Co-occurring mental health and substance use disorders are associated with poorer outcomes, prolonged inpatient admissions, frequent readmissions, and fragmented care. Despite national policy advocating integrated treatment, services remain largely siloed, resulting in the persistent “wrong door” phenomenon highlighted in Carol Black’s Independent Review of Drugs. Local needs assessment within Essex Partnership University NHS Foundation Trust (EPUT) identified low staff confidence, lack of clear pathways, minimal psychological input, and poor continuity between inpatient and community services for this population. This Quality Improvement (QI) project aimed to design and implement a pilot inpatient Dual Diagnosis Support Service to improve access to integrated care, enhance staff capability, reduce stigma, and strengthen transition from inpatient admission to community-based support.

A pilot Dual Diagnosis Liaison Service was implemented across three adult inpatient wards in Colchester using existing workforce capacity and no additional funding. The intervention was co-designed with ward managers, multidisciplinary staff, and patients, incorporating lived-experience priorities. Key components included: routine dual diagnosis assessment within seven days of admission; specialist consultation on integrated treatment planning; motivational enhancement and psychoeducation; liaison with psychology andsocial services; and early, structured signposting to community substance misuse and social support services prior to discharge. A phased QI methodology was adopted, supported by governance oversight and iterative service refinement. Process and outcome measures included staff-reported confidence, access to specialist advice, clarity of discharge pathways, and patient experience feedback. Workforce development was embedded through targeted training and ongoing specialist consultation.

Early qualitative feedback indicates improved staff confidence in managing dual diagnosis presentations and increased clarity regarding referral, discharge planning, and community follow-up. Ward teams reported improved access to specialist expertise and enhanced collaboration with external services. Patients valued timely, non-stigmatising support addressing both mental health and substance use needs, particularly early engagement and psychological input. The pilot demonstrated feasibility, acceptability, and scalability within existing resources, directly addressing previously identified service gaps and aligning with national priorities for integrated care and reduction of avoidable hospitalisation.

This QI project demonstrates that an inpatient Dual Diagnosis Support Service can be implemented effectively without additional funding, delivering early improvements in staff capability, patient experience, and pathway integration. The structured, co-produced, and data-informed approach supports sustainability and scalability. Findings from the six-month pilot will inform refinement and planned expansion into community mental health teams, contributing to system-wide improvements in care for people with co-occurring mental health and substance use disorders.

St Andrews Healthcare in Northampton is a tertiary psychiatric hospital with multiple divisions, aiming to lead Complex Mental Health care. It includes secure units across 3 divisions, in varying security levels and specialist needs.

Resident doctors identified through a survey that the current induction process does not support new doctors. Three main areas of concern were identified: information about their job roles, feeling confident for on-calls, and feeling welcomed. Some doctors commented that it took up to one year for them to feel comfortable in their duties.

A Buddy programme was developed with formalised sessions to support a new non-consultant doctor. These included Speciality Doctors, Clinical Teaching Fellows and Associate Specialists and all eligible new doctors participated. It began as a 6-month pilot in Medium Secure Unit before launching to the whole of Northampton site. It ran between March 2024–December 2025. A comprehensive information booklet was created to support the Lead Buddies of each division on subjects to cover with their colleague. Feedback included pre-and post-intervention survey with binary answers, a Buddy feedback form, and additional feedback through e-mails. It was sponsored by one of the Associate Medical Directors and with the approval of all Clinical Directors.

The pre-programme survey noted only 18% of Resident doctor shaving enough information during their induction.

Post-intervention survey increased this to 100%. Confidence about their role has increased from 25% to 100%.

Despite the increase of confidence for starting on-calls, there was still remaining anxiety noted about the complexity. All doctors scored for anxiety about the on-calls in the pre-questionnaire. Post-intervention feedback noted remaining anxiety due to the size of the site. The programme enhanced the preparedness for on-calls by 57%.

Feeling welcomed had increased from 60% to 100% by the end of the programme.

Buddy programme had an overwhelmingly positive effect for new Resident doctors. There are identified areas for future improvement. The organisational changes of the size of the site are likely to resolve one of these. The remaining areas include further analysis of the complexity of cases during on-calls and the turnover rate of non-consultant doctors.

Multidisciplinary Team meetings are essential to care planning, rehabilitation, and discharge. However, MDTs are often experienced differently by each service user. Each service user brings their own preferences, communication styles and expectations to the MDT setting. This quality improvement project aimed to explore their views on MDT and developed a sustainable process whereby patients' views are explored and the MDT process is adjusted to their needs and preferences.

We used the 6-step quality improvement approach and completed three Plan–Do–Study–Act cycles. Baseline insight was gathered using a structured Likert scale questionnaire to explore service users’ views and experiences of MDT meetings. Responses were rated on a five-point scale from very satisfied to very unsatisfied. The questionnaire explored aspects of MDTs including: feeling prepared for the MDT; preference for order of speaking; comfort with the number of people present; understanding who is in the meeting and their roles; having enough time to share views; comfort within the MDT environment; feeling listened to; feeling safe and respected; whether personal topics were discussed; understanding what was being said; understanding next steps; whether the MDT gave hope for recovery; and overall MDT experience.

Initial data identified five domains impacting MDT experience: preparation for the MDT, feeling listened to, having key topics discussed, environmental comfort, and understanding next steps following the MDT. Across three PDSA cycles, targeted interventions were introduced to improve service user experience of MDT meetings. Theseincluded adding the My MDT preferences tool to the Care Plan that allowed service users to express personal preferences regarding MDT format, environment, timing, and support. Another change involved improving the existing pre-MDT preparation form, and introducing a process whereby administrative staff emailed weekend staff. Another adjustment included offering a post-MDT form. Following the interventions, Likert scale scores improved in all questions. The greatest improvement was seen in feeling listened to (mean score improved from 2.0 to 1.5) and understanding next steps after the MDT (1.9 to 1.5).

A flexible and person-centred MDT process can improve service user experience. The project has been adopted into routine practice with plans for ongoing monitoring to sustain improvements. This approach is transferable to other inpatient settings aiming to strengthen service user experience in MDTs.

Psychiatry trainees experience high workload and emotional demand. Peer-to-peer connection and the use of safe reflective spaces are protective factors, but access can be inconsistent. We used PDSA cycles to test whether an ongoing mental health-themed filmclub session (film, followed by facilitated discussion) was associated with immediate (same-evening) improvements in self-reported wellbeing and peer connection, and an immediate reduction in feelings of burnout.

Setting: an open-to-all, mental health-themed film club with attendees including psychiatry trainees, other clinical staff, and non-clinicians. Intervention: film screening followed by a facilitated group discussion. Measures: brief anonymous surveys completed immediately pre- and post-session. Outcomes were: self-reported wellbeing, peer connection, and level of burnout. The post-session survey included an assessment of psychological safety during the session, plus free-text feedback for qualitative assessment. Likert responses in each domain were converted to numerical scores (1–5) and analysed quantitatively. After session 1, PDSA was used including reviewing qualitative feedback to inform refinements and confirm the post-film discussion as a key component.

Two cycles were completed with different films: Aftersun (2022) (session 1) and Taste of Cherry (1997) (session 2). Session 1: pre n=12, post n=11. Mean wellbeing increased from 3.17 to 4.00 (+0.83). Mean peer connection increased from 3.25 to 4.55 (+1.30). Mean burnout decreased from 2.92 to 2.73 (−0.19). Discussion comfort was high (mean 4.64/5). Session 2: pre n=13, post n=12. Mean wellbeing increased from 3.69 to 4.17 (+0.47). Mean peer connection increased from 4.38 to 4.75 (+0.37). Mean burnout decreased from 3.23 to 2.83 (−0.40). Psychological safety in the discussion remained high (mean 4.58/5; median 5). Free-text responses across both cycles repeatedly identified the post-film discussion as the main impact, describing peer-to-peer connection, widening of cultural perspectives, and a non-judgemental atmosphere.

Across two QI cycles, a psychiatry film club was feasible to run and evaluate and was associated with immediate improvements in wellbeing and peer connection, with modest reductions in burnout feelings. These are key issues facing the mental health workforce and a film club represents a creative way to improve measures. Psychological safety ratings were consistently high and qualitative feedback suggests facilitated discussion as the key active component. Future cycles will look at sustained improvements in wellbeing. A future goal is to expand to other regions and embed into the core training curriculum.

This quality improvement project sought to design and implement a new handover system for mental health hospitals in North Glasgow. The new system aimed to improve ease of access and editing, alongside reducing the frequency of missed tasks for resident doctors.

Resident doctors across Gartnavel Royal Hospital and Stobhill Hospital were surveyed (cycle 1) between 06/06/25 and 13/06/2025 regarding their opinions on their respective existing Microsoft Excel handover systems, as well as the frequency of missedtasks and their willingness to try a new system. A new system was designed for each hospital using the Planner task management software on Microsoft Teams, adapted from a similar successful pilot in South Glasgow. Training sessions were delivered over June and July 2025, and the new systems were implemented on 18/07/2025. Resident doctors were surveyed again (cycle 2) between 04/08/2025 and 12/08/2025 regarding their opinions on the new system, any missed tasks and whether they wished to keep the new system or revert to the previous one. Adjustments to systems were made as per respondents’ wishes. Guidance posters were displayed in each hospital between October 2025 and January 2026 to aid using the systems, and the doctors were surveyed once again (cycle 3) between 28/01/2026 and 04/02/2026 using the same questions.

Please note “easy” will be used where respondents rated the system easy or very easy. There were a total of 10 respondents in cycle 1: 70% found the now-previous system easy to access, only 50% found it easy to edit and 40% found they had missed tasks. Only 10% were opposed to trialling a new system. In cycle 2, there were a total of 22 respondents: 73% found the new system easy to access, 81% found it easy to edit and only 18% had missed tasks. 73% wished to keep the new system. In cycle 3, preliminary results show 10 respondents thus far: 100% found the new system easy to access and edit, only 10% had missed tasks and 100% wished to keep the new system. The system is now part of Standard Operating Procedure in North Glasgow.

A new digital handover system replaced previous systems for each North Glasgow mental health hospital. The new system improved ease of access and editing as well as reducing the frequency of missed tasks for resident doctors. Displaying guidance posters further improved each of these categories and all doctors wished to keep the new system.

Clinicians working in perinatal psychiatric settings frequently encounter blood results that fall outside standard reference ranges due to the physiological changes of the “fourth trimester”. While information regarding accepted blood test levels throughout pregnancy is readily available, there is a lack of comprehensive, concise guidance for interpreting postpartum blood parameters and the time they require to return to baseline. This can lead to diagnostic uncertainty, unnecessary repeat investigations, and inappropriate specialist referrals. This Quality Improvement Project (QIP) was developed to address this gap in clinical confidence and reduce the burden of unnecessary medical interventions in the postnatal period. The project aimed to develop a comprehensive, evidence-based reference tool for postpartum blood parameter recovery timeframes and to evaluate its impact on clinician confidence and decision-making.

A reference guidance document was developed through review of published literature and clinical guidelines. This document summarized postpartum trends and accepted reference ranges for common investigations, including haematological, biochemical, and inflammatory markers (e.g., FBC, LFTs, U&Es, and thyroid function). To evaluate the impactof this intervention, an anonymous electronic survey was distributed to clinicians to assess their confidence levels before and after providing access to the guide. Improvement was judged based on clinicians’ self-reported confidence using a Likert scale, and qualitative analysis was performed on free-text feedback provided in the survey.

The survey was sent to 53 clinicians, with 25 responses received at the time of writing. Preliminary survey data demonstrated a marked increase in clinician confidence following the introduction of the reference guide. Participants reported greater clarity in distinguishing normal physiological postpartum shifts from true pathology. Early qualitative feedback suggests a reduced perceived need for specialist referrals and repeat blood tests, supporting the tool’s utility in streamlining clinical care. Data collection is ongoing.

This QIP highlights a need for accessible, postnatal-specific guidance for doctors working in psychiatry. The resulting reference tool is a low-cost, sustainable intervention that improves clinician confidence and supports appropriate resource allocation. This guidance is considered for inclusion in local induction materials for doctors on psychiatric perinatal wards, with next steps including dissemination to wards nationally and potential for broader application in primary care.

Discharge summaries (aka electronic discharge notifications, eDNFs) are a vital part of care, ensuring clear and timely communication between services and allowing for an accurate record of care to be maintained. If eDNFs are not completed in a timely fashion, or not completed at all, service users struggle to access follow-up care, repeat prescriptions and referrals to other services. In mid 2024, on Vincent Square Eating Disorders Unit (VSEDS), eDNFs were not being completed in a timely manner – many were not completed at all. From May 2024 to August 2024, of 15 patients discharged:

• • 5 had an eDNF completed at time of discharge (33.3%).

• • 3 had an eDNF completed late (20%).

• • 7 did not have an eDNF completed at all (46.7%).

Our aim: 70% of patients discharged from VSEDS will have an eDNF completed within 24 hours

This project ran from mid 2024 to early 2025. We implemented 4 PDSA cycles, which included:

PDSA 1: weekly scheduled meetings between ward doctors and pharmacists.

PDSA 2: discharge medications prescribed and email sent to pharmacy at time that decision to discharge is made.

PDSA 3: attempted implementation of protected time for ward doctors to complete eDNFs (unsuccessful).

PDSA4: On Wednesday mornings pharmacy notified of all potential discharges; all discharge medications prescribed at this time.

Our QI project included input from a number of Experts by Experience, service users who have had previous experience of discharge from VSEDS. They emphasized the importance of a timely, clear and concise eDNF and spoke about the impact on their ongoing care and wellbeing. Some of their feedback is represented in our poster.

From November 2024 to February 2025:

• • 14 patients were discharged from the ward.

• • All of these patients had a discharge summary completed within 72 hours of discharge.

• • 12 of these patients (85.7%) had a discharge summary completed within 24 hours of discharge.

Our first PDSA cycle was unsuccessful – we found that in practice this simply added another meeting without making a difference to efficiency. PDSA cycle 2 appears to have the most impact by allowing pharmacy to process TTAs without having to wait for ward doctors to write a lengthy discharge notification first. We were ultimately unable to implement PDSA 3 successfully. In PDSA 4, we attempted to systematise PDSA 2 by setting a once weekly notification process for pharmacy regarding upcoming discharges.

The aim of this quality improvement project was for initial seclusion reviews completed by resident doctors to achieve 80% compliance when standardised against all domains featured in the Mental Health Units (Use of Force) Act 2018 between the dates of September 2025 and January 2026.

A quality improvement project was undertaken between September 2025 and January 2026. A driver diagram was developed at project initiation to identify primary drivers, which included improving clinicians’ understanding of documentation requirements, increasing access to relevant criteria and resources and enhancing multidisciplinary knowledge regarding patient seclusions. Secondary drivers included targeted education for new and current doctors, improving accessibility and usability of the seclusion review template and policy and strengthening multidisciplinary team communication. A fishbone diagram was created, highlighting contributing factors related to people (time pressures, burnout, unfamiliarity with the process), process (time-consuming steps, inadequate handovers, limited out-of-hours support) and environment (reviews occurring overnight, limited software support). Based on these diagrams, a total of 4 PDSA cycles were performed, implementing 4 change ideas: (1) increasing accessibility to the seclusion proforma in handover, (2) circulating the proforma via email, (3) incorporating teaching into the academic programme, and (4) providing core trainee teaching in small groups. Regular audits were undertaken at two weekly intervals, and data was analysed using a Statistical Process Control chart.

Despite the interventions, there was minimal change in the overall compliance rate. Of the reviews that met all required criteria, compliance increased from 75% to 83%. This is likely attributable to the small number of seclusion reviews occurring within each two-week period, as well as the random variation introduced by different on-call doctors. These factors produced substantial fluctuations in the results, depending on the doctors' level of training and the workload of their shifts. At the level of individual domains, documentation of risk assessment to self and others alongside subjective and objective assessments of physical health increased, indicating a positive change.

This quality improvement project demonstrates that achieving the target of 80% compliance with the seclusion review requirements set out in the Mental Health Units (Use of Force) Act 2018 is unlikely to be sustained through educational or individual-level interventions alone. More directive system-level approaches may be required for sustained compliance, such as mandatory completion of all domains prior to submission of a seclusion review and efforts to reduce the overall use of seclusion to allow adequate time for high-quality, reflective documentation. Improving compliance with seclusion reviews is central to patient safety and safeguarding the rights of service users.

Clinic letters are a key method of communication between secondary mental health services, primary care, and patients. However, traditional psychiatry clinic letters are often lengthy, clinician-centred, and difficult for readers to quickly identify key information and actions. This sits at odds with national priorities emphasising patient-centred care, shared decision-making, and improved collaboration across healthcare interfaces.

Informal feedback within our service suggested that existing clinic letters lacked clarity and accessibility for both general practitioners (GPs) and patients.

This quality improvement project aimed to design and implement a structured, patient-addressed clinic letter template and to evaluate its impact on satisfaction with letter length, layout, ease of understanding, and content among GPs and patients.

A structured clinic letter template was developed through multidisciplinary discussion, informed by best-practice guidance and principles of patient-centred communication. Key features included clear headings, concise language, explicit action points, and written directly to the patient, with GPs copied into correspondence.

GP satisfaction with clinic letters was assessed before and after implementation using a brief feedback survey. Respondents rated satisfaction with letter length, layout, ease of understanding, and content as satisfied, neutral, or dissatisfied. Following implementation, patient feedback was also collected, as patients did not routinely receive clinic letters prior to this project.

GP satisfaction was assessed pre- and post-intervention (n=6 pre; n=8 post); patient feedback was collected post-intervention (n=12).

Following implementation of the structured clinic letter template:

• • GP satisfaction withletter lengthincreased from17% to 100%.

• • GP satisfaction withletter clarityincreased from50% to 100%.

• • GP satisfaction withletter contentincreased from33% to 87%(neutral responses reduced from 50% to 0%).

• • GP satisfaction withlayoutincreased from17% to 88%(neutral responses reduced from 50% to 0%).

Patient feedback demonstrated 100% satisfactionwith letter length, clarity, content, and layout.

Routine sharing of clinic letters with patients represented an additional improvement post-intervention, improving transparency and patient involvement.

Implementation of a structured, patient-addressed clinic letter template led to substantial improvements in GP and patient satisfaction with letter length, clarity, content and layout. This project demonstrates how simple, low-resource changes to written communication can support patient-centred care and improve collaboration across the primary–secondary care interface, aligning with national strategic priorities for mental health services.

To develop a peer group of clinical academic residents in the West Midlands Deanery.

The SPARK project (Supporting Psychiatric Academic Research for Knowledge) began in 2024 in the West Midlands Deanery to support resident doctors to achieve the research requirements of the higher training curriculum. From this work it became apparent that a smaller cohort of academicallyfocussed residents wanted support with applications and their additional training needs.

We started a series of meetings for clinical academic residents and doctors interested in academic psychiatry careers working in the West Midlands. We held our first hybrid meeting in October 2025 at the University of Birmingham. This consisted of a hot networking lunch, a career talk from clinical Associate Prof Dr Ben Perry, a talk on theclinical academic training pathway and time for networking. We created a WhatsApp group where we share funding and job opportunities as they arise.

A second meeting is booked for March 2026 and will feature a career journey talk from Prof Femi Oyebode. This will be held at the University of Warwick so residents get exposed to different universities in the Midlands.

At the first meeting we measured pre-and post-session awareness of, and interest in, clinical academic careers.

21 participants recorded their attendance at the first SPARK 2 meeting, 16 in person and five online. The attendees were a mix of ACFs, core trainees, higher trainees, a foundation doctor, a clinical research fellow, an SAS doctor and a medical student.

Participants were asked to respond to the statement “I know what a clinical academic is and what they do”; 58% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. Participants were asked to respond to the statement “I understand the typical training and career pathway for a clinical academic”; 41% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. After the session 100% of participants responded “Agree” or “Strongly agree” with the statement “The seminar improved my understanding of clinical academia”.

One resident stated afterwards “That event really was pivotal” to his subsequent appointment as an ACF.

SPARK 2 is a quality improvement project in the West Midlands to support clinical academic residents in the region. We run meetings and have created a WhatsAppgroup to allow for networking and the sharing of knowledge and resources.

To improve higher psychiatry resident doctors’ access to research opportunities in the West Midlands Deanery.

The updated training curricula in 2022 requires higher psychiatry resident doctors to demonstrate involvement with ethically approved research studies. Some residents were struggling to achieve this competency.

We commenced a QI project in November 2024 to support residents with research opportunities. We have implemented these four approaches.

1. Working Group: we meet as a working group every few months, chaired by the Head of School, to discuss strategy.

2. Research project document: we compiled a list of ethically approved research projects available in the region with contacts for each. This is accessible to resident doctors in the region via the learning platform PGVLE. We are currently on the second version and plan to update this document annually.

3. Linking residents with projects: we educate resident doctors on their research requirements at their teaching sessions. We meet with residents 1:1 at their request and link them to research projects in their area of interest.

4. Co-ordinating research engagement: we ensure members of the working group are involved in relevant projects run throughout the region. These include the annual Research Day in the Black Country NHS Trust, the MRCPsych course, the annual Medical Student Psychiatry Summer School in Birmingham, the monthly Regional Training Days for the higher resident doctors, and the funded Research and Academic Network Meetings in Coventry and Warwickshire NHS Trust.

A preliminary survey of satisfaction with the non-clinical elements of training was completed in October 2024 for the West Midlands General Adult Higher Residents (n=36) and repeated in October 2025 (n=11).

In 2024, 42% said they were somewhat or extremely unconfident in their knowledge about the portfolio requirements for research; in 2025 this was reduced to 18%. In 2024, 69% said they had not been given adequate opportunities to meet research training requirements; in 2025 this was 45%.

We have been working to support resident doctors in the West Midlands to achieve their research competencies during higher training. Satisfaction with the awareness of research requirements and the opportunities to achieve them have increased. We believe these approaches can be used in other regions.

Evaluate current practice in diagnosis and management of neuro developmental disorders (NDD) including Autism (ASD) and Attention-Deficit-Hyperactivity Disorder (ADHD) in Early Intervention Psychosis (EIP) services across the UK given frequent comorbidity of ADHD/ASD and Psychosis.

Gather data on care provision, use of third sector services and ascertain training and confidence in NDD within EIP services.

Highlight the need for robust NDD training to facilitate diagnosis and management within mental health teams, reducing pressure on services.

An online survey was disseminated to members in EIP services through RCPsych General Adult faculty and the EIP network. Data collected included prefilled and free text responses regarding EIP team demographics, current NDD assessment practice, care provided (including medication), use of third sector services, level of NDD training and, confidence assessed on a Likert scale. Quantitative and Qualitative data was analysed to capture key themes.

55 responses from 36 trusts across England and Wales were received; 85% (n=46) were EIP teams, 60% serving mixed urban/rural populations.

ADHD: Assessment: 75% (n=41) referred externally for assessment, with only 9% (n=5) completing assessments within EIP teams. A further 13%(n=7) shared assessments with another trust team.

Pharmacology: 47% (n=26) relied on third sector prescribers to prescribe ADHD medication, 15% (n=8) prescribed within teams, whilst 30% (n=17) used shared care agreements or prescribed together with another trust team.

ASD: Assessment: 70% (n=39) of assessments were completed by external services; only 7% (n=4) were conducted within EIP teams.

Post-diagnostic support: 45% (n=25) only provided signposting advice and 19% (n=10) offered no support.

NDD Training: 49% (n=27) reported no formal NDD training, of the 40% (n=22) that did, qualifications included ADOS, ADI-R and DIVA. Key barriers were lack of NDD skills and training opportunities, alongside funding and commissioning constraints.

Confidence: Confidence in NDD assessment and management was moderate, average confidence was 3/5 (42%) with remaining 29% spread both ≤2 or ≥4.

Qualitative Responses: Frequent themes included limited training and diagnostic inability. Overwhelming number of EIP teams rely on external services for NDD assessment. Teams with NDD training found it beneficial to services overall; others highlighted necessity for enhanced NDD diagnostic skills.

The elevated risk of multiple adverse outcomes in this population highlights the critical importance of allocating resources for clinician training and upskilling in the diagnosis and management of NDD, equitable access to services, and effective screening, diagnosis, and treatment within existing EIP services.

To assess the time difference in creating CDDs and EDDs manually versus using Copilot in general adult psychiatry.

To assess the quality of AI generated CDDs and EDDs.

Resident doctors will be asked to time themselves while writing a CDD and EDDmanually for a selected patient. They will then use the Copilot agent to generate a CDD and EDD for the same patient and record the time taken. The time difference will be analysed to determine the efficiency gains. Qualitative feedback will also be collected regarding the usability and accuracy of the Copilot-generated documents.

Rationale: The audit was prompted by the auditor’s personal experience with dyslexia and the challenges of managing discharge documentation in a high-pressure clinical environment. The Copilot agent offers a potential solution to reduce documentation time and improve patient flow.

Service areas/teams included: The audit was carried out in Royal Cornhill hospital and included data from general adult psychiatry.

Sample Size: 5 patient cases.

Metrics Recorded:

• • Time taken with Copilot vs. without Copilot,

• • Number of TrakCare pages referenced,

• • Number and nature of mistakes,

• • Qualitative comments on errors,

• • Minutes saved and percentage time saved,

For CDDs:

• • Average time saved: 13 minutes 13 seconds per case.

• • Average percentage time saved: 75.3%

• • Largest amount of time saved: 17 minutes 34 seconds (≈74.5% reduction).

• • Largest percentage of time saved: 76.6%.

For EDDs:

• • Average time saved: 26 minutes 22 seconds per case.

• • Average percentage time saved: 76.7%.

• • Largest amount of time saved: 33 minutes 34 seconds (≈79.9% reduction).

• • Largest percentage of time saved: 81.5%.

Error Analysis: Common issues included missing clinical data (e.g., blood results, imaging) due to incomplete inpatient records, medication discrepancies caused by changes not reflected in TrackCare, and errors linked to prior documentation (e.g., suspected perforation). Not all CDDs and EDDs contained all the information about medications due to inaccurate or incomplete record keeping on TrakCare. No errors were due to hallucination by the AI.

Observations: Significant time savings were achieved in most cases. Accuracy depends on completeness of source documentation and integration with TrackCare.

The Copilot agent demonstrates substantial potential to reduce documentation time while maintaining acceptable accuracy. However, integration with real-time clinical data and improved handling of medication updates are essential for reliability.

Research and literature on female offenders are relatively scarce compared to their male counterparts. In Singapore, female offenders are remanded either at the only local psychiatric hospital (Institute of Mental Health) or at Changi Prison. The judge remands them for between two to three weeks at the first instance to determine if these offenders with suspected mental disorders have the ability to plead in court and to determine if their suspected mental health conditions have any contribution to their offending behaviour. Legal determinations of unsoundness of mind at the time of offence and fitness to plead at the time of trial carry significant implications for criminal responsibility and case disposition. The psychiatrist also has to instruct the court about the nature of the mental disorder, the risk of reoffending and recidivism and whether treatment is possible and also feasible in each remandee. This study reviews the psychiatric and legal characteristics of female remandees assessed at the Institute of Mental Health (IMH), Singapore, over a one-year period.

A retrospective review of the electronic records was conducted by psychiatric doctors posted to the IMH. The details and medical records of the female remandees referred to IMH for forensic psychiatric assessment over one year was assessed by computer and a template for data extraction filled in manually. Demographic data, psychiatric diagnoses, offence characteristics, substance use history, and legal opinions on unsoundness of mind and fitness to plead were record, examined and analysed. Diagnostic distributions were analysed within the groups assessed as of unsound mind and/or without fitness to plead, with attention to overlap and discordance between these legal constructs.

Out of 280 female remandees assessed over 12 months, 12 (4%) were assessed as of unsound mind and 13 (≈5%) as unfit to plead. Schizophrenia was the most common diagnosis in both groups, followed by major neurocognitive disorder. Most individuals in both categories were charged with non-violent offences, and none had a documented substance use history. While there was substantial overlap between unsoundness of mind and unfitness to plead, several discordant cases were identified, illustrating the temporal and conceptual distinction between these determinations. Major neurocognitive disorder was particularly prominent among those unfit to plead, reflecting the central role of current cognitive capacity in trial competence. These findings challenge assumptions that forensic psychiatric morbidity is primarily associated with violence or substance misuse and highlight the relevance of endogenous psychiatric and neurocognitive conditions in female remandees.

Female remandees assessed as of unsound mind or unfit to plead constitute a small but highly vulnerable population. Their comparatively small numbers compared to male offenders has meant that most programmes and services on the whole tend to be geared towards the majority male population. However women remandees represent female offenders, who have unique issues and needs different from their male counterparts, characterised by severe psychotic and neurocognitive disorders, predominantly non-violent offending, and absence of substance use. Clear differentiation between mental state at the time of offence and present fitness to plead is essential. This would be crucial in the future development of gender-specific programmes for incarcerated women orgender-responsive programming for female offenders. To do so, we would need to assess choices and attitudes that lead to the commission of the crime but also address these factors in the context of central issues specially for women, specifically, history of trauma and violence, substance abuse and economic marginality.

Menstrual and menopausal health significantly influences mental health, with hormonal fluctuations affecting mood regulation, emotional stability, cognition, and vulnerability to psychiatric relapse. Psychiatric medications, especially antipsychotics associated with hyperprolactinaemia, can further disrupt menstrual cycles, contributing to distress, reduced quality of life, and treatment non-adherence. Despite this, menstrual health assessment is often absent from routine psychiatric review. Systematic screening during admission is therefore essential to identify treatable contributors to mental state deterioration and to deliver truly holistic care. Our aim was to evaluate how frequently menstrual and menopausal health was assessed on all inpatient psychiatric female wards at Lambeth Hospital (South London and Maudsley Trust), and to measure the impact of targeted interventions on improving active screening rates.

Baseline audit: review of clinical documentation for all patients admitted during the audit period on the wards was reviewed. Screening was categorised as:

Active screening: clinicians directly asked about menstrual or menopausal status and symptoms.

Incidental screening: information volunteered or noted indirectly.

Interventions included staff training, patient information materials, and updated clerking prompts.

A reaudit 5 months later assessed the same parameters.

Baseline:

• • 3/44 (7%) patients actively screened.

• • 8/44 (18%) patients had appropriate menstrual health intervention.

• • Menstrual status was unknown for the majority of patients, and menstrual-related interventions were rare.

Re-audit:

• • 28/45 (62%) patients actively screened.

• • 33/45 (73%)patients had appropriate menstrual health intervention.

This represents a significant improvement on both wards. Menstrual symptoms such as dysmenorrhoea, menorrhagia, peri-menopausal changes, and amenorrhoea were more consistently identified, leading to appropriate interventions. Interventions included appropriate counselling, products and patient information leaflet.

Our project shows that routine menstrual and menopausal health screening in psychiatric inpatient care is feasible, clinically meaningful, and substantially improved through simple service-level interventions. Embedding structured questions into admission processes enhances safe prescribing and promotes person-centred care. This project demonstrates that menstrual health assessment should be a standard component of psychiatric inpatient practice.

Traditional Community Mental Health Team (CMHT) follow-up relies on clinician scheduled appointments at fixed intervals, which may not be responsive to individual patient needs. Patient-Initiated Follow-Up (PIFU) enables patients to request timely review based on symptom change rather than routine scheduling. This project evaluated implementation of a PIFU pathway for a cohort of patients within Aston and Nechells CMHTs, with Aston acting as a control using the conventional pre-scheduled follow-up model and Nechells implementing PIFU, to assess the impact on access, capacity and patient experience.

The pathway was designed using NHS England's published PIFU guidance and registered with the Trust’s Quality Improvement team. A dedicated PIFU category was created within the electronic patient record, clinicians were allocated weekly PIFU review slots, and relevant staff received training. Following clinical assessment, patients werescreened using agreed criteria to identify those with PIFU-suitable mental health presentations, adequate capacity and ability to self-initiate contact. The process was explained and informed consent obtained. All transfers to PIFU were discussed at multidisciplinary team meetings prior to implementation. Patients re-accessed care by contacting the CMHT directly and were offered appointments within seven days. Uptake of PIFU and its impact on routine appointment availability were monitored and compared between Nechells and Aston CMHTs. Vacant PIFU slots were repurposed for ad hoc reviews of patients attending Clozapine or depot clinic.

From February 2025 to May 2025, 183 patients had been placed on the PIFU pathway, with 31 PIFU reviews completed. In June 2025, Nechells CMHT demonstrated a 37.22% reduction in routine clinic waiting times compared with Aston CMHT, alongside improved capacity for review slots within 14 days. By December 2025, there were 311 patients on the PIFU pathway. Patient feedback demonstrated good understanding of the pathway, with 66.7% reporting clear understanding and 72.7% confidence in getting access. Since initiation, 31.5% of patients had contacted the team, with 68.2% finding access easy. Overall, 76.8% preferred PIFU and 92.6% wished to continue on the pathway, a small proportion expressed preference for the traditional model.

A PIFU pathway within CMHT for selected patients resulted in significant reductions in waiting times, improved clinic capacity and gave favourable patient satisfaction. The model supports timely access to care while optimising resource use. Following the results of this project, formal standard operating procedure was developed and trust-wide rollout of PIFU across all CMHTs within Birmingham and Solihull Mental HealthFoundation Trust is planned with further evaluation.

Substance and alcohol misuse are highly prevalent and frequently comorbidin forensic psychiatric populations. This comorbidity is clinically important because it is associated with relapse, poorer engagement, and heightened risk of re-offending.

To evaluate substance and alcohol misuse risk/relapse-prevention provision within KMMH inpatient forensic services by: (1) describing the cohort’s substance/alcohol misuse profile and related risks; (2) assessing whether substance/alcohol misuse was assessed at admission; and (3) describing programme offer and uptake.

Service evaluation using routinely collected clinical data for current inpatients across KMMH forensic services. Data were extracted from electronic health records and analysed descriptively.

Sample: N=102. Gender: male 87/102 (85.3%), female 15/102 (14.7%). Assessment at admission: substance and alcohol misuse assessed in 54/102 (52.9%) and not assessed in 48/102 (47.1%). Active substance misuse was recorded in 14/102 (13.7%) and active alcohol use in 13/102 (12.7%). Withdrawal symptoms/incidents were recorded in 2/101 (2.0%) and detoxification was required in 1/101 (1.0%). IV drug users 3/102 (2.9%). Incidents of ongoing substance misuse: yes 5/102 (4.9%).

Substance categories recorded (multi-label; percentages use N as denominator): Cannabis/cannabinoids 50/102 (49.0%); Stimulants 42/102 (41.2%); Alcohol 32/102 (31.4%); Novel psychoactive substances (NPS) 14/102 (13.7%); Opioids 11/102 (10.8%); Hallucinogens/dissociatives 8/102 (7.8%); Sedatives/hypnotics 4/102 (3.9%).

Comorbid mental health diagnosis (multi-label; percentages use N as denominator): Psychotic illness 64/102 (62.7%); Mood disorder 14/102 (13.7%); Anxiety disorder (9.8%); Personality disorder 24/102 (23.5%); Neurodivergent 22/102 (21.6%); Paraphilias 2/102 (2.0%); Other 7/102 (6.9%).

Substance misuse programme provision: a substance misuse programme was offered to 44/102 (43.1%). Of those offered (n=44), 33/44 (75.0%) attended and 11/44 (25.0%) did not attend.

Previous engagement with substance misuse services (as recorded in the notes–percentages using N as denominator): Community setting 14/102 (13.7%); Acute inpatient setting 3/102 (2.9%); Forensic inpatient setting 16/102 (15.7%); Prison setting 7/102 (6.9%).

This service evaluation highlights two key quality-improvement opportunities. First, nearly half of patients had no recorded drug or alcohol misuse assessment at admission, suggesting inconsistent screening and/or documentation.

Second, although recorded active use and acute withdrawal/detoxification needs were relatively uncommon, a large proportion of the cohort had histories involving multiple substance classes. This supports the case for proactive relapse-prevention pathways in forensic settings, even when current dependence indicators are not prominent.

Attendance was high among those offered a programme (75%), indicating acceptability; however, fewer than half of the overall cohort were documented as being offered a programme, suggesting possible unmet need or variation in eligibility identification.

To systematically evaluate the structural and functional capacity of mental health services in Gaza following over 2 years of active conflict (Oct 2023–Jan 2026), quantify infrastructure and workforce losses, and identify critical service gaps requiring humanitarian response prioritization.

This service evaluation utilized triangulated data sources: (a) official Ministry of Health Mental Health Department records (Oct 2023–Jan 2026); (b) field observations carried out by World Health Organization (WHO) fieldworkers (Oct 2024–Nov 2025); (c) Mental Health and Psychosocial Support (MHPSS) Technical Working Group coordination data and facility assessments (Oct 2023–Jan 2026). The evaluation was conducted using standardised MHPSS assessment toolkits adapted to the local context. Evaluation scope encompassed all governmental psychiatric facilities, community mental health centres, selected local and international non-governmental organisation (NGO) service points, workforce capacity, medication supply infrastructure, and service accessibility across Gaza Strip. Analysis employed descriptive statistics and thematic categorization of operational barriers. Data sources comprised aggregated, non-identifiable service statistics and infrastructure assessments.

Gaza's sole functional psychiatric hospital (39-bed capacity, 2,200 annual emergency presentations, 719 annual admissions pre-conflict) sustained structural damage, rendering it non-operational since November 2023. A replacement psychiatric hospital that was planned before the war and was due to open in 2024 sustained damage before activation. All six governmental Community Mental Health Centres (serving approximately 100,000 annual service users) were destroyed (during April 2024–2025).

Workforce capacity declined critically: over 10 mental health professionals were confirmed killed, with only three Board-certified practicing psychiatrists remaining in Gaza (two more projected upon completion of the current training cohort in 2026). Pre-war, there was a single Board-certified child and adolescent psychiatrist, currently unable to practice within Gaza. Multiple NGO facilities sustained destruction or damage. Psychotropic medication supply chains were severely disrupted following the destruction of the WHO's pharmaceutical warehouse. Health information infrastructure, including electronic medical record systems and referral pathways, became non-functional. Several key service restoration priorities were identified, including: establishing minimum psychiatric referral capacity for acute presentations; securing sustainable psychotropic medication supply and implementing clinical supervision and psychological support systems for the remaining workforce.

Findings demonstrate structural collapse of specialized mental health service capacity. Feasible mechanisms to support the identified priorities for service restoration include integrating MH inpatient services in primary and secondary health facilities, context-specific capacity building, international tele-supervision partnerships and workforce protection measures as integrated response components.

The Advice and Guidance Service for Young Adult Mental Health Service (age 18–25) in Suffolk was established in October 2024 to support GPs with quick and effective treatment advice through a non-face to face platform in managing young adults with mental health difficulties.

No formal evaluation of the service had been conducted since the commencement of the service in October 2024.

The aim of this service evaluation project was to understand the use of the service; its effectiveness and any barriers associated with its use.

Data around the use of Advice and Guidance service by GP surgeries in both East and West Suffolk region was collected from the eReferral System (eRS) portal.

Specific Evaluation Questions were used to get feedback regarding the awareness and user experience of the A&G service for YAMHS in Suffolk from the GP trainees who work closely with GPs in various GP surgeries in Suffolk.

There were a total of 82 referrals to Suffolk YAMHS via the Advice and Guidance Service and the number of referrals was limited to less than 12 each month.

It was evident that the service was being used by various GP surgeries in both East and West Suffolk.

When looking at the outcomes for these referrals, it was evident that 61 out of total 81 A&G referrals were returned with advice. Among the remaining 20 A&G referrals, 18 were converted into a full referral to the YAMHS team and 2 were returned to the referring GP requesting further information regarding the cases for the team to be able to provide any advice or guidance.

When looking into the barriers for use, unawareness of the existence of the service was a major factor.

An information leaflet was created and sent out to all the GP surgeries in Suffolk via email. Copies of the information leaflet were handed out to the GP trainees attending the West Suffolk GP teaching programme to increase awareness and encouragement towards the service.

The A&G service for YAMHS holds the potential to be an extremely helpful service for the GPs and secondary mental health services in reducing the number of referrals and unnecessary waiting times for cases where quick and effective treatment advice can be appropriately provided through a non-face to face platform.

The barrier in using the Advice and Guidance service for YAMHS was unawareness of the availability of the service among the GPs and their trainees.

We believe that increasing awareness of the service in primary care would greatly increase the use of the service.

Older adults experiencing acute mental health crises often face prolonged inpatient stays due to multimorbidity and complex psychosocial needs. The shift from hospital care to supporting people to recover in their own homes, with the right support in place, was the basis for the introduction of the Functional Intensive Response & Response Team (FIRST).

The South-East Essex FIRST (SE FIRST), a virtual ward, which commenced operations in June 2023, was one of three teams set up to provide these services across our trust. It is a multidisciplinary service catering for older adults aged ≥70 years, with flexibility to accommodate 65–69-year-olds with significant frailty. Its objectives were to intervene early, act as a gatekeeper for informal psychiatric hospital admissions, and support timely hospital discharge.

This service evaluation reviewed all referrals from June 2023 to June 2025. Approval was obtained from the Research Team, and data governance principles were adhered to.

Information was extracted from referral records supplemented by the electronic systems. This included socio-demographic, clinical, and referral variables, which were analysed using descriptive statistics.

In total 309 unique referrals were received, out of which 21 (6.8%) individuals required multiple episodes of care over the period. The majority were female (64.7%), with a mean age of 77.2(±7.0) years. Over three-quarters (76.1%) had a prior psychiatric diagnosis, with mood disorders (41.1%) and organic disorders (19.1%) being the most prevalent. Most referrals originated from Mental Health Liaison Teams (36.2%) and Older Adults CMHT (34.3%). Mental health deterioration was the leading reason for referral (74.1%) followed by post-discharge support (23.3%). Following a two-clinician assessment and multidisciplinary discussion, nearly a third (30.7%) were not considered suitable for FIRST with signposting to appropriate services, 100 (32.4%) were accepted for home treatment, of which 73 were successfully managed with a mean duration of 33.9 (±50.8) days. This translated to an overall admission avoidance rate of approximately 24%. For those whose admission was unavoidable (n=62), they were considered too risky to be managed in the community. Feedback, though limited (16%), was overwhelmingly positive, highlighting professionalism, kindness, and responsiveness which exemplifies our trust motto of ‘We care, we learn, we empower’.

SE FIRST has demonstrated effectiveness in delivering safe, person-centred crisis care for older adults, reducing admissions rates or duration and promoting continuity of care. Future priorities would include strengthening data systems and implementing structured indicators such as tracking admission avoidance rates, quantifying bed-days saved and optimizing service delivery.