Aims: A trial of Balint Group for eleven medical students during their psychiatry placement in Rotherham, UK, to add to the existing pool of evidence regarding the impact of Balint Group on empathy, communication skills, understanding of doctor-patient interaction and to improve the understanding of the wider socio-political context of patients, with the hope of developing agency, consultation abilities, advocacy and well-being among future doctors.

Methods: Balint Groups were facilitated by two Psychiatry Core Trainees with weekly supervision by a consultant medical psychotherapist. Five sessions were integrated into the students’ weekly timetable. The students were sent questionnaires before and after the pilot, asking for views on the role of psychological factors in the doctor-patient interaction as well as Balint Groups. There were seven closed questions in both questionnaires and an extra two open questions in the ending questionnaire.

Results: Three students attended all sessions, with others having inconsistent attendance, resulting in six to ten students in each session. With each subsequent session, the students displayed more openness and reflection during discussions. Ten students answered the initial questionnaire and nine the ending questionnaire. Therapeutic relationships were discussed in the context of wider issues, such as abortion, homophobia, migration and racism, menopause, and prejudice from healthcare professionals towards patients from lower socio-economic backgrounds. In answers to the open questions, the students highlighted the beneficial effects of the sessions on their subjective levels of empathy, better understanding of psychosocial factors involved in patients’ presentation, benefits of reflection to help resolve internal conflicts, reduce burnout and create solidarity between students. However, there was no significant change in the answers to the closed questions. This could be a result of inconsistent attendance, short duration of trial and ambiguity of questions. The students were, on average, already highly aware of the role psychological factors play in patients’ presentation and had some awareness of the role of doctors’ attitudes towards patients, which could have contributed to this also. Both trainees found their own benefits facilitating the sessions; improving their leadership, organisation and psychotherapy skills.

Conclusion: This five-week Balint Group pilot produced benefits described by the medical students as improved empathy, psychosocial awareness, reflective practice, reducing burnout and improving peer to peer bonds. The pilot also demonstrated the role of Balint Groups as an educational tool to enhance sociopolitical understanding; empowering doctors as advocates and addressing harmful biases that can otherwise persist in healthcare settings.

Aims: The unique demands of studying for a healthcare-related degree are associated with an increased risk of developing mental health problems. Stigma and fear of repercussions for their future careers may be a barrier to these students seeking professional help. Mental Health First Aid (MHFA) is a globally disseminated psycho-education course, training members of the public to recognise and respond to people experiencing mental health problems in their communities. Training healthcare professional (HCP) students in MHFA may help them support their peers and optimise their own wellbeing.

We aimed to review the literature regarding experiences of MHFA in medical, nursing and allied HCP students and its impact on mental health knowledge, confidence and skills in supporting others, stigmatising attitudes, self-care, peer support and student wellbeing.

Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (ID: CRD42024589509). Electronic databases (Ovid, Medline, PsycINFO, CINAHL and ERIC) were searched on 9/10/2024 for primary studies evaluating the impact of MHFA in HCP students. Data was extracted independently by two authors. Study quality was assessed using the MMERSQI (Modified Medical Education Research Study Quality Instrument) and Cochrane Risk of Bias tool.

Results: Searches identified 1613 studies, 25 of which met inclusion criteria. Study types were heterogeneous, including four randomised controlled trials (RCTs) and four qualitative studies. Eight studies reported that MHFA significantly improved post-test knowledge and mental health literacy. Fourteen studies reported enhanced confidence in providing MHFA post-training. Three studies described outcomes based on performance on simulation assessments, and eight studies reported reduction in discriminatory attitudes following MHFA training. Data on peer support and student wellbeing was limited. Qualitative studies suggested that MHFA clarified misconceptions around mental illness, facilitated supporting friends and family, and helped with self-care and seeking professional support for their own mental health. Student pharmacists felt that skills gained from MHFA were particularly advantageous in their professional roles. Qualitative data also suggested that tailored content for HCP students and increased pace of delivery would be beneficial.

Conclusion: The evidence base on this topic is limited, with many small studies and few RCTs. However, the available literature suggests that MHFA may be a promising strategy to improve mental health literacy, confidence, skills, and reduce stigma in HCP students. Findings suggest that there is demand for bespoke MHFA courses for HCP students, which may fulfil an unmet need in facilitating them to provide support to their peers, and optimise their own wellbeing.

Aims: Risk of burnout amongst Resident Doctors is higher now than even pandemic levels with 63% of trainees at moderate-high risk in the 2024 GMC NTS. With an ever-increasing need to consider novel approaches to tackle this, Art Therapy (AT) “experiential” workshops were delivered for attendees of the weekly academic programme at SABP NHS Foundation Trust.

The primary aim was to explore whether engaging in AT could positively impact doctors in 5 wellbeing measures: relaxation, self-awareness, self-confidence, connection with others and positivity about the day ahead. The secondary aims were for doctors to gain personal experience of the psychotherapeutic nature of AT and an understanding of the role of AT in treating mental illnesses.

Methods: The workshops were delivered by Art Therapists to 3 different cohorts between October and November 2024. The workshops comprised:

A 10-minute arts-based cross bilateral stimulation exercise.

A 40-minute art making session.

Collective reflection on individual art pieces with psychotherapeutic facilitation.

The pre- and post-workshop surveys included 6 Likert scales measuring wellbeing and understanding of AT, and 2 items exploring perceived personal and professional benefit of AT to doctors. Since the surveys were not labelled for matching, independent samples t-tests (α=0.05) and descriptive statistics were used for analysis.

Results: 62 participants completed the pre-workshop survey (55 Resident Doctors and 7 others (Consultants, non-training grade doctors, PAs)); 43 participants completed the post-workshop survey (39 Resident Doctors). All 6 Likert items scores increased post-workshop, with the following being statistically significant:

Relaxation (p <0.001; MD 1.12, 95% CI 0.68 to 1.56);

Self-confidence (p<0.001; MD 0.73, 95% CI 0.31 to 1.15);

Connection with others (p<0.001; MD 0.66, 95% CI 0.30 to 1.01);

Positivity about day ahead (p=0.04; MD 0.46, 95% CI 0.02 to 0.90)

Understanding of art therapy (p<0.001; MD 1.35, CI 1.02 to 1.70).

The increase in self-awareness scores was borderline statistically significant (p=0.06; MD 0.65, 95% CI 0.19 to 1.11).

Post-workshop, there was an increase in the proportion of respondents who felt AT could be beneficial to doctors personally (74% to 98%) and professionally (61% to 93%).

Conclusion: Engaging in Art Therapy during work hours has a significantly positive impact on doctors’ wellbeing, with particularly strong evidence for increased relaxation, self-confidence and connection with others. With an overwhelming majority of respondents agreeing it could provide personal and professional benefit to doctors, Psychiatry training schemes would do well to consider arts-based psychotherapeutic approaches within their localities to enhance trainee wellbeing.

Aims: The RCPsych’s position statement recommends a spirituality/religious belief (S/R) history be routinely considered in clinical assessments, and that an understanding of S/R and their relationship to psychiatric disorders are essential components of psychiatric training. In reality, psychiatric training at local and collegiate level is likely lacking in both quality and quantity of training in S/R considerations. There are likely a myriad of factors barring trainees from broaching this topic, which this survey-based QI project sought to explore.

Aims: 1. Explore Resident Doctors’ attitudes towards the significance of spirituality/religion (S/R) in mental health. 2. Explore Resident Doctors’ experiences and satisfaction with S/R training in Psychiatry. 3. Explore current frequency with which Resident Doctors’ consider S/R in clinical assessments. 4. Establish Resident Doctors’ perceived confidence in and barriers to exploring S/R in their clinical assessments.

Methods: An online, self-completion questionnaire was constructed for a target population of 108 Resident Doctors employed with SABP trust during the survey window from 16/07/2024 to 27/08/2024. It was advertised through work email and WhatsApp groups.

The survey included 8 quantitative items and 1 free-text item, exploring various aspects of trainees’ perceptions around S/R. The quantitative items were analysed using simple descriptive statistics and the free-text item was analysed using thematic analysis via coding.

Results: The survey received a total of 39 responses (1 FY Doctor, 8 GP trainees, 19 core trainees and 11 higher specialty trainees).

Quantitative analysis: 90% felt S/R consideration was extremely or somewhat important clinically; 54% felt either neutral or not confident in exploring S/R clinically; 49% reported they rarely or never consider S/R clinically; 15% reported satisfaction with current S/R training; 90% felt there was an unmet training need on S/R considerations in Psychiatry.

Common barriers to consideration included: Lack of training (64%), concerns around triggering psychopathology (46%) and lack of time (46%).

Qualitative analysis: The free-text item explored any other perceived barriers. Responses were coded into 7 clear themes: fear of litigation, cultural barrier, lack of awareness, time pressures, lack of prompting and lack of training.

Conclusion: This project highlights a significant disconnect between the RCPsych’s position on spirituality and trainees’ current experiences. Interestingly, the common barriers that emerged are all factors that can be addressed via formal teaching/training at the local and regional level, which should seek to dispel fears and normalise conversation around and consideration of this oft neglected yet essential aspect of holistic mental health care.

Aims: The Kent and Medway Psychiatry Undergraduate Scheme (KAMPUS) aims to provide medical students with experience in psychiatry at an early stage in their training, and psychiatry trainees the opportunity to develop mentoring and leadership skills.

Early exposure to psychiatry improves student perceptions of the specialty. KAMPUS is based on a similar programme in a London medical school which has reported positive outcomes. KAMPUS was adapted for the structure and geography of the local medical school and mental health trust.

Methods: A committee of psychiatrists, trainees and student representatives co-developed KAMPUS and wrote handbooks for students, trainees and clinical supervisors. Year 1–2 students and core psychiatry trainees were invited to participate. 18 students and 15 trainees registered for KAMPUS in the 2023–2024 academic year. Lead mentors supported small groups of students virtually, and clinic-based mentors were trainees based near the school, who provided clinical shadowing opportunities. Combined educational/social events were organised in collaboration with the Psychiatry Society, and a formal day of mentoring training was provided for trainees.

Results: Trainees provided regular mentoring and shadowing opportunities. Lead mentor group discussion topics included training pathways, case presentations and practice exam questions. Two educational/social events were attended by students and trainees. Trainees gave positive feedback regarding mentoring training.

Conclusion: KAMPUS is deliverable across the wide geographical area covered by the medical school and mental health trust in Kent. It has provided early experience in psychiatry for students and a development opportunity for trainees, with positive initial feedback.

Aims: People with learning disabilities (LD) experience significant health inequalities, including higher rates of obesity and associated comorbidities. This quality improvement (QI) project within East London NHS Foundation Trust (ELFT) aimed to enhance weight management interventions for individuals with LD by improving engagement with weight monitoring and lifestyle interventions.

Methods: A multidisciplinary team (MDT) implemented the Model for Improvement framework to address low rates of BMI (Body Mass Index) and weight recording among service users. Baseline data showed that less than 30% of service users had BMI recorded, and fewer than 3% had their weight documented at appointments. Interventions included training staff in routine weight monitoring, introducing accessible health education materials, and implementing structured weight management pathways. Plan-Do-Study-Act (PDSA) cycles were used to iteratively test and refine these changes. A total of 30 service users participated in the project over 12 months.

Results: The interventions led to significant improvements in weight monitoring and engagement with weight management strategies. By the end of the project, BMI recording increased to over 80%, and weight documentation rose to over 60%, demonstrating improved adherence to monitoring practices. In terms of clinical outcomes, 40% of service users achieved a ≥5% reduction in body weight, highlighting the effectiveness of tailored interventions. Furthermore, there is increased engagement with structured dietary and physical activity programmes, with over 75% of service users consistently participating. Additionally, 85% of carers reported increased confidence in supporting service users with weight management, further enhancing sustainability.

Conclusion: This QI project successfully demonstrated that structured, MDT-led interventions can improve weight management and health monitoring in individuals with LD. Increased documentation rates and service user engagement suggest that targeted, person-centred approaches can address health inequalities effectively. Future efforts will focus on scaling up these interventions, addressing remaining barriers to participation, and evaluating long-term sustainability.

Aims: People with severe mental illness (SMI) experience greater physical health inequalities, poorer health outcomes and significantly lower life expectancy (15–20 years) than the general population. Despite National and local guidelines on routine physical monitoring to mitigate these inequalities, the practice in this clinic is inconsistent, often fraught with delays and inefficiencies. This quality improvement project (QIP) aims to achieve full compliance with monitoring guidelines to 100% over 8 weeks, enhancing patient safety and outcomes.

Methods: A baseline audit on compliance with physical health monitoring guidelines was conducted by reviewing the local and national guidelines, clinic records, the monitoring log, and Resident Doctors’ outstanding reviews list. A semi-structured staff interview and reviewing GP correspondence identified key barriers to compliance. Three changes were introduced using the PDSA framework (plan, do, study, act); first staff training on Kardia ECG interpretation; then weekly logging and mop-up of outstanding ECG (electrocardiogram) and blood test results; and third, streamlining workflow by improving cover and swap during annual leaves to ensure continuity.

Results: There was a significant improvement in compliance with physical health monitoring during the project. Outstanding blood test results decreased from 140 to 24, and pending ECG results from 16 to 1 in four weeks. By eight weeks, full compliance (100%) was achieved. The weekly mop-up proved the most effective intervention in clearing the backlog while staff reported that training in Kardia enhanced their confidence in conducting the reviews.

Conclusion: The QIP illustrates that improving physical health intervention requires targeted interventions that can result in improved physical health monitoring in community mental health centres. Sustaining this improvement requires enhancing staff skills and confidence, greater team collaboration and coordination of planned staff absences through appropriate swapping and cover arrangements. Future work will focus on developing a centre-specific guide, improved induction and shadowing for Resident Doctors and involving them in job planning.

Aims: The MBBRACE (confidential enquiry into maternal deaths in the UK) report tells us women in the perinatal period are a high-risk group and that this is not always recognized. The unique nature and complexities of perinatal illness that can present in these vulnerable groups requires thinking about both mother and baby. MBBRACE report tells us that we must recognize these risks and there must be a lowered threshold for accessing and referring to Mother and Baby Units and how to do this out-of-hours. As a gateway to mental health services, FRS, IHTT, ALPS services must have perinatal awareness and risk training as mandatory.

This quality-improvement project aims to improve clinical skills, service delivery and patient safety

Methods: We aimed to first identify the knowledge level of the FRS, IHTT and ALPS teams, if they had attended any perinatal training before (in the last 12 months, longer than 12 months or never) and asking their areas of developmental needs. This was through interactive online questionnaire tools (pre-intervention questionnaires). Then teaching sessions on perinatal mental health risks delivered to these teams. A post-intervention questionnaire to objectively measure improvements in skill and confidence.

Results: Pre-questionnaire revealed for majority of responders, the last time they attended a perinatal mental health teaching was 12 months ago – 3 years (barring ALPS, who had a teaching few months ago). Confidence level pre-intervention (teaching) – 14% (not confident), 28% (slightly confident), 51% (somewhat confident) and 7% (confident). Post-intervention – 33%(confident), 50% (very confident), 17% (extremely confident).

The outcome was that confidence levels in identifying and managing perinatal mental health risks were significantly increased.

Conclusion: Having regular inter-team teaching sessions on perinatal mental health risks (including perinatal red flags) increases the confidence levels of first line/Acute Clinical Services in identifying and promptly managing these perinatal mental health risks. This would in turn reduce perinatal mental health safety incidences or near misses.

Aims: The management of acute behavioural disturbances necessitates an appreciation for the potential methods, risks, and monitoring requirements needed following assessment and initiation of management. A previous quality improvement project highlighted variability in clinicians initiating rapid tranquillisation agents in response to the same clinical vignette. This study aimed to improve Resident doctors’ confidence in deciding to use pharmacological or non-pharmacological methods in managing acute disturbance by 25%.

Methods: Initially, a fishbone diagram was created to help visualise the possible causes contributing towards lack of confidence in managing acute behavioural disturbance via word-of-mouth conversations. Subsequently, a quantitative survey was circulated amongst 25 resident doctors in a single district general hospital. The survey consisted of questions using a 5-point Likert Scale, with scores of ‘1’ representing ‘no’ and ‘5’ representing ‘extremely’. Following this, a teaching session was organised as part of the local foundation programme teaching series to help clarify common queries. A second questionnaire was then circulated, and feedback was gained to investigate changes in confidence, as well as inform future interventions.

Results: A total of 25 people had completed the baseline questionnaire. Confidence in utilising non-pharmacological approaches improved by 21%. Confidence in prescribing in acute disturbances improved by 32%. Overall confidence in managing a delirious patient improved by 26%.

Conclusion: Post-intervention, Resident doctors’ confidence in managing acute disturbances improved by 26%. Following feedback, a poster has been developed, and Resident doctors’ confidence will be re-audited.

Aims: The term ‘Black Wednesday’ has been used to describe the August national changeover day for nearly 50,000 junior doctors in the NHS, a day when a new cohort of inexperienced doctors start work. Junior trainees have reported a 7–14% reduced satisfaction compared with higher specialist trainees.

Doctors need to be supported in the workplace to provide safe and high-quality patient care. Induction as a minimum should introduce trainees to organisational policies, procedures and arrangements for clinical governance, orientation, and support. Although there is an existing induction system, having a written structured manual will assist the trainees to get through this process more easily. This project aimed to develop an Induction handbook containing all necessary information and links for trainees in Psychiatry at SBUHB to improve trainees’ overall satisfaction of the induction programme.

Methods: Data was collected through baseline pre-QI questionnaire which was analysed by a Pareto chart. Following that the induction handbook was circulated to the trainees and a post-QI questionnaire was completed and final data was analysed and compared against the pre-QI results

The project had one PDSA cycle. During which we approached different mental health services directorates within SBUHB as well as community and inpatient consultants for their input. Policies search was carried out on the health board intranet and SharePoint drive.

Results: The post-QI questionnaire receiving 15/18 respondents showed: 60% respondents rated very satisfied, 26.7% satisfied while 13.3% rated neutral; 60% respondents strongly agreed and 26.7% agreed that the handbook will help in safe delivery of patient care while 13.3% rated neutral.

Conclusion: The Post-QI survey has successfully confirmed that the updated and improved induction handbook has helped to improve the trainee’s satisfaction and overall experience by having a more comprehensive induction; as it has all the necessary information required to guide them through different systems and processes. Ultimately, finding it very helpful to get the required training to deliver the safe and effective patient care needed at their new placements.

Aims: An effective and safe clinical handover system is at the heart of safe healthcare delivery, ensuring continuity of care between clinical teams. Handovers are completed face-to-face or verbally and recorded within the NHFT’s SharePoint handover system, the standard agreed upon within the Trust. This project aimed to improve the usability, access, and safety of a preexisting SharePoint handover system.

Methods: A pre-implementation survey with 30 responses from the Resident doctors showed that 90% of respondents were aware of the handover system. Still, only 60% carried out face-to-face handovers regularly, while 40% relied on other methods. 35% viewed the SharePoint handover system positively, but 50% found it inefficient, suggesting improvements. Model for Improvement Quality Improvement Methodology was used to design and develop this change project; working alongside key stakeholders (Resident doctors, Medical Education unit, Quality Improvement team and Information Technology (IT) professionals), changes were made using a Plan-Do-Study-Act (PDSA) framework to improve awareness, access, usability and accuracy of the SharePoint handover system. Awareness improved through sessions in the Resident doctors’ induction, emails and medical education newsletter. Working in collaboration with the IT team, the SharePoint system was securely moved to a safe server with changes made to the template and dropdown options to improve safety and accuracy. Automatic email reminders were set up to improve handover job completion and recording. A PowerBI dashboard was created to assess system use and the quality of the handover recording to ensure ongoing quality assurance and improvements.

Results: Six-week baseline data showed that the compliance rate of handovers was 80%, with 20% of handovers indicating neither face-to-face nor verbal communication. Only 20% (42 out of 209) of the jobs were marked complete, against standards of 100%.

After implementing change ideas, four-week data showed 100% compliance, indicating that all handovers were completed and recorded. Only 23.03% of the jobs were marked complete on the handover system, indicating an area for further improvement.

Conclusion: A Trustwide Standard Operating Procedure for Resident Doctor Handover is being developed, and further IT changes are planned to continuously monitor and improve the handover system. In this case, collaborative leadership, perseverance when encountering roadblocks, and a systematic data-driven improvement approach with iterative changes helped establish a safer, more usable, and accessible handover system.

Aims: Individuals with severe mental illness have been recorded to have a life expectancy 10–20 years shorter than the general population, with part of this discrepancy being attributable to an increased risk of cardiovascular disease. The QRISK3 score is a validated tool for assessing an individual’s 10-year risk of a myocardial infarction or stroke.

Our aim was to assess the practicality and impact of making calculation of the QRISK3 score routine practice for new admissions onto our general adult acute male inpatient ward, in order to improve detection of increased cardiovascular risk and offer atorvastatin as primary prevention if indicated.

Methods: Over the course of six months (August 2024–February 2025), we calculated the QRISK3 score for 50 inpatients on a general adult male acute ward. Patients who had a score of 10% or more were counselled on their increased risk of stroke or myocardial infarction, and were offered atorvastatin as primary prevention.

Results: At the start of data collection, only one of the 17 patients on the ward was on a statin and none of the patients had a documented QRISK3 score.

Of the 50 patients included, 10 of them had a QRISK3 score of 10% or more. Of those 10, two were already on a statin. Of the remaining eight, four agreed to start atorvastatin whilst the remaining four declined.

QRISK3 scores were included on the discharge summaries of all patients who they had been calculated for, with a request to the patient’s GP to revisit the topic of primary prevention in the future for those patients who had declined a statin.

The average time to acquire the information required to calculate the score for a patient was 6 minutes and 24 seconds.

Conclusion: Calculating the QRISK3 score for psychiatric inpatients is a quick process that can feasibly be a part of a checklist for new psychiatric admissions and may increase the proportion of patients on appropriate treatment with a statin.

In the future, use of a semi-structured interview that includes both statin counselling and lifestyle advice can be implemented, and we will trial this for the second cycle to see if it has an impact on uptake of a statin. Future research could involve longitudinal follow-up of cardiovascular outcomes to assess the impact of primary prevention in this patient population.

Aims: To reinforce nurses’ initial physical health management knowledge on Darwen and Calder wards at Pendleview unit (LSCFT). This quality improvement project attempted to bridge the gap (of physical health knowledge) amongst nursing staff by providing a short teaching course of 3 topics to mental health nurses on Darwen and Calder ward at Pendleview mental health unit, Royal Blackburn Hospital.

Methods: The quality improvement project was conducted using the PDSA (plan, do, study, act) cycle methodology. The sample included 20 mental health nurses across Darwen and Calder wards in Pendleview unit. Three teaching sessions were delivered to nursing staff by doctors on both Darwen and Calder wards (6 in total) covering blood sugar monitoring, EWS and escalation and pain management. Quantitative and qualitative data was collected via pre- and post-teaching feedback forms, assessing nurses’ confidence and knowledge in managing physical health conditions. Confidence and knowledge were both scored on Likert scales numbered from 1–5.

Results: 85% of nurses (17 of 20) stated they had not received training on the teaching topics before starting work Data across the three teaching sessions revealed the following;

Blood sugar monitoring (n=8): Mean confidence (1 – not at all confident, 5 – confident) increased from 2.75 95% CI [1.85, 3.65] to 4.75 95% CI [4.45, 5.05] out of 5. Mean knowledge (1 – very poor, 5 – extremely good) increased from 2.75 95% CI [2.292, 3.208] to 4.75 95% CI [4.45, 5.05] out of 5.

EWS and escalation (n=6): Mean confidence increased from 3.5 95% CI [2.493, 4.507] to 4.3 95% CI [3.704, 4.896] out of 5. Mean knowledge increased from 3.5 95% CI [3.1, 3.9] to 4.5 95% CI [4.1, 4.9] out of 5.

Pain management (n=6): Mean confidence increased from 4.33 95% CI [3.953, 4.707] to 4.83 95% CI [4.532, 5.128] out of 5. Mean knowledge increased from 3.5 95% CI [3.1, 3.9] to 4.67 95% CI [4.293, 5.047] out of 5.

Conclusion: Physical health management teaching to mental health nursing staff has shown to increase nurses’ confidence and knowledge in physical health. Providing physical health management teaching trust wide can help to eliminate knowledge gaps among the nursing staff, irrespective of their prior knowledge. Flow charts, posters, and providing regular physical health teaching and training to nurses during induction and beyond can all aid to empower nursing staff. A further QI cycle could be explored, looking into new teaching content after determining any additional gaps in physical health knowledge of the nursing staff.

Aims: Psychotic illnesses are more common in people with intellectual disabilities with rates as high as three times what is found in the general population. Making a diagnosis of psychosis in intellectual disability is complicated by various reasons such as communication difficulties, comorbidities, cultural differences, diagnostic overshadowing, and atypical presentation. The presence of comorbid Autism can further complicate the diagnostic process.

The clinical approach in diagnosing psychosis in people with intellectual disabilities must be based on a phenomenological assessment that aims to clarify in the patient, objective reality (that may include the “normal alternate” reality of neurodivergence) and the “loss of reality contact” observed in psychosis, from one another.

Our aim in this article is to illustrate phenomenologically the atypical nature of psychotic symptoms in people with neurodevelopmental disorders compared with the general population.

Methods: We analysed features of the mental state examinations of men admitted to the regional medium secure unit for men with neurodevelopmental disorders over the period of June 2021 and September 2024, identifying atypical descriptions of psychotic phenomena as indicated in the ICD–11 criteria.

Results: Over the study period, 16 men with psychosis and neurodevelopmental conditions were managed. The abnormal phenomena recorded included both classical descriptions similar to the general population and some atypical descriptions also.

In addition to bizarre, persecutory and grandiose ideas, other abnormal beliefs were reported as “bad thoughts”, and “paranoia”. Somatic, visual, and auditory hallucinations were also documented. Second- and third-person auditory hallucinations were experienced as external, located inside the head, or in some cases unclear. Abnormal thinking processes were described as “muddled thoughts” or “my head is screwed”. Clinicians also highlighted muddled conversation, disjointed thoughts, speaking in unfamiliar (non-existent) language, repetitive speech, minimal effective conversation, perplexity and loosening of associations. Negative symptoms were quite common including grossly disorganised behaviours such as agitation, combativeness, physical and sexual violence.

Conclusion: Core features of neurodevelopmental disorders may be misinterpreted as symptoms of psychosis and when psychotic phenomena are described atypically, clinicians may miss the diagnosis often with negative consequences for the patients.

Aims: The audit was conducted to evaluate the effectiveness and procedural compliance of pre- and post-Electroconvulsive Therapy (ECT) assessments in accordance with the Scottish Electroconvulsive Therapy Accreditation Network (SEAN) Standard. Specifically, it assessed whether healthcare professionals are adhering to protocols by conducting the required Montreal Cognitive Assessment (MoCA), Montgomery–Åsberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) evaluations. The goal is to enhance patient care and ensure strict adherence to established SEAN standards.

Methods: The audit utilized a retrospective analysis of patient records who received ECT in the two years 2022 and 2023. The focus was on the completeness of the MoCA, MADRS, and CGI assessments pre-ECT, immediately post-ECT, and during follow-ups at three and six months. ECT notes and digital notes were collected, and ECT packs were scrutinized to collect the data of the patients.

Results: Out of 32 patients evaluated, 20 underwent a Montreal Cognitive Assessment (MoCA) prior to electroconvulsive therapy (ECT). It was not feasible to conduct the assessment for 6 patients, and it remains not done for another 6. Post-ECT, only 10 patients have completed MoCA, with none receiving follow-up assessments at 3 or 6 months. Regarding the MADRS (Montgomery–Åsberg Depression Rating Scale), 28 patients were assessed before ECT. Two were unable to undergo this assessment, and it was not performed for another 2 patients. Post-ECT, 11 patients have completed their MADRS, but no follow-ups have been conducted at 3 or 6 months. For the Clinical Global Impression (CGI) scale, assessments were completed pre-ECT for 26 patients, with 2 unable to participate. Post-ECT, the CGI was completed for 13 patients, but there has been no follow-up at 3 or 6 months.

Conclusion: The audit reveals that while the pre-ECT MOCA, MADRS, and CGI assessments met established standards, there were notable gaps in the completion of post-ECT evaluations. Particularly concerning was the poor completion rate of these assessments at both the 3-month and 6-month intervals. To address this, the audit recommends implementing robust processes to ensure the consistent and timely completion of these crucial assessments, which are essential for evaluating not only the therapeutic efficacy of ECT but also its cognitive side effects. Additionally, the audit suggests the establishment of specialized clinics staffed by senior-level specialist nurses to conduct these assessments. This approach would not only facilitate the collection of comprehensive data on the effectiveness of ECT but also enhance research into its cognitive aspects.

Aims: We aimed to assess adherence to the Mental Health Act Code of Practice within University Hospital Wishaw’s inpatient psychiatry setting, focusing on the documentation of consent to treatment for patients under Compulsory Treatment Orders (CTO). Compulsory Treatment Orders (CTO) authorize the treatment of mental disorders under specific legal and ethical guidelines, requiring meticulous documentation of consent. Initial reviews highlighted poor electronic documentation standards for patients under CTOs, prompting a proposed practice change to include scanning and filing consent forms electronically.

Methods: An initial review was conducted in December 2022 across three inpatient wards at Wishaw General Hospital, covering 57 patient records to establish the presence and adequacy of T2 and T3 documentation. A follow-up review in January 2025 re-examined 65 records to assess improvements in electronic record-keeping and documentation practices following the implementation of the proposed changes.

Results: The 2024 review showed that all patients under CTOs had their T2B or T3B forms properly documented in physical and electronic formats. However, only 70% had their consent status adequately recorded in the electronic clinical notes. This marked a significant improvement in electronic record-keeping from the initial 2022 review.

Conclusion: The integration of scanned consent forms into electronic records has enhanced the accessibility and quality of documentation, allowing for better coordination of care across multiple units. Despite these improvements, the consistent documentation of patients’ capacity and consent status during clinical reviews remains a challenge. Ongoing education for medical staff and further reviews are recommended to ensure continuous adherence to the Mental Health Act Code of Practice and improve documentation practices.

Aims: Preconception planning is an essential component of improving maternal and child health, particularly for individuals with mental health conditions. Within this population those with severe and enduring mental illnesses face significant barriers to accessing preconception care and are at higher risk of unplanned pregnancy, leading to suboptimal outcomes for both mothers and babies. This poster outlines the establishment of a preconception planning clinic for individuals within a mental health rehabilitation setting, developed through a collaborative initiative between the Rehabilitation and Recovery Service, Perinatal Mental Health Service, All Wales Psychiatric Genomics Service and Sexual Health services.

The clinic aims to provide personalised, multidisciplinary support to women with severe and enduring mental health conditions who are of childbearing age, ensuring that their mental health, medical, and social needs are addressed in a holistic and coordinated manner. Key components include individualised care planning, medication review, counselling on genetic risk to the baby, and psychosocial support, as well as the provision of education on reproductive health, contraception, and healthy relationships. Risks and impact to both mother and baby will be central to all discussions.

Methods: Through close collaboration between the Rehabilitation and Recovery Service, Perinatal Mental Health Service, All Wales Psychiatric Genomics Service and Sexual Health services, the clinic will foster an integrated approach to care, promoting early intervention and prevention of adverse outcomes. This initiative also supports service users in navigating the complexities of mental health during pregnancy, enhancing their confidence in planning for a safe and supported conception.

Results: The hope is that this clinic will promote proactive discussion of reproduction and sexual health within a population that have historically been overlooked in this aspect and reduce associated stigma and inequity.

Conclusion: The poster will showcase the clinic’s design, key challenges encountered, strategies for team integration, and initial outcomes from service users, with the aim of providing a model for other settings seeking to improve preconception care for individuals with severe and enduring mental illness.

Aims: Dopamine agonists are prescribed to treat several major physical and mental illnesses. Rotigotine, ropinerole, pramipexole (full agonists) are routinely used to treat symptoms of restless leg syndrome, whilst aripiprazole (partial agonist) is used as both an antipsychotic and mood stabiliser.

There is significant co-morbidity between gambling disorder and those psychiatric presentations resulting in the prescribing of aripiprazole. Full and partial dopamine agonists are known to increase the risk of de-novo gambling disorder, and exacerbation of existing gambling disorder. The aims of the audit were thus as follows:

To ensure that 100% of initial assessments include a full medication history, comprising current dopamine agonist (full or partial) prescribing history and indication for prescribing.

To ensure that 100% of patients identified at referral as prescribed dopamine agonists are screened by a psychiatrist within the service prior to allocation to the appropriate gambling disorder treatment pathway.

Methods: 402 initial assessments were carried out in the service in 2023. A random sample of 30 was selected using a random number generator and the initial assessments extracted from the Trust electronic record system (Care Director). Initial assessments were screened by a CT3 doctor to ascertain if a complete drug history was documented. The presence of dopamine agonist prescribing was noted including the drug name. Where dopamine agonists were prescribed, medical records were referenced to check if a screen was conducted by a psychiatrist.

Results: 53% (16/30) of the sample had a full drug history documented. 17% (5/30) of the sample were prescribed a dopamine agonist and in all cases, this was aripiprazole. Of the 5 patients in the sample prescribed aripiprazole, only 1 was documented as being referred for screening by a psychiatrist prior to commencement of psychological treatment for gambling disorder.

Conclusion: 53% of records sampled had a full drug history documented, suggesting that there are further patients who were prescribed dopamine agonists at the point of initial assessment that the service was unaware of. Of the 17% of the sample that were prescribed dopamine agonists, all cases were aripiprazole. This highlights the significant psychiatric co-morbidity and the importance of screening by a psychiatrist to exclude the dopamine agonist as a causative factor in the presentation.

Further staff training on the clinical importance of dopamine agonists in this context, ensuring 100% of initial assessments include a complete drug history, and discussion with a psychiatrist where appropriate are recommended to improve patient care within the service.

Aims: A recent MHRA alert highlighted a possible association between valproate use by men around conception and an increased risk of neurodevelopmental disorders in their children.

To ensure that 100% of male patients on valproate in the practice are informed about family planning risks associated with valproate use and have documented advice recorded in patient electronic record system (EMIS) within 2 months.

Methods: The cohort consisted of 22 male patients on valproate, identified using the EMIS system. These patients were targeted for the intervention to ensure compliance with the MHRA guidance on family planning risks.

The first intervention involved sending an Accurx text message to all 22 patients. outlining the potential risks associated with valproate use around conception, need for effective contraception for both partners, and encouraged patients to contact the practice if they were planning to start a family.

After 1.5 months, a follow-up intervention was conducted. All 22 patients were contacted by phone to verify whether they had received the text, assess their awareness of the MHRA guidance, and provide family planning advice if they were previously unaware. Phone calls were made on two separate occasions, spaced two weeks apart, to maximise the likelihood of reaching patients.

Results: Of the 22 patients, 18 were successfully contacted. Amongst these, 8 confirmed receiving the original text message, while 10 didn’t. During the phone calls, it was noted that 5 patients were already aware of the MHRA alert, 13 were unaware but were informed of the guidance during the call.

Patients were also given an opportunity to ask any further questions or express concerns. For those who required additional information, the option of a consultation with the practice pharmacist was offered. Despite repeated attempts, 4 patients could not be reached.

Conclusion: This QIP revealed significant gaps in patient awareness of valproate family planning risks and the challenges of engaging patients with automated messaging. Key reflections include: Challenges with Automated Texting; Improved Communication with Phone Calls; Limited Patient Engagement.

This QIP successfully raised awareness of an MHRA alert regarding valproate use among male patients in a GP practice. While the initial response to automated texts was poor, follow-up phone calls ensured that most patients were informed. The project underscored the importance of a multi-modal, sustained approach to patient education for sensitive topics like family planning.

Recommendations

Routine Medication Reviews.

Pharmacist-Led Discussions.

Enhanced Communication Strategies.

Practice-Wide Alerts.

Aims: The 2019–20 Community Pharmacy Quality Scheme audit concluded 34% of audited patients were unfamiliar with lithium toxicity symptoms, where 29% were unaware of how to prevent it, highlighting the gap in effective patient education. Our preliminary research revealed that 50% of medical professionals lacked confidence in providing lithium counselling with 41% being either unaware or unsure of how to counsel a patient if they had missed a dose. Therefore, we aim to tackle staff knowledge and improve abilities in lithium counselling to enhance patient safety and understanding, ultimately leading to fewer incidences of toxicity and harm.

Methods: An initial survey was conducted to assess healthcare professionals’ confidence in lithium counselling prior to the teaching sessions, identifying specific gaps in knowledge among staff. The Quality Improvement Project was implemented through two Plan-Do-Study-Act (PDSA) cycles:

PDSA Cycle 1 (19 attendees): A lecture-based teaching session using an online presentation was delivered, covering key information regarding lithium counselling. An improvement in knowledge was assessed using pre- and post-session quizzes, created using the information in the “Lithium Policy KMPT Handbook”.

PDSA Cycle 2 (6 attendees): An interactive OSCE-based teaching session was delivered to reinforce and apply the content from PDSA 1 via two clinical-based scenarios including discussion and feedback.

All teaching material was distributed to staff members, and the session was recorded for future training opportunities, accounting for standardised teaching methods.

Results: The baseline average score was 50%. Following the PDSA 1 session, this increased to 79%, demonstrating a statistically significant improvement (t = ×5.14, p<0.001). Following the PDSA 2 session, there was a slight decrease to 77%.

Key areas of knowledge that showed notable improvement after PDSA 1 included:

1 – Missed Dose Advice: χ² (1, N=37 =0.000154, p=0.05.

2 – Lithium use in pregnancy: χ² (1, N=37)=0.00056, p=0.05.

3 – Initiating lithium monitoring: χ² (1, N=37)=0.004238, p=0.05.

Direct comparison between post PDSA 1 and 2 is limited due to the lack of participant continuity.

Conclusion: After PDSA 1, a clear improvement in staff scores was observed. Despite showing a slight decrease in knowledge after PDSA 2, both teaching methods proved effective in improving lithium counselling knowledge from baseline.

We hypothesise that attending both sessions would lead to the greatest improvement; however, scheduling constraints prevented consistent attendance. Attempting to account for this, sessions were planned online. Upon reflection, recording and disseminating all teaching resources were vital in ensuring standardised training.