Staff working in community mental health teams (CMHTs) experience high levels of occupational stress and burnout, which can impact wellbeing, staff retention, and quality of patient care. Mindfulness-based approaches have demonstrated benefit for stress reduction, but their implementation within routine psychiatric services for NHS staff remains limited.

Aims were to improve wellbeing and reduce perceived stress among CMHT staff through a brief, structured mindfulness-based wellbeing programme delivered as a quality improvement initiative.

A six-week mindfulness and wellbeing course was delivered to CMHT staff within a routine clinical setting. The programme was designed and delivered in person by the lead author, a clinician with formal training in mindfulness and meditation, rather than via digital or pre-recorded materials, ensuring consistency of intervention delivery.

Sessions included psychoeducation, brief mindfulness practices, and practical stress-management strategies. Wellbeing was measured using the World Health Organization Five Well-Being Index (WHO-5) pre- and post-intervention. Perceived stress was assessed before and after each session using a 0–10 self-report scale. Optional qualitative feedback was collected via free-text comments to explore participants’ experiences of the intervention. All questionnaires were anonymised using unique participant codes, allowing responses to be linked longitudinally without identifiable information.

Post-intervention, WHO-5 scores demonstrated an improvement in self-reportedwellbeing after six weeks compared with baseline scores. Mean perceived stress scores also showed an overall reduction across individual weekly sessions. Qualitative feedback identified themes of increased calm, improved emotional regulation at work, and a greater sense of psychological safety within the team.

This quality improvement project suggests that a brief, mindfulness-based intervention is feasible, engaging, and may improve wellbeing among CMHT staff. Such interventions may represent a low-cost, scalable approach to supporting staff wellbeing within psychiatric services. Further cycles with larger samples and longer follow-up are warranted.

There is growing awareness of the complex bidirectional interactions between hormonal and mental health, with fluctuations across the menstrual cycle, perimenopause and menopause influencing the onset, severity and course of psychiatric illness. Despite this, reproductive health is often poorly assessed and documented in psychiatric inpatient settings. An initial audit across multiple inpatient wards demonstrated a substantial deficit in theidentification and documentation of reproductive health information. Our trust policy recommends that women are asked within 24 hours of admission about menstrual problems, menopause and breastfeeding; however, discussing these sensitive issues is often inappropriate or overlooked during acute psychiatric admissions. In this ongoing quality improvement project (QIP) we aim to increase awareness and detection of women’s health problems in female psychiatric inpatients using a trauma-informed approach led by trained nursing staff. We hypothesised that shifting responsibility from early medical clerking to appropriately timed nurse-led conversations would be more acceptable and feasible, while improving identification of clinically relevant issues.

The QIP intervention was initiated on a single 15-bed female acute psychiatric ward. Nurses with additional training in women’s health were designated as Women’s Health Champions (WHCs). Their role included offering one-to-one conversations with service users when clinically appropriate, running twice-monthly educational groups, providing written information on the ward and escalating concerns to the medical team. The first Plan–Do–Study–Act (PDSA) cycle focused on assessing feasibility and uptake of one-to-one conversations over a three-week period, alongside qualitative identification of implementation challenges.

During the first QIP cycle, 7 of 15 service users were deemed well enough to participate in a one-to-one women’s health conversation. Three service users were offered a conversation over three weeks; two engaged in brief discussions. Barriers identified included limited nursing time, fluctuating mental state of service users and uncertainty around documentation and information-sharing. Key process issues to be addressed in future cycles: the need for thorough documentation to avoid missing ‘red flags’; obtaining explicit consentto share information with the medical team, and documenting whether a service user is well enough to participate.

Early findings suggest that a nurse-led, trauma-informed model for addressing women’s health in psychiatric inpatients is feasible but constrained by acuity and resource limitations. While uptake was limited, the project identified clear, actionable system changes to support safer and more consistent practice. These results support revising existing policy to prioritise timing, consent and documentation rather than rigid early-admission targets.

There has been a recent increase in incidents in Pine Ward at Park Royal mental health unit. Feedback from staff/patients is that they don't feel safe and there has been staff sickness due to physical aggression towards them. We proposed to do this QI project in order to improve the staff and patient safety on the ward.

The aim of this QI project was to improve safety for patients and staff on Pine Ward by 20% by end of December 2025, to reduce incidents of violence and aggression and strengthen communication and team work.

Key changes: Weekly community meeting; Improve observation of patient positive strengths; Messages in nursing station on using soft words; and Section 17 leave flow chart given to patients.

Data collection (November–December 2025)

• We reviewed patient and staff safety on ward from mid November to end of December.

• We collected data on the following questions:

– Patient staff conflict survey.

– Patient safety feedback form.

– Staff safety feedback form.

Patient safety improved by 25% and staff safety improved by 30%.

Incidents of Verbal aggression in day shift decreased from 4 to 2 per shift.

Incidents of Aggression towards objects in day shift decreased from 2 to 1.

Decrease PRN psychotropic use in day shift from 4 to 2.

Communication between patients and staff is key for safety. Community meeting is a great opportunity to explore patient ideas and can be used for education about section 17 leave.

Thinking about patient qualities and strength affect how we perceive patient as person and influence positive therapeutic relations.

Verbal aggression against staff is a key concerns and needs to be worked on. Record of incidents of aggression on datix to be reviewed in future audit.

Delirium is frequently misdiagnosed as psychosis in general hospital settings, leading to inappropriate Psychiatry referrals and delays in medical management. This quality improvement initiative aimed to reduce the misdiagnosis of delirium as psychosis by improving early recognition across non-psychiatric departments. Secondary aims were to examine department-wise variation in misdiagnosis, assess uptake of the Confusion Assessment Method for the ICU (CAM-ICU), compare the effectiveness of different CAM-ICU teaching strategies, and evaluate changes in time to delirium management.

This quality improvement project was conducted in a tertiary care teaching hospital over six months and included referrals from Medicine, Surgery, Obstetrics & Gynaecology, Orthopaedics, and ICU. A baseline audit was undertaken over two months, including all inpatient Psychiatry referrals labelled “suspected psychosis” (n=130). Data collected included referring department, final diagnosis (delirium or psychosis), CAM-ICU use prior to referral, and time to initiation of delirium management. Pre-intervention CAM-ICU use was 0% across all departments.

A targeted educational intervention was delivered over four weeks. Departments received CAM-ICU training using different methods: didactic teaching sessions (Medicine, Surgery), bedside demonstrations (ICU, Orthopaedics), and visual quick-reference materials with brief ward-based teaching (Obstetrics & Gynaecology). A post-intervention re-evaluation was conducted over a further two months (n=126) using identical outcome measures. Department-wise changes in misdiagnosis rates, CAM-ICU uptake, and time to delirium management were analysed and compared across teaching modalities.

At baseline, 82 of 130 referrals (63%) for suspected psychosis were diagnosed as delirium. Misdiagnosis rates varied across departments: Medicine 70%, Surgery 68%, Orthopaedics 62%, Obstetrics & Gynaecology 58%, and ICU 45%. Mean time to initiation of delirium management was 22 hours.

Following the intervention, overall misdiagnosis was reduced to 39 of 126 referrals (31%). Department-wise misdiagnosis rates decreased to Medicine 38%, Surgery 42%, Orthopaedics 25%, Obstetrics & Gynaecology 34%, and ICU 18%. Overall CAM-ICU uptake increased to 56%, with highest use in departments receiving bedside-based training (ICU 72%, Orthopaedics 65%). Mean time to delirium management reduced from 22 hours to 11 hours.

This quality improvement initiative demonstrates that a substantial proportion of referrals labelled as psychosis represent delirium, with marked department-wise variation. Structured CAM-ICU training improved screening uptake, reduced misdiagnosis, and shortened delays to treatment. Bedside and interactive teaching methods were associated with greater improvements than didactic approaches alone. Embedding routine delirium screeninginto inpatient referral pathways is a feasible and effective strategy to enhance patient safety and consultation–liaison psychiatry practice.

Women accessing perinatal mental health services face marked physical health inequalities, exacerbated by pregnancy-related risks and the metabolic burden of psychotropic medication. Despite national guidance, compliance with physical health monitoring is poor, lifestyle interventions are inconsistently delivered, and engagement with external services is limited. This quality improvement project (QIP) aimed to address these gaps by establishing a dedicated in-house perinatal physical health clinic within our perinatal mental health service.

To improve compliance with NICE recommended physical health monitoring for women prescribed antipsychotics; improve staff knowledge and confidence in physical health assessment and monitoring and increase access to holistic lifestyle and women’s health support.

A baseline audit evaluated compliance with antipsychotic physical health monitoring (weight, blood pressure, glucose/Hbs-362c-glycated haemoglobin, lipid profile,ECG-electrocardiography, and movement disorder assessment) and the provision of lifestyle and women’s health advice. Staff knowledge and confidence were assessed using a pre-intervention survey. A twice-weekly physical health clinic was introduced, offering comprehensive physical health checks, structured lifestyle questionnaires and advice (diet, exercise, smoking and alcohol), and women’s health education (contraception and screening). Targeted teaching sessions were delivered to staff, and a repeat audit and post-intervention staff survey were completed following a four-week pilot.

Post-intervention audit data demonstrated substantial improvements in all monitoring domains, with completion rates for baseline physical health measures increasing from 40–60% to 100%. Monitoring for movement disorders and metabolic risk factors also significantly improved, whilst completion of lifestyle questionnaires increased from 0% to 100%, and documentation of dietary, contraceptive, and breast and cervical screening advice became universal. Staff confidence markedly improved, with only 14% initially reporting very good understanding of antipsychotic monitoring, compared to 100% reporting good to excellent understanding following teaching. All respondents reported increased confidence and would recommend the programme.

Introducing a dedicated in-house perinatal physical health clinic resulted in significantly improved compliance with national guidance, enhanced staff confidence, and strengthened the provision of holistic care. This model demonstrates a sustainable, transferable and scalable approach to reducing physical health inequalities within perinatal mental health services.

This quality improvement project aimed to enhance staff morale within the Psychiatry of Intellectual Disability service at Lakeview Hospital, part of the Western Health and Social Care Trust. This was achieved through the development and implementation of a ‘GREATIX’ scheme designed to recognise and celebrate exemplary staff practice between April 2025 and June 2025.

Baseline staff morale was assessed using a Likert-style questionnaire distributed to the multidisciplinary team working within Lakeview Hospital. Following this, a ‘GREATIX’ nomination process was introduced, allowing staff to nominate colleagues for recognition. Fortnightly meetings were held with charge nurses to review nominations and determine successful recipients. Eligibility required nominees to demonstrate behaviours aligned with the Trust’s core values: working together, excellence, openness, honesty, and compassion. Successful nominees were awarded a ‘GREATIX’ certificate and a £5 voucher. In July 2025, following implementation of the intervention, a repeat Likert-style survey was circulated to reassess staff morale.

The baseline survey received 28 responses, while the post-intervention survey received 22 responses. Mean self-reported tiredness following a shift decreased from 3.71 atbaseline to 2.41 post-intervention (Likert scale: 1=not tired, 5=extremely tired). Perceived impact of work showed an improvement, with mean scores increasing from 3.54 at baseline to 3.73 post-intervention (Likert scale: 1=little difference, 5=huge difference). Feelings of collegial support also increased, with mean scores rising from 3.68 to 3.87 (Likert scale: 1=not supported, 5=well supported).

Both surveys included free-text responses regarding ward morale. Baseline responses described morale as “OK”, “pretty good”, and “adequate”. Post-intervention responses suggested a modest improvement, with comments such as “a little better” and one respondent describing the GREATIX scheme as “a lovely addition”.

Implementation of the GREATIX scheme was associated with improvements in staff-reported energy levels after shifts, perceived collegial support, and feelings of having made a positive contribution at work. These findings suggest that structured recognition initiatives may have a positive impact on staff morale. Further PDSA cycles are planned within the Western Health and Social Care Trust to build on these outcomes.

Resident doctor handbooks are a key system-level resource supporting safe, effective working and trainee induction. Within Lancashire and South Cumbria NHS Foundation Trust (LSCFT), variation was identified between the East and Central psychiatry locality handbooks, reflecting differences in site coverage and resulting in gaps in essential information. This inconsistency risked inefficiency, uncertainty, and increased anxiety for new starters. The aim of this quality improvement project was to improve the consistency, accessibility, and reliability of resident doctor information by identifying and addressing variation in handbook content and standardising guidance across the East and Central localities.

A baseline comparison of the East and Central resident doctor handbooks was undertaken to identify missing content, inconsistencies, and areas lacking sufficient detail. Content was reviewed against key trainee domains, including emergency management, risk and legal processes, physical health responsibilities, and routine ward duties. Identified gaps informed a structured programme of handbook revision. Iterative updates were discussed with the Central locality educational lead and reviewed with the consultant body at consultant meetings and within monthly college tutor meetings. Finalised content was reviewed with the East locality educational lead to validate accuracy and ensure parity across both handbooks.

The intervention resulted in a standardised handbook structure and improved content parity across the East and Central localities. Previously missing sections were added to the Central handbook, new clinically relevant sections were introduced to both handbooks, and existing sections were expanded to improve clarity and usability. Updates focused on psychiatric and medical emergencies, management of acute disturbance, risk and legalprocesses, physical health assessment, and practical ward guidance. Positive feedback was received from educational leads in both localities and from the consultant body, alongside informal positive trainee feedback regarding clarity and usability. The revised handbooks were distributed to new starters in August 2025, with planned redistribution to subsequent cohorts in February 2026.

This quality improvement project successfully addressed unwarranted variation in resident doctor handbook content across two psychiatry localities through standardisation and educational lead(s) co-production. Improving the consistency and accessibility of trainee information supports safer working, enhances trainee experience, and reduces uncertainty for new starters. Future work will include extending the intervention to the North locality, incorporating additional clinically relevant content such as venous thromboembolism assessment guidance, and ensuring parity across specialty-specific handbooks, including learning disability and forensic services.

Sengkang General Hospital is one of the newest General Hospitals in Singapore. Among the other medical specialities, the department of psychiatry is one which is growing to provide the North East region of Singapore. Our close ally in managing psychiatric patients is the Institute of Mental Health which is a Tertiary Psychiatric care provider. The aim of the exercise was to equip the A&E with assessment and disposition of patients according to the needs and risks which the patient poses.

The Psychiatry department working with the A&E and the Emergency Room of the Institute of Mental Health embarked to develop a protocol/workflow which would assist the A&E in assessing and equip them in placing the patients in the right setting based on the risks and needs. After many cycles of modelling and remodelling of the workflow a final version which was acceptable to all concerned was agreed upon.

This was important to develop as Sengkang General Hospital's department of psychiatry is still in the process of having a fully equipped unit. The junior manpower needed to cover the on call system is still a work in progress.This hasleftthe A&E devoid of full residential cover especially out of hours and during weekends.

Other issues which had to be simultaneously looked at were the comfort of the A&E staff who are at various levels of training, the ease of the Tertiary Care hospital (Institute of Mental Health) in accepting patients and also the comfort of patients to move between hospitals.

The assessments were broadly based on the CSSRS (Columbia-Suicide Severity Rating Scale). This scale is widely used in most of the hospitals in Singapore in suicide risk assessments. The workflow was colour coded for simplicity of use and understanding. Subtracts were developed for use in the child and Adolescent population. Another important aspect to to be taken into consideration was the “medical fitness” of the patient which would also be a deciding factor in the disposition.

A year now into the implementation: the results of the intervention have been promising.The erstwhile problem of difficulties in disposition of patients has reduced significantly, so that it has stopped being a “rolling agenda” item on the inter hospital meetings. There is a nice bonhomie between the 3 stakeholders in management of patients who present with suicide risk to the A&E. Patient movement between hospitals and departments is clearer. Patients get a clearer explanation on why they are moved to a particular destination.

In a General Hospital setting, one of the most important aspect of service provision is the inter-departmental cooperation and exchange of expertise in management of patients. In this instance what seemed to be a simple intervention went a long way in managing a very important section of patients who present to the hospital at a time when theyare most needy and vulnerable. A clear assessment and management of these patients at a place where they are best managed was achieved with appropriate but simplistic intervention. A further scope to come up with similar interventions in psychiatric patients who are presenting with suicide risk is being discussed at the moment.

Drug-related deaths in England and Wales continue to rise, with opioids remaining the most frequently implicated substances. Individuals receiving care from mental health services commonly experience co-occurring substance use disorders, with overdose risk heightened by increasing contamination of street drugs with potent synthetic opioids.

15% of service users under the care of Home Treatment Teams (HTTs) experience substance misuse, making this an important setting for harm-reduction interventions.

Take-home naloxone (THN), an opioid receptor antagonist used in emergency treatment of opioid overdose, is an evidence-based harm-reduction intervention. Patient Group Directions (PGDs) are legal frameworks that allow authorised non-medical healthcare professionals tosupply or administer specified medicines. Although PGDs have facilitated widespread THN provision in addiction services, implementation within HTT settings remains limited.

This quality improvement project aimed to increase access to THN for eligible service users within an adult HTT.

Electronic records for 30 consecutive service users receiving care from the HTT were reviewed to assess substance use patterns, eligibility for THN and whether THN was offered.

A PGD for THN supply was introduced in collaboration with pharmacy services. Readily accessible THN stock was established within the team’s medication cupboard to facilitate prompt provision. Multidisciplinary teaching sessions were delivered to staff, focusing on overdose risk, THN eligibility criteria and service user education.

Following implementation, electronic records for a further 30 consecutive service users were reviewed using the same criteria, and outcomes compared with baseline data.

At baseline, 13.3% of service users (n=4) met eligibility for THN, of whom 50% (n=2) were offered THN. In both cases, THN was supplied following medical review.

Following the intervention, 16.7% of service users (n=5) were eligible for THN, with 80% (n=4) being offered THN by a combination of medical and nursing professionals.

A clinically significant proportion of HTT service users were identified as being at risk of opioid overdose. The introduction of focused harm-reduction interventions, including a PGD, improved access to THN, and targeted staff education, was associated with increased provision of THN within the HTT setting. While THN is commonly used within addiction services, we are the first team providing care for general adults in our trust to implement this as part of routine care.

Further work is required to optimise service user uptake, address barriers including stigma and limited overdose awareness, and implement interventions across wider community mental health services. For interested teams, we recommend liaising with pharmacy services to explore local PGDs.

To quantify anticholinergic burden among older adults newly referred to the Central Aberdeenshire Community Mental Health Team (CMHT) between February 2024 and February 2025, and to evaluate whether clinicians documented interventions to review or mitigate anticholinergic medications when the burden was clinically significant.

This quality improvement project reviewed all general practitioner referrals to the Central Aberdeenshire CMHT during the study period. Of 241 referrals, 30 deceased patients were excluded, leaving 211 patient records for analysis. Prescribed medications were reviewed and anticholinergic burden was calculated using both the German Anticholinergic Burden Score and the Anticholinergic Cognitive Burden (ACB) Scale; where discrepanciesoccurred, the higher score was used to prioritise patient safety. An ACB score ≥3 was considered clinically significant. For these patients, clinical records were examined to identify documented interventions, categorised as switching to less anticholinergic alternatives, suggesting a medical review, deprescribing, or dose adjustment/reduction.

Among the 211 patients (age range 61–101 years), 73% were prescribed at least one anticholinergic medication and 32.7% (N=69) had a clinically significant anticholinergic burden (ACB ≥3), with scores ranging from 0 to 11. Anticholinergic burden was strongly associated with polypharmacy: 63.9% of patients prescribed eight or more medications had an ACB ≥3, compared with 11.8% of those on fewer than five medications. High-burden medications most frequently prescribed included quetiapine, amitriptyline, and solifenacin.

Despite the prevalence of significant anticholinergic burden, 75.4% of affected patients had no documented intervention. Interventions included deprescribing (8.7%), dose adjustment or reduction (8.7%), suggesting a medical review (4.4%), and switching to a less anticholinergic alternative (2.9%).

Clinically significant anticholinergic burden remains common among older adults referred to CMHT services and is closely linked to polypharmacy. However, documented clinical interventions have declined compared with previous local audits, indicating a widening gap between risk identification and active management. Embedding routine anticholinergic burden calculation into assessments, prompting systematic medication review for patients with ACB ≥3, and supporting clinicians with targeted education may improve patient safety. A re-audit is planned to evaluate the impact of these interventions.

The aim was to create a visual representation of a patient's journey through an acute male unit within a medium secure setting at a specialist forensic mental health service. This poster would also be accompanied by leaflets about specific topics that patients can request if they would like further information. I noticed that many patients admitted onto the ward were asking the same questions to me and other staff during their ward rounds which identified an unmet need. Patients did not have a resource to find out answers or know who best to approach, so I wanted to resolve this. I aimed to improve patient experience on the ward which would improve outcomes and reduce frustration, the risk of getting incorrect information, aggression and complaints.

I organised focus groups with both patients and staff from each discipline of the Multidisciplinary Team to gather qualitative data about this topic, including thoughts on the idea of the poster itself, and what kind of information they would want included. I frequently joined patient Community Meetings and provided versions of the poster before it was printed so that they could continue to provide their opinions and contributions so it would be co-produced and to ensure the information was relevant.

Once the poster was on display on the ward, I organised further focus groups to collect qualitative data again from both patients and staff. The results were overwhelmingly positive. Some feedback from patients included comments such as “It is easy to understand”, “It is helpful to have a visual poster that I can refer to without having to ask staff”. Feedback from staff included comments such as “Great visuals and really clear to follow”.

This poster has so far had a positive outcome for both patients and staff. For patients it has helped to reduce confusion when admitted onto the ward and frustration regarding the ward processes and their next steps. They have felt more empowered in the knowledge that they can seek answers to commonly asked questions of their own accord. For staff it has allowed ward rounds to be more directed and they feel their role is more understood. The project has scope and is potentially in the process of being replicated in other wards within the service, and could also be replicated in other units nationally so that patients would be able to have a similar experience.

Benzodiazepines are commonly prescribed for short-term treatment of anxiety andagitation on acute adult psychiatric wards, though long-term use can lead to dependence and withdrawal. ‘It is widely recognised that discharge prescriptions from mental health hospitals have high levels of prescribing and communication errors, and Sussex Partnership NHS Foundation Trust (SPFT) have written guidelines to ensure benzodiazepines are weaned effectively and communicated clearly to the GP.

• • To improve compliance with Sussex Partnership Trust Guidelines.

• • To provide safe weaning regimens for benzodiazepines.

• • To provide clear handovers to GPs, and avoid unnecessary repeat prescriptions of benzodiazepines in the community.

The standards audited against were the SPFT guidelines that 100% of patients should have:

1. The date of initiation and indication of benzodiazepine recorded.

No patient should be discharged from hospital on a benzodiazepine unless they were established on long-term treatment prior to admission or continued use is supported by a consultant psychiatrist.

If the benzodiazepine is expected to continue, the indication, duration, dose and details of any reducing regimen should be communicated to the GP.

A preliminary audit was completed for patients discharged from the Eastbourne Department of Psychiatry from September to October 2024. Data were taken from carenotes, discharge summary, scanned medication charts and ward review notes.

Following the preliminary audit, teaching on appropriate benzodiazepine prescribing was delivered to residents at the start of their rotation. Following this, we reaudited with same standards from October 2025 to January 2026.

In the initial audit, 12.5% were prescribed regular benzodiazepines and 15% PRN on discharge. Of these 80% patients were documented to be on long-term treatment and 40% had documented indication and reducing regimen.

In the repeat audit, 9% were prescribed regular benzodiazepines on discharge and 0% PRN on discharge. Of this 100% of patients had this supported by a consultant and had indication, duration of treatment and reducing regimen documented.

The reaudit showed a reduced frequency of prescribing of benzodiazepines on discharge, and all had a reducing regimen documented, demonstrating significant improvement. Due to difficulty in arranging teaching for the whole cohort of residents, the teaching and repeat audit focused only on the male ward at the Department of Psychiatry. The wards may have different prescribing patterns which limits the generalisability of the results. Future plans involve arranging a teaching session at the induction of new residents, and re-audit to see if the improved compliance is maintained.

Autistic adults are at increased risk of mental health crises, yet their representation within crisis services and staff preparedness remain under-researched. This study aimed to determine the prevalence of diagnosed and suspected autism spectrum disorder (ASD) among referrals to a Crisis Resolution and Home Treatment Team (CRHTT), describe associated crisis presentations, and assess staff training experiences and knowledge.

A retrospective observational service evaluation was conducted within a crisis team in Sheffield, UK. A random sample of 400 adult referrals was selected from 2397 referrals. Demographic data, ASD diagnostic status, and presenting complaints were extracted from electronic records. Staff knowledge and training were assessed using an adapted National Autism Implementation Team questionnaire. Quantitative data were analysed descriptively and compared with population prevalence estimates; qualitative free-text responses were analysed thematically.

Among the 400 referrals, 10.5% had a formal ASD diagnosis and 11.3% were suspected cases, yielding a combined prevalence of 21.8%, over nine times higher than general population estimates. Common crisis presentations included suicidal thoughts or behaviours (41%), acute psychotic episodes (24%), and worsening psychiatric comorbidities (18%). One-third of suspected ASD cases had not been referred for diagnostic assessment. Forty percent of staff reported no ASD-specific training, and only 10% rated their knowledge as full. Qualitative findings highlighted insufficient, overly generic training and low confidence in managing autistic adults in crisis.

Autistic adults are substantially overrepresented in mental health crisis services, yet diagnostic delays and limited staff training persist. Improving autism-specific training, strengthening diagnostic referral pathways, and adopting more proactive models of care are essential to enhance crisis support and reduce repeated emergency presentations among autistic adults.

People with intellectual disability are frequently prescribed psychotropic medications for challenging behaviour, despite guidance advocating for holistic and non-pharmacological Multidisciplinary Team (MDT) support to understand and address the underlying causes of challenging behaviours. Approximately 17% of adults with intellectual disabilities receive antipsychotics for symptomatic management in the absence of mental illness, a rate 16 times higher than the general population. STOMP (Stopping The Over Medication of People with Intellectual Disabilities and/or Autism) is a national project to reduce inappropriate prescribing. Decreasing psychotropic medications without appropriate alternatives risks destabilisation, and so we wanted to ensure our STOMP pathway provided holistic support tomeet the needs and wishes of service users, their carers and care providers. We used a co-production methodology to achieve this.

Service users eligible for STOMP review were identified. Semi-structured interviews were conducted with family carers (n=8) and care-provider representatives (n=4). Interview guides were based on STOMP principles and refined by the MDT. Interviews were analysed using content and thematic coding. Findings were reported back to participants and cross-verified using a large language model for research triangulation, and then translated into pathway components during MDT design meetings.

Interviews highlighted shared priorities for reducing challenging behaviour and improving quality of life. Both groups stressed the need for coordinated input from the Integrated Learning Disability Service and primary care, predictable routines, meaningful tasks with supported independence, clear plans for care changes, an allocated worker, and communication support. Participants felt medication provided stability but did not address underlying triggers. They requested more thorough medication reviews with clearer explanations of rationale and side effects. Significant concern was expressed about destabilisation if medication was reduced without reliable alternatives and clear crisis plans. Service improvement priorities included respite provision, timely social care responses, better access to physical healthcare, and tailored staff training.

Co-production identified significant anxieties about medication reduction, but emphasised that it is feasible when reliable alternatives are in place, such as coordinated MDT input, communication support, and clear crisis plans. The analysis showed that good social care support forms a large and essential element of this, including community access,day opportunities and respite provision. Integrated Learning Disability Services (with health and social care working together in the same organisation) can make such a service user focused approach much easier to deliver, which should result in significant improvements in quality of life, and reduced side-effect burden.

Cardiac arrest on ward–post incident review and reflections identified recognition and escalation of the physically deteriorating patient as a key improvement target to improve staff morale and confidence moving forward in context of incident.

SMART goals:

Specific – Improve nursing staff and allied health professionals’ ability in recognising, managing, and escalating physically unwell patients.

Measurable – with results measured via standardized questionnaire scores.

Achievable – through a specialized teaching programme developed by ward doctors.

Relevant – in context of recent significant incident on the ward.

Time specific – in a 6-month timeframe.

Teaching sessions targeting initial assessment and escalation of the physically deteriorating patient were delivered on a two-weekly basis over a time of 4 months, each session was 30 minutes in duration. Subdivision of broad topics was introduced to address nuanced scenarios. Domains were chosen based on common clinical queries and situations that were identified on the ward from a survey of both doctors, nursing staff and allied health care professionals. Session content was pitched at a role-specific level. Session topics included–Airways, NEWS2, SBAR, hypoglycaemia, fluid monitoring, pain, seizures, stroke, UTI.

Data was collected via pre-/post-course questionnaires. The questionnaire consisted of 9 questions in SBA format, following a short clinical scenario stem – 1 question for each clinical domain. Confidence scores (Likert scale) were assessed for each of the 9 domains.

Confidence improved across all wards following the teaching sessions. Small but notable decline in clinical performance post-training in some areas. Persistent performance gap between RMNs and HCAs.

Teaching sessions were delivered in modality of one live session per topic – making it difficult to ensure that all surveyed staff had attended all sessions. There were limited opportunities for staff to review the teaching material after a session, or especially if a session was missed due to rota or clinical commitments.

Therefore an opportunity was identified to develop e-learning modules focusing on weakest domains (Airways, NEWS, SBAR, UTI, hypoglycaemia).

Mode of delivery would be changed to e-learning modules on a digital learningplatform. This allows for easy access for staff in their various schedules, the ability to revisit the material, as well as increased ease in collecting data, adjusting the teaching materials and maintaining consistency in quality of teaching across time.

Effective handovers are crucial for patient safety and continuity of care in psychiatry. The Excel-based handover format used across three South Glasgow-linked hospitals (Dykebar, Leverndale and Inverclyde) frequently contained unresolved or outdated tasks, and did not clearly indicate urgency or ownership. Previous audits highlighted inefficiencies in this system, revealing an opportunity for innovation. We aimed to introduce a new Microsoft Teams handover, to improve clarity and efficiency and support safe on-call working across all three sites.

Between December 2024 and March 2025, feedback was collected from resident doctors across three South Glasgow psychiatric hospitals via anonymised Likert scale and free-text surveys, to explore their experiences with the Excel handover and openness towards trialling a new Teams format. The handover was created using Planner software, utilising tabsand columns to organise wards. Advice was sought from Information Governance regarding use of patient data, and subsequently implemented: the system was made private with closely managed access, and a retention period was applied via automated workflows to transfer completed tasks onto a private Excel sheet every three months, to be stored locally for audit trail. Clinical directors and residents received demonstrations and tutorials, and approved of the launch. The Teams system was implemented across all three sites in April 2025. Post-intervention feedback was collected in May 2025 to gauge opinions on the new handover; following this, the system remained in use and was later replicated at other Glasgow hospitals with our guidance on setup and workflow.

All eight participants in the preliminary survey indicated they found the Excel handover had become inefficient and unclear, and were interested in trialling the new system. Following launch of the Teams handover, all 15 respondents agreed it brought improved usability, clarity, and clinical efficiency. Comments acknowledged the clean interface and the ability to check tasks off, assign due-dates, and schedule repeating tasks ahead of time. Later in 2025, resident doctors in North Glasgow reached out and successfully adapted this project at Gartnavel and Stobhill hospitals, demonstrating positive change across multiple areas of the health board.

The findings provide evidence of improved satisfaction with the on-call handover since our introduction of the Teams interface. It is suggested that resident doctors value clarity and efficiency for smooth, safe team-working. The small sample size and single-region implementation limit generalisability, but feedback shows the project has brought a positive change to clinical work and has now been implemented at multiple hospitals.

We aimed to evaluate the number and circumstances of falls in our 6-bed older adult ward and our 12-bed dementia specialist unit.

Records were reviewed if the patient had falls ≥2 during admission. Data was collected in October and December from our records and our incident reporting system. Education sessions were held between audit cycles and medications reviewed using STOP-STARTT criteria after ward rounds.

From initial audit (n=12) to repeat audit (n=10) falls were approximately similar, 25 and 22 respectively. PRN use associated with the falls were 32% in October and 45% in December, and number of patients with ACB score of 3+ was 7 and 6 respectively. Physical observations taken post-fall increased from 44% to 82%, but incident reporting decreased from 84% to 36%. In the initial audit one patient accounted for 36% of the falls with 3 having not fallen, and in repeat audit 2 patients accounted for 77% of falls, with 6 having not fallen.

All patients had received MDT input with falls bundles and care plans andregular physiotherapy review. Pre-existing extensive falls protocols are well-adhered by staff and the majority of ACB burden is due to necessary medications for stress and distress which limits ability to reduce falls risk. We identified there is ongoing scope for medication reconciliation, and there is a follow-up QIP starting to evaluate de-prescribing medication in this high-risk cohort with geriatrician advice.

The Haringey Community Rehabilitation team has a high burden of patients on depot antipsychotic medication (n=45). This quality improvement project aims to increase the proportion of depots being administered on time to ensure treatment is delivered as intended, reduce time spent in MDT meetings identifying depot due dates and improve staff-reported ease of tracking depots.

A baseline audit of depot administration was conducted over four weeks in November 2025. Weekly counts of missed depot administrations found that, on average, 16% of depot injections were either missed or not administered on the scheduled date. In response, a spreadsheet tracking tool, “the depot tracker”, was developed which recorded patient name, depot name and dose, date last administered, date next administration due and named carecoordinator. A traffic-light system was used to indicate depot status: green (due that day), orange (due within seven days), and red (overdue). This allowed prompt identification of which depots are due and which are overdue and facilitated weekly forward planning, including cover during care coordinator leave.

The depot tracker was implemented in December 2025 and incorporated into the weekly MDT meeting agenda with resident doctors updating the tracker weekly. A follow-up audit was conducted post-implementation to reassess rates of timely depot administration. Pre-and post-implementation staff surveys were conducted to assess staff views on ease of tracking when depots are due, including when care coordinators are on leave, and whether tracking depots took up time in MDT meetings. The survey gathered quantitative (5-point Likert scale) and qualitative (free text question) data.

Prior to the depot tracker being introduced a weekly average of 16% of depots were not being administered on time. This reduced to an average of 10% of depots being missed, based on eight weeks of post-implementation data. Regarding improving ease of tracking when depots are due there was a 71.4% improvement noted by MDT members (n=10) and a 66.6% improvement in tracking depots when care coordinators are on leave. In addition, there was a 46.8% improvement in time taken during MDT meetings to look up depot information (n=10).

Following implementation of the depot tracker there has been a reduction in frequency of depots being missed, as well as improvements in staff-perceived ease of depot tracking including improved continuity of depot delivery during care coordinator leave, and increased time efficiency of MDT meetings.

Working with carers alongside service users improves clinical outcomes, service user experience, and reduces risks of suicide and self-harm. Caring significantly impacts carers' physical and mental health, yet carers often feel unsupported. This project was conducted in a specialist community rehabilitation team in Sheffield supporting 50 service users with significant support needs. The aims of the project were to improve carer engagement and support, and to identify gaps in carer recording.

A survey based on the Royal College of Psychiatrists standards for community rehabilitation services was distributed electronically to a total of 58 friends, families and carers of current service users. Alongside this an audit of Electronic Patient Records (EPR) was conducted to identify formally recorded carers. This took place in March 2025. The results of this survey and audit were then used to implement changes within the service.

The audit revealed that only 3 out of 50 service users (6%) had formally identified carers recorded, totalling 6 carers. Many more friends and family were recorded without carer status identified.

The response rate of the survey was 24% (14/58). All 14 respondents identified as carers when presented with a definition of a carer as described by Carers UK, suggesting significant under-recording of carers. Carer feedback was generally positive: 93% had emergency contact information, 78% felt well supported by the team, 71% had been offered individual time with team members, and 64% felt involved in care decisions. Areas for development included information around available carers groups, with only 50% being aware these existed, and only 14% of carers being provided with written information about the team.

A bimonthly family, friends, and carers support group was established jointly with the inpatient rehabilitation service. Attendees have given positive feedback regarding this. The written carers pack was reviewed. The team’s view of who constituted a carer was broadened–due to limitations with the EPR carer status wasn’t easily formally recorded, but any family and friends involved in care were considered carers.

This project highlighted gaps in the identification and recording of carers under the community team, despite good levels of carer engagement. The major implemented change was that of a carers group, which was well-received.

The 10% access rate target for perinatal mental health services in the UK was introduced as part of NHS England’s broader strategy to expand and improve access to specialist perinatal mental health care. Within our organisation, the 10% target was actively discussed and various strategies had been implemented to achieve the target. It became evident that women with mental health difficulties on the milder spectrum, where primary care interventions were appropriate, a full new patient assessment (NPA) was not indicated. The hope was that a light assessment (LA) pathway would develop a more responsive pathway for referrals which would be more suitable for other services, it would allow signposting for mild and less complex referrals to the appropriate services in a more timely manner and it would allow clinicians to prioritise time on more complex presentations.

The aim was to implement a LA pathway to support the service to reach the 10% access target.

Consultation with other perinatal teams around the country followed. Concerns on balancing seeing milder cases while preventing team burnout were also shared by them and options for a less in-depth initial assessment in these cases were explored.

The NLFT service agreed to a trial of a LA pathway for mild cases. A LA template and guidance on its use, were created and subsequently discussed in service-wide meetings and adjusted according to feedback. It was formally implemented on 27 January 2025 with plan for feedback meeting in 4 weeks and total trial of 6 months.

The NLFT perinatal service, consists of 3 teams. Two different systems were implemented based on the preference of the individual teams, differing on the days/hours duty service isrun and the days LA appointments are scheduled. In both systems LAs could be converted to NPAs if it becomes evident during the appointment that the patient requires a more in-depth assessment.

For the period of the LA pilot from 27 January 2025 to 30 May 2025, the specialist perinatal service received 684 referrals. All referrals were accepted, unless they were out of borough or not within the perinatal period.

Of the 684 referrals received, 71 (10%) were allocated for a light assessment. 81% of the women allocated for light assessments attended their assessments. 15% (11) allocated for a light assessment, did not attend their assessment and were discharged and 2.5% (2) declined the assessment. Of the 2 that declined the assessment, one was discharged and 1 requested for an NPA, assessed and subsequently discharged. Of the 58 women who attended the LA, 74% (43) were assessed and discharged and 21% (15) were assessed and taken on. The data across the 3 teams were very similar, other than the number of days from triage to assessment. In the south team, the assessments were scheduled within 5 weeks from referral whereas in the west and east teams all assessments were scheduled within 3 weeks from referral.

Qualitative staff feedback was gathered via questionnaires. The main points brought up are as follows:

• • Better triaging guidance needed for newer staff.

• • More information needed on risks and more info in referrals.

• • If uncertain based on info on the referral form, request for more info, if still not sufficient refer for a full NPA.

• • LA’s are helpful for efficient signposting and time-saving. They work well when patients are appropriately triaged. Women are seen, sign posted and discharged in a week.

• • Seeing moderate to severe people quicker. People moved through the service quicker, reducing caseloads.

• • LAx template very clear.

LA are held by Duty, rather than individual clinicians. Better to be a little bit stressed on Duty for longer term gain.

Patient questionnaires were created and were sent out after the LA was conducted.

Setting up the LA pathway has allowed the team to broaden the number of women they see, while preventing team burnout and achieving better resource allocation to SMIs (serious mental illness).

Some of the challenges faced during this project include:

• • Unexpected loss of trust video-call system.

• • Some staff anxiety whether any important information was missed (this is managed by presenting cases at the weekly MDT).

• • Some of the LAs being re-referred (this is monitored and re-referrals are allocated an NPA).

• • Limited information on referrals.

• • Poor response rate on patient feedback questionnaires.

Other reflections and considerations:

• • Based on feedback on how the name “Light Assessment” can be perceived amongst other teams and patients, the service changed the name “Light Assessment” so as not to diminish the work being done.

• • Request readjusting the 10% target for the reduced birth rate in the area.

• • From 21/1/25 self-referral links were also implemented which improved the access rate to the service further.

Next steps:

The feedback overwhelmingly directed towards continuing with the light assessment pathway.

Improve the triage process to the appropriate assessment pathway and consideration of conducting education to referrers of the information needed. Following discussions, it was agreed that when receiving an inappropriate referral we would seek further information from the referrer before accepting it. The team continues to conduct teaching sessions to other teams and this will be highlighted during teaching.

Some NLFT perinatal teams experienced difficulties with primary care teams accepting the referrals from our team as their impression had been that once a referral was accepted by our teams for assessment, the referral would be appropriate for secondary care. The change in the way the team operates in accepting and managing referrals will be highlighted to them. Referrers will also be made aware to inform patients of how the team operates in order to manage expectations.

Details of the pilot were shared with other perinatal teams in LSPCA meetings. Other perinatal services have also reached out to our team and details of the light assessment pathway has been shared with them so that it can be implemented elsewhere.