently students seem to have an intrinsic disinterest in psychiatry despite later becoming better informed through psychiatric placement. Culture is notoriously hard to change, particularly within medicine. This stigma exists both in the lay and medical communities with early potentially inaccurate lay views of psychiatry being validated and reinforced throughout medical school.

To improve postgraduate psychiatry education and training in Northern Ireland.

Historically within Northern Ireland there has been a postgraduate Member of the Royal College of Psychiatrists (MRCPsych) teaching programme delivered to core trainees in preparation for MRCPsych examinations. There has been no official teaching programme for higher trainees. Northern Ireland Medical and Dental Training Agency (NIMDTA), in collaboration with the Royal College of Psychiatrists in Northern Ireland and all five Trusts developed the novel idea of introducing Postgraduate Education Fellows, to oversee and improve core training, and to develop a bespoke higher training programme.

The Postgraduate Education Fellows met to collate information from various sources in relation to issues within the current teaching programme and address these along with the development of new initiatives. The fellows further act as a point of contact for all trainees within their Trust to provide advice and support with education if needed.

One higher trainee was appointed to the role of Postgraduate Education Fellow in each Trust within the NIMDTA deanery for a term of 1 year.

The starting point was delivering the pre-established teaching timetable and gaining feedback from core trainees to identify areas for improvement. The next phase involved piloting traditional and contemporary methods of feedback. A further development was designing a mock paper A delivered under exam conditions. Two mock Clinical Assessment of Skills and Competencies (CASC) exams were organised under exam conditions, offering other trainees the opportunity to act as simulated patients and examiners.

The third aspect of this role involved creating a programme of higher trainee seminars. Baseline data were collated and identified key areas that higher trainees felt they needed further training and guidance in.

Using baseline data on the current teaching programme and from higher trainees as well as incorporating quality improvement methodology, we have been making small changes to each aspect of the teaching programme and evaluating the changes made. The feedback from trainees has been positive as evidenced by quantitative and qualitative feedback. 8 candidates sat our first mock CASC with a 100% pass rate in their MRCPsych CASC examination. There has been a positive response to the higher trainee seminar programme.

This programme has produced good outcomes to date and sets foundations for the future development of post graduate psychiatry education in Northern Ireland.

In the changes brought about by remote working, the local psychotherapy case discussion group (Balint Group) has developed as a remote service via video consultation. It is important to consider the effect that this change in method of delivery has had on experience.

An anonymous survey was distributed to determine the benefits and challenges from participants and facilitators with at least a month of virtual Balint Group experience. The open-ended survey questions captured extended answer responses from 16 students and trainees, and 5 (co-)facilitators, within Nottinghamshire Healthcare NHS Foundation Trust. The qualitative feedback was analysed by thematic analysis, identifying three main themes.

The first theme of practicalities was centred around access to the group. The virtual format had benefits in terms of reducing travel and time commitment and so improving attendance. However, disadvantages were in technological issues and finding a private and safe environment, individuals often not leaving the work environment on which they were reflecting.

The second theme of communication identified how virtual methods are a less natural way of interacting (for example sequential point making), losing both immediacy of reactions and non-verbal communication. There was a loss of essential communication cues, with disjointed conversation affecting contribution.

The third theme of group dynamics had some advantages, feeling less intimidating virtually. Yet disadvantages included loss of group cohesion, with participants not building the same relationships (on arriving and leaving a group space), and trust. The more subtle emotions in the group might be missed and opinions given less openly. The facilitators needed to be more directive and experienced difficulties maintaining group engagement and managing the frame.

The advantages of virtual format are more based on accessibility and the disadvantages more experiential. There are elements of being physically remote that lead to a disembodied experience, that might impact on capacity to reflect emotionally. This might make it more difficult to identify unconscious processes and the experience might be more cognitive. There is a risk that virtually participants will feel more alone with difficult feelings and unsupported by the group.

When mental health is being affected by social isolation due to the pandemic, having groups virtually can mimic this isolation in working life. Overall the preference remained for an in-person group.

However, it was clear that access to some form of a group was important, to contain anxiety during these unprecedented times.