Aims: Enduring inequalities in mental healthcare exist between UK minority ethnic and White British groups, which were further aggravated during the pandemic. Through 2022–23 the nationally funded ARIADNE research project carried out qualitative research and co-production workshops to suggest local (in four participating sites of England) and also identified over-arching solutions to improve access and experience of care. After the ARIADNE research project ended, a further co-designed impact analysis initiative was carried out in 2024 in two original participating sites (Coventry/Warwickshire and East London).

Methods: Workshops were held in the two sites, attended by staff and experts by experience (carers and service users) to explore the impact and progress of the action plans from the ARIADNE study. Subsequently a national workshop was then held bringing together national opinion leaders and local stakeholders to identify key themes.

Results: A content analysis of the workshops and the national event minutes were carried out to identify progress, ongoing barriers and solutions to improving access:

There is a need to refine the concept of minoritised communities. Sharing experiences of racism towards individuals from minority ethnic groups who grew up in England and towards immigrants would be valuable. Care providers should arrange safe spaces for these conversations.

Pandemic and lockdown deteriorated the quality of mental health care provision and increased demand for mental health support. This disproportionately affected ethnic minorities and exacerbated their struggle in accessing mental healthcare complicated by stigma (both internal, in-group, external and cultural).

Professionals were in some cases experienced as being ‘blind’ to the issues of ethnic minorities and also impacted by institutional racism.

Education, cultural mediation and digital interventions that can offer solutions and overcome barriers to access the solutions need to be local and personalised.

Crucially, a human rights approach is required to promote integration and social cohesion. Offer of care should be diversified by including participatory culture, voluntary sector involvement and lived-experience involvement (e.g. peer work). Some potentially helpful developments and service reconfigurations were noted with population-based approach and neighbourhood models of community mental health care.

Conclusion: Locally led co-production research offer valuable intelligence and can be a resource to local health systems. It can utilised in planning of service re-design and resource allocation. Such continuous co-production increases research impact and minimises delay in putting research findings into practice. The themes raised and initiatives undertaken may be inspirational to other areas and national initiatives.

Aims: This quality improvement project (QIP) aims to evaluate the assessment of anticholinergic burden (ACB) of medications, using a validated tool, in patients admitted to Bristol Royal Infirmary and referred to Later Life Liaison Psychiatry, aiming to increase awareness and reduce ACB where appropriate.

Methods: The Anticholinergic burden Effect on Cognition (AEC) validated tool was selected to assess ACB. Baseline data was collected and anonymised from 20 patients via team assessments in patient records. Data included the AEC score, medications involved, prescription indication, whether ACB was considered, and if AEC score was documented.

An educational intervention involved teaching liaison psychiatry staff on ACB, AEC and strategies for deprescribing or switching medication. The team’s knowledge was evaluated before and after teaching using questionnaires. An educational poster was displayed around the office.

Post-intervention data was collected from five additional patients, and the results were analysed.

Results: Baseline data showed 25% of patients (n=20) scored AEC ≥3. 30% were on multiple medications with an AEC score, 50% were prescribed antidepressants, predominantly mirtazapine and sertraline (both AEC=1). Only 15% of the assessments had a documented AEC.

Prior to the educational intervention, 71% of the team reported their ACB knowledge level as “very poor”, “poor”, or “average”. After the teaching, 71% of the team rated their knowledge as “very good”, indicating significant improvement.

Following the intervention, no patients (n=5) scored AEC ≥3, and 60% of assessments documented the AEC score.

Conclusion: The most prescribed medications contributing to ACB were, in order, cyclizine, mirtazapine and sertraline, aligning with current national literature. Most patients with AEC ≥3 were taking multiple drugs, leading to a cumulative effect. Of the assessments that did not document the AEC score after teaching, all had scores of 0, suggesting staff may not view this score as significant.

All psychiatry liaison colleagues acknowledged the importance of ACB, but had a knowledge gap prior to the educational intervention, which showed improvement following a well-received teaching session.

This QIP demonstrates patients interfacing with old age psychiatry liaison can have a high ACB. The liaison team are well-placed to acknowledge and review these medications collaboratively with medical colleagues. An education intervention shows improvements in assessing ACB in our service.

For sustainability, further service level interventions have been implemented, including bookmarking the AEC calculator on staff computers (medichec.com) and adding a prompt to the team’s initial assessment template to check AEC. These measures aim to continue improving patient outcomes.

Aims: This service evaluation sought to assess the consistency of documentation in 5 key areas of analgesic prescribing in a medium secure forensic unit in South Wales.

Methods: Five key areas which are important to document when prescribing analgesia were defined as follows: 1) Indication, 2) Prescription Review, 3) Risk, 4) Discontinuation Guidance and 5) Patient Counselling on Analgesic Choice. Data was collated on these 5 key areas for opioid and pregabalin prescriptions between 1 November 2023 and 1 April 2024. Using Hospital Electronic Prescribing and Medicines Administration (HEPMA), it was possible to establish prescription data. Information on each prescription was then collated from: clinical team meeting (CTM) notes, nursing notes, GP contact records and tribunal reports for each patient.

Results: There were 18 analgesic prescriptions which fitted project criteria. 11% prescriptions were for morphine, 17% for co-codamol, 39% for codeine and 33% for pregabalin. Documentation across the 5 key areas was deficient, with 0% patients with documentation in all 5 key areas, 14% patients with documentation in 4 areas, 36% patients with documentation in 3 areas and 50% patients with documentation in <2 areas. Indications were better recorded in CTM notes than on HEPMA. On HEPMA, only 50% prescriptions had an indication, and of those only 6% had a specific indication with the remainder noted as “pain” (33%) or “pain team advice” (11%). In comparison, 90% prescriptions from CTM notes had an indication; the most common indication being leg pain (40%). In terms of prescription reviews, only 56% prescriptions were reviewed. No patients had any documented consideration of the risk of prescribing analgesia based on their substance misuse history despite 93% patients included having a recorded substance misuse history. 57% patients were prescribed the drug they have a recorded history of addiction to. Only 36% prescriptions documented the physical health risks of prescribing analgesia. Similarly, there was no documented guidance for any patient on circumstances to discontinue analgesia. In regard to patient counselling, only 50% patients were counselled on the choice of analgesia.

Conclusion: Multiple sources of information made it time consuming to get a holistic view of each prescription. Some of the key areas such as discontinuation guidance and substance misuse risk were not documented at all, with other areas having sporadic documentation depending on the prescriber. To improve future practice, changing HEPMA to have mandatory fields to record 5 key areas when prescribing analgesia would ensure consistency of documentation.

Aims: People under mental health (MH) services’ care are at increased risk of suicide. We aimed to identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.

Methods: A population-based study of all who died by suicide in the year following an MH services contact in Wales, 2001–2015 (cases), paired with similar patients, with the same mental health diagnoses, who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database – Cymru with primary and secondary healthcare records. We present odds ratios and 95% confidence intervals (OR [95% CI]) of conditional logistic regression.

Results: We matched 1,031 cases with 5,155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm.

A high proportion (98.3%) of cases were in contact with primary and secondary healthcare services in the year before their death. Compared with controls, cases were more likely to attend emergency departments (OR 2.4 [2.1–2.7]) and have emergency hospital admissions (OR 1.5 [1.4–1.7]); but less likely to have primary care contacts (OR 0.7 [0.6–0.9]), out-patient attendances (OR 0.2 [0.2–0.3]) and missed/cancelled out-patient appointments (OR 0.9 [0.8–1.0]).

A high proportion of cases presented to primary and secondary healthcare services with accidents, injury and poisoning, and especially self-harm – more so than controls (for self-harm, 28.5% of cases compared with 8.5% of controls; OR 3.6 [2.8–4.5]). This was particularly true for female patients admitted to hospital with injury and poisoning (OR 3.3 [2.5–4.5] in females compared with 2.6 [2.1–3.1] in males).

Conclusion: We may be missing existing opportunities to intervene across all settings, particularly when people present to emergency departments and hospitals, especially with self-harm. Intent underlying injury and poisoning events may be undisclosed, or recorded as undetermined or without specifying intent when they may in fact be self-harm, particularly in females. Efforts should be made to appropriately identify those who are self-harming, including by direct and non-judgmental questioning on presentation underpinned by staff training and awareness. Prevention efforts should focus on strengthening non-urgent and routine contacts (primary care and outpatients), responding to emergency contacts, and better self-harm care. This study also highlights the benefits of enhancing clinical audit systems with routinely collected data for data completeness, breadth, and depth.

Aims: Primary insomnia, a separate diagnosis that is now included within the newly broader categorization of insomnia, greatly affects the quality of life. This meta-analysis evaluates the efficacy and safety of orexin receptor antagonists (ORAs) and Z-drugs for insomnia in adults.

Pharmacological approaches to the management of insomnia include the use of our own rendition of those generic drugs commonly referred to as ORAs and Z-drugs. Z-drugs are mainly used; nevertheless, doubts as to their long-term security remain. Targeted at orexin receptors, ORAs are novel. This system consolidates knowledge for use in clinical evaluation and management.

Methods: Accordingly, a Cochrane-Central Register of Controlled Trials Database, a Systematic review using the keywords, ORAs, and Z-drugs was conducted. The criteria for patient inclusion involved all adults diagnosed with insomnia. Measurements of the extent of benefits from the interventions were: Total sleep time, sleep onset latency, and adverse effects.

Bias was determined using SRR and overall risk of bias was determined using the ROB 2 tool. This meta-analysis was conducted by applying random effects models.

Results: Six trials showed that ORAs shortened sleep onset latency compared with zolpidem and other Z-drugs (mean difference −15.3 min, 95% CI −22.1 to −8.5). Total sleep time was similar to total time between sleep onset and wake-up in both groups. ORAs demonstrated a superior safety profile, with lower incidence of next-day somnolence (risk ratio: 0).

This was associated with a decreased risk for cognitive impairment at follow up (risk ratio: 0.65, 95% CI: 0.52–0.81) and for dependency (risk ratio: 0.38, 95% CI: 0.25–0.58).

According to the funnel plot analysis there was no significant publication bias that exists within the studies.

Conclusion: They [ORAs] are at least as effective as the Z-drugs in the management of insomnia and are safer in terms of next-day implications and withdrawal especially in elderly patients. These experiments affirm using ORAs as a first-line pharmacological remedy in chronic insomnia in adults.

Retrograde amnesia for autobiographical memories is a commonly self-reported cognitive side-effect of electroconvulsive therapy (ECT), but it is unclear to what extent objective performance differs between ECT-exposed and ECT-unexposed patients with depression. We investigated the association between exposure to brief-pulse (1.0 ms) bitemporal or high-dose right unilateral ECT and retrograde amnesia at short- and long-term follow-up, compared with inpatient controls with moderate-to-severe depression without lifetime exposure to ECT and receiving psychotropic pharmacotherapy and other aspects of routine inpatient care. In propensity score analyses, statistically significant reductions in autobiographical memory recall consistency were found in bitemporal and high-dose right unilateral ECT within days of an ECT course and 3 months following final ECT session. The reduction in autobiographical memory consistency was substantially more pronounced in bitemporal ECT. Retrograde amnesia for items recalled before ECT occurs with commonly utilised ECT techniques, and may be a persisting adverse cognitive effect of ECT.

Aims: Mental health disorders represent a significant burden globally, yet access to psychiatric care remains limited, especially in low- and middle-income countries. In Sudan, the utilization of mental health services is restricted by financial constraints, social stigma, and lack of service availability. This study aims to identify key barriers affecting mental health service utilization in Khartoum, assess the availability and affordability of essential psychotropic medications, and explore their influence on patient access to care.

Methods: A cross-sectional hospital-based study was conducted from October to December 2022 at Tigani El-mahi Psychiatric Teaching Hospital and Taha Bashar Psychiatric Hospitals in Khartoum. A stratified random sample of 384 psychiatric outpatients and their caregivers was interviewed using a structured questionnaire covering demographics, accessibility, affordability, stigma, and attitudes toward psychiatric care. Additionally, the availability of 24 essential psychotropic medications was assessed in public and private pharmacies. Ethical approval was obtained, and informed consent was secured from all participants.

Results: The most commonly reported barriers to mental health service utilization were financial constraints (34.4%), limited-service availability (21.4%), and stigma (10.9%). Over 84% of participants reported no psychiatric services within their locality, 49.5% travelled 1–3 hours, while 24.2% travelled more than 3 hours to access care. Medication shortages were significant, with the availability of essential psychiatric drugs ranging from 16.1–28.6% in public hospital pharmacies and hardly exceeding 37.5% in private pharmacies. Affordability was a major concern, with 70.3% of participants stating that prescribed medications were unaffordable and difficult to purchase. Education level was significantly associated with healthcare-seeking behaviour (p=0.018), with university-educated individuals more likely to seek treatment. These findings align with studies from other LMICs, where financial and accessibility challenges are similarly identified as major barriers to psychiatric service utilization.

Conclusion: Mental health service utilization in Sudan is severely impacted by financial constraints, limited-service availability, and stigma. Addressing these barriers requires integrating psychiatric care into primary healthcare, expanding community-based services, and ensuring the affordability and availability of essential psychotropic medications. Subsidized medication programmes, targeted community outreach, and mental health literacy initiatives could play a key role in improving accessibility. These findings contribute to the global discourse on mental health equity in resource-limited settings and underscore the urgent need for policy reforms and investment in mental health infrastructure.

Funding Statement: No external funding was received for this study.