The primary objective of this baseline audit was to evaluate the performance of mentalhealth and substance misuse services across all five Welsh prison sites against evidence-based quality standards.

The study sought to identify models of care, highlight areas of best practice, pinpoint thematic gaps requiring additional strategic resource or funding, and inform the development of a future network for prison mental health and substance misuse services in Wales.

The audit utilised a peer-review methodology developed by the Quality Network for Prison Mental Health Services (QNPMHS). Each service underwent a two-month self-assessment against 238 standards, followed by an intensive in-person review visit between September 2024 and July 2025.

Data collection involved 92 semi-structured interviews with frontline staff, prison colleagues, and patients, alongside environmental tours and documentation reviews. Compliance was measured against Mental Health (MH) standards and the 2024 Substance Misuse Treatment Framework.

Visits were undertaken by the College Centre for Quality Improvement (CCQI), commissioned by RCPsych Wales as part of the Prison partnership agreement between Welsh Government and HMPPS.

The audit revealed variable compliance levels, with average scores of 62.8% for mental health and 57.7% for substance misuse standards. Key findings included:

• • Service Models: Most services follow a nurse-led model, with significant gaps in access to psychology, occupational therapy, and psychiatry.

• • Substance Misuse: Only one prison (HMP Berwyn) maintained a full clinical SM team, while others relied on single practitioners managing high caseloads.

• • Neurodiversity: While “whole-prison” neurodiversity support managers exist, healthcare teams lack the commissioning to provide formal assessments or diagnoses for ADHD and Autism.

• • Operational Barriers: Challenges included a lack of confidential consultation rooms, insufficient IT resources, and inconsistent provision of monthly clinical supervision.

While pockets of good practice exist, particularly in collaborative duty worker roles, the Welsh prison estate faces systemic challenges regarding clinical multidisciplinary input and specialist pathways.

The report recommends immediate investment in specialist Substance Misuse staff, formalising neurodivergent care pathways, and enhancing clinical working environments.

Implementing adapted assessments for older adults and ensuring monthly clinical supervision are critical priorities to improve the quality and safety of care.

The review provides critical insight, informing the development of a future network for prison mental health and substance misuse services in Wales, commissioned by Welsh Government.

To evaluate the appropriateness, quality, and outcomes of referrals to the Enhanced Team East (ETE) in order to ensure that the service is effectively targeted to individuals with complex mental health needs who require intensive, multidisciplinary community support.

Retrospective review of referrals processed by ETE over the defined period (January 2025 - June 2025), focusing on Single Point of Access (SPA)-received referrals, duty system triage, and MDT decision-making. it was designed to evaluate referral patterns, adherence to inclusion criteria, and outcomes, while identifying opportunities for process improvement.

• • A total of 60 referrals were received over the 6-month period, showing steady demand for the Enhanced Team East (ETE). Most of the referrals were from the wards and SPA.

• • Only 31.7% were accepted, suggesting many referrals may not meet the threshold or that SPA/teams may need clearer guidance on referral criteria.

• • Significant proportions were transferred to Core teams(traditional CMHT) (23.3%) or discharged (18.3%), indicating opportunities for improved triage or alternative pathways before referral.

• • The processing time for accepted referral ranged from 7 days to 94 days, with an average of 32.6 days.

• • Most of the referrals were from the wa

• • The evaluation shows that the Enhanced Team East receives a steady flow of referrals, but only a subset of these referrals meet the threshold for acceptance.

• • Processing-time analysis reveals variability in responsiveness, indicating potential workflow delays within triage and allocation processes.

• • Improving clarity around referral criteria, strengthening collaboration with referring teams, and reviewing triage processes could enhance the efficiency and appropriateness of referrals.

• • Overall, the findings provide a strong basis for targeted service improvements and support the need for future reaudit to measure progress

• • To provide patient with a method to give honest and protected feedback around activities offered on the ward and also to allow the improvement of activities offered on Waterton Ward, Newton Lodge.

• • To provide staff with the opportunity to identify gaps in service provision around activities offered on Waterton Ward, Newton Lodge.

A survey was conducted in person with patients on Waterton ward using a printed survey questionnaire between May and June of 2025. An anonymous staff survey questionnaire was printed and given to members of staff on the ward to complete between May and June 2025

The data were analysed by the project lead. Both quantitative and qualitative data were collected. Data were grouped into themes to aid the analysis and presentation of the results

• • The survey highlighted a disparity in awareness of available activities on the ward. While some activities, such as the Horticulture Garden, Community Sessions, and Walking Group, have full awareness among patients, others, such as the Lego Group and Driving Skills Group, have very low awareness.

• • Enjoying the activities, staff persistence, more awareness, and an additional occupational therapist are key motivators for engagement.

• • Patients expressed interest in additional activities, including vocational skills like painting and decorating, music groups, more gym time, and more frequent walking groups.

• • The responses emphasize a wide range of life skills patients believe will prepare them for reintegration into the community. Cooking, budgeting, shopping, banking, and IT skills are frequently mentioned, reinforcing the importance of practical education and independence.

• • Patient satisfaction with current activities on the ward appears varied–while some patients feel satisfied, a portion remain indifferent or dissatisfied

From the staff survey, staffing shortages was consistently mentioned across different staff roles as a barrier to providing rehabilitation services on the ward. Staff satisfaction with the ward activities was mixed with 55% of respondents expressing dissatisfaction.

The findings from the patient survey underscore a need for better communication and promotion of existing activities, improved scheduling, and staff availability. This project highlighted the need for patient and staff participation in improving the interventions and activities offered on the ward.

High-quality clinical documentation is essential for patient safety, continuity of care, and compliance with regulatory standards. However, maintaining documentation quality within complex electronic medical record (EMR) systems can be challenging in training environments, particularly in psychiatry where documentation requirements are extensive. While resident involvement in quality improvement is encouraged, there is limited evaluation of structured trainee-led governance models in clinical informatics. This study aimed to evaluate the impact of a trainee-led informatics leadership initiative on EMR documentation compliance within the Psychiatry Residency Program at Hamad Medical Corporation (HMC). It was hypothesised that formal trainee leadership and continuous engagement would be associated with improved compliance across key documentation indicators.

A longitudinal quality improvement evaluation was conducted following the establishment of the Cerner Documentation Leadership Subcommittee in August 2022. The subcommittee consisted of psychiatry residents assigned formal leadership roles focused on documentation quality and clinical informatics. The initiative included monthly educational sessions, targeted feedback on documentation performance, iterative workflow optimisation, and continuous auditing of documentation standards. Compliance was assessed using 16 documentation indicators aligned with Joint Commission International (JCI) standards. Longitudinal compliance data were extracted from Cerner audit reports and reviewed across 2023 to examine trends, improvements, and variability in documentation performance over time.

Following implementation of the trainee-led leadership model, sustained improvements were observed across multiple documentation domains. History and Physical documentation and Medication Reconciliation maintained consistently high compliance rates throughout the evaluation period, with average compliance ranging between 86% and 90%. Comprehensive Assessment documentation showed the most notable improvement, increasing from a baseline compliance rate of 13% to 77% by the end of the evaluation year. Active trainee involvement in institutional reaccreditation processes and collaboration with Health Informatics teams supported optimisation of Cerner documentation templates and improvements in clinical workflow. Periodic declines in selected metrics were observed during resident rotation changes and onboarding of new trainees, indicating the influence of workforce turnover and the need for ongoing education and reinforcement.

This evaluation demonstrates that a structured trainee-led informatics leadership model can improve EMR documentation compliance within a psychiatry residency program. Embedding residents in formal documentation governance roles supported sustained quality improvement while promoting accountability, leadership development, and systems-based practice. Ongoing education and continuous monitoring are necessary to maintain gains, particularly during trainee transitions. Integrating informatics leadership into residency training may strengthen regulatory readiness and support safe, high-quality psychiatric care.

Adherence to opioid substitution therapy is critical for treatment success, yet missed doses and unsupervised take-home doses can increase relapse or overdose risk. This service evaluation aimed to assess patterns of missed supervised doses and take-home medication use, identify factors associated with non-adherence, and evaluate potential service improvements.

A retrospective service evaluation was conducted in an addictions psychiatry outpatient clinic. Adults aged ≥18 years receiving methadone or buprenorphine for at least three months were included. Patients were excluded if they had transferred care during the evaluation period, had incomplete pharmacy records, or were unable to engage in routine clinic follow-up due to acute intoxication, severe withdrawal, cognitive impairment, or acute psychiatric instability. Data were extracted from clinic and pharmacy records, including supervised dose attendance, take-home dosing patterns, demographic information, concurrent substance use, and housing status. Descriptive statistics were used to summarise missedsupervised doses, take-home medication issues, and associated factors, with exploratory comparisons between patients with and without polysubstance use.

A total of 120 patients on opioid substitution therapy (methadone n=75, buprenorphine n=45) were included in the service evaluation. Missed supervised doses were common, with 36 patients (30%) missing ≥2 doses in the preceding month and 18 patients (15%) missing ≥4 doses. Issues with take-home medication were documented in 22 patients (18%), including misplacement (n=12) and suspected diversion (n=10). Polysubstance use was prevalent, with 52 patients (43%) reporting concurrent use of cocaine, cannabis, or illicit benzodiazepines; missed supervised doses were more frequent among these patients (42% vs 21%, p<0.05). Younger age (<35 years), unstable housing, and high polysubstance use were associated with higher rates of missed doses. In 28 of the patients with frequent missed doses, additional adherence support was documented, including increased supervised dosing and motivational interventions. Review of clinic and pharmacy records demonstrated that systematic evaluation of adherence patterns is feasible and provides clinically actionable information for optimizing patient safety and treatment outcomes.

Missed supervised doses and take-home medication issues are common among patients receiving opioid substitution therapy, particularly in those with polysubstance use, younger age, or unstable housing. These findings highlight the importance of structured adherence monitoring, targeted support interventions, and careful supervision of take-home doses to optimize treatment outcomes and reduce harm. Routine evaluation of adherence patterns is feasible in outpatient addiction services and can provide actionable insights for improving patient safety and the overall quality of care.

This service evaluation aimed to assess how consistently overdose risk factors are recorded in routine outpatient clinical records, identify gaps in documentation, and explore patient characteristics associated with missing or incomplete risk assessments.

A retrospective service evaluation was conducted in an addictions psychiatry outpatient clinic. Adults aged ≥18 years receiving methadone or buprenorphine during a six-month period were included. Patients were excluded if they had transferred care during this period or had incomplete medical records. Clinical notes and pharmacy records were reviewed to extract information on overdose risk factors, including polysubstance use, previous overdose, co-prescribed benzodiazepines, psychiatric comorbidities, and naloxone provision. Demographic information and substance use patterns were also collected. Data were analysed descriptively to summarise documentation rates, and exploratory comparisons were made between patients with and without recorded overdose risk factors

A total of 110 patients were included (methadone n=68, buprenorphine n=42). Overdose risk factors were documented in 61 patients (55%), leaving 45% without recorded risk assessment. Naloxone provision was documented in only 44 patients (40% of total), including 12 patients with known polysubstance use who had no recorded naloxone offer. Polysubstance use was present in 48 patients (44%), and these individuals were more likely to have risk factors documented (65% vs 48%), although a substantial proportion remained undocumented. Patients with co-occurring psychiatric diagnoses were also more likely to have documented overdose risk, but documentation consistency varied widely. The review demonstrated that systematic evaluation of overdose risk documentation is feasible within routine outpatient records and can identify gaps that may compromise patient safety.

Overdose risk is inconsistently documented in OST outpatient settings, despite high prevalence of polysubstance use and psychiatric comorbidity. Gaps in documentation, including missed naloxone provision, highlight the need for structured protocols and staff training to ensure that high-risk patients are identified and receive appropriate harm reduction interventions. Implementing routine overdose risk assessments within clinical workflows is feasible and may improve safety, patient outcomes, and overall quality of care.

Non-engagement in outpatient addiction services is frequently attributed to poor motivation or readiness to change. This evaluation aimed to examine demographic and service-level factors associated with non-attendance, and to test whether documented motivation predicted engagement.

A retrospective review of all new referrals to a UK outpatient addiction service over 12 months was undertaken (n=214). Demographic, clinical, and appointment data were analysed, including housing status, referral source, clinician continuity, and attendance. Patient feedback recorded during routine contacts was thematically reviewed.

Mean age was 41 years; 62% were male. Primary substances were alcohol (48%), opiates (27%), stimulants (15%), and polysubstance use (10%). Overall DNA rate was 29%, rising to 38% following initial assessment. Housing instability was associated with higher DNA rates (43% vs 23%). Clinician changes were associated with increased non-attendance (DNA 41% vs 24%). No association was found between documented motivation and attendance. Over half of those who initially disengaged (54%) re-presented within 6 months.

Non-engagement in outpatient addiction services is better understood as a dynamic interaction between patient circumstances and service design rather than a simple reflection of motivation. Interventions focused on continuity, flexible scheduling, and proactive follow-up may reduce disengagement more effectively than motivational approaches alone. Reframing non-engagement as a service-level challenge has importantimplications for engagement strategies, clinician attitudes, and outcome evaluation in addiction psychiatry.

Outcome measurement in addiction psychiatry commonly prioritises abstinence, attendance, and treatment completion. These endpoints may fail to capture meaningful clinical progress, particularly in outpatient settings where recovery is often non-linear. This evaluation aimed to compare routinely recorded service outcomes with patient-reported indicators of progress, and to assess their relationship to engagement and re-presentation.

A retrospective service evaluation was conducted within an outpatient addiction service. Consecutive patients completing at least one follow-up appointment over a 6-month period were included (n=162). Routine outcome measures (attendance, substance use status, treatment completion) were extracted from clinical records. Patient-reported outcomes were obtained through brief structured questions recorded during routine reviews, focusing on stability, harm reduction, and help-seeking behaviour.

The cohort had a mean age of 42 years; 60% were male. Abstinence at last contact was documented in 28% of patients, while 71% demonstrated at least one patient-reported functional improvement. Improvements included reduced substance-related harm (46%), increased stability in housing or relationships (39%), and earlier help-seeking during relapse (33%). Attendance and abstinence showed weak correlation with patient-reported progress. Notably, 58% of patients who did not meet traditional “successful outcome” criteria reported clinically meaningful gains. Re-presentation rates within 6 months were lower among patients reporting functional improvements, regardless of abstinence status.

Routinely used endpoints in addiction psychiatry may underestimate meaningful recovery and distort service effectiveness. Incorporating patient-centred and functional outcome measures alongside traditional metrics may better reflect real-world progress and inform service development in outpatient addiction care.

Multidisciplinary team (MDT) input is widely recommended in outpatient addiction services to address complex needs, but its use and impact in routine practice are poorly understood. This study aimed to identify which patients receive MDT interventions and examine their outcomes compared with those who do not.

A retrospective service evaluation was conducted in an outpatient addictions service over 12 months. All patients referred to the MDT for review were included (n=82), and compared with a matched cohort of patients not referred (n=130). Demographics, primary substance, comorbid mental health diagnoses, housing status, and treatment engagement were recorded. Functional outcomes (housing stability, employment/education, engagement with support services) were extracted from routine clinical records. Simple descriptive statistics and relative comparisons were used to identify patterns of MDT referral and benefit.

The MDT cohort had a mean age of 39 years; 64% were male. Primary substances included alcohol (41%), opiates (32%), stimulants (19%), and polysubstance use (8%). Comorbid mental health conditions were present in 57% of MDT patients versus 24% in non-MDT patients. Housing instability was more common in the MDT group (42% vs 18%). Functional improvements were observed in 61% of MDT patients, compared with 34% in non-MDT patients. The greatest gains were seen in patients with both comorbid mental illness and housing instability, particularly in engagement with social support services (46% vs 22% in non-MDT patients).

MDT input in outpatient addiction services is selectively applied to patients with complex social and mental health needs. These patients demonstrate substantially higherfunctional gains than non-MDT patients, highlighting the value of targeted MDT interventions. Structured referral criteria and routine evaluation may help maximise MDT effectiveness and ensure equitable access.

Effective outpatient addiction care depends on patients understanding and retaining clinical advice. However, the extent to which patients recall guidance after appointments is poorly studied. This evaluation aimed to assess patient recall of advice immediately after consultation and one week later, and to explore factors associated with retention.

A prospective service evaluation was conducted in a UK outpatient addictions clinic. Consecutive patients attending a routine follow-up over 6 months were invited to participate (n=121). Demographics (age, gender, primary substance, housing status) and appointment characteristics (clinician continuity, consultation length) were recorded. Recall was assessed via brief structured questionnaires immediately post-consultation and at one-week follow-up, covering key treatment advice, harm-reduction strategies, and safetyguidance. Data were analysed descriptively and associations with patient or appointment factors explored.

Mean age was 40 years; 59% were male. Primary substances included alcohol (46%), opiates (29%), and stimulants/polysubstance use (25%). Immediate recall of all key advice was 68%, but this dropped to 42% at one week. Recall was higher among patients with continuity of care (47% vs 35%) and those attending longer consultations (>30 minutes: 52% vs <30 minutes: 38%). Housing instability and polysubstance use were associated with lower recall. Clinician confidence in patient understanding consistently exceeded actual recall.

Patient recall of clinical advice in outpatient addiction services declines sharply within one week. Continuity of care and longer consultations are associated with improved retention. Simplifying messages, repeating key advice, and providing written or digital reinforcement may enhance understanding and engagement, with implications for treatment planning and service effectiveness.

Effectively adapting a SEDU in the management of patients with T1DE – challenges, multi-professional working, capacity, and consent in determining outcomes.

Background: Individuals with disordered eating and T1DE pose a challenge across services, due to complications that arise from the interplay of this two-in-one condition, which could be life threatening.

The insidious onset of disturbed eating and its progression to disordered eating behaviours has been recodified in newer diagnostic manuals. Patients with type 1 diabetes mellitus (T1D) remain a source of consternation to professionals and families. Type 1 diabetes mellitus and disordered eating (T1DE), previously known as diabulimia, is not uncommon.

The UK APPG on Eating Disorders emphasise the need for adequate resourcing with integration of services. In response, the Royal College of Psychiatry annexe to MEED addresses diagnoses by highlighting key criteria.

Re-adapting for T1DE involved: training on T1D with diabetic specialists regarding CGM devices, traditional finger-prick testing, insulin pen management, meal planning and insulin dosing, carb-counting (DAFNE); Implementing the T1DE Behaviour Checklist, and our Quick Guide to Diabetes Management in Patients with T1DE.

Other interventions: Medical - monitoring pre/post-meal BG, serum ketones etc., Psychology – EDE-Q, PHQ-9, GAD-7, fear hierarchy, OT – MOHO-based assessment of function including exposure, Dietetic - carb and calorie counting tools, Nursing care planning with physical monitoring. Family therapy, goal planning with community ED, PC and KCL national T1DE services and application of the MHA. Pre-screening for neurodevelopmental disorders, personality disorders and common mental health conditions.

150 admissions were recorded over 24 months with complexities such as ASD, ADHD, trauma, personality disorder and self-harm being prevalent. We admitted three of four T1DE referrals – one under section 2 of the MHA, rescinded prior to discharge, and the other informal reassessed and detained under section 3, subsequently rescinded five months later. The third remained informal throughout admission. Outcomes include improvement in binge purging or restriction (>6000kcal to approximate 1800kcal daily), HBs-489C by 30-40%, weight stabilisation, and adherence to insulin doses and administration. There were marked improvements in distress tolerance, EDE-Q and anxiety scores. Two patients returned to employment or university. They responded positively to reinstating antidepressants and one to stimulant treatment.

The service adapted, utilising expert support whilst exploring innovative interventions to facilitate treatment of T1DE. Challenges encountered reinforce the need for clinicians to address barriers and improve engagement by applying a reflective MDT approach. Aligning with patients and family goals is crucial for sustained outcomes.

Menopause is increasingly recognised as a contributor to mental health presentations. There is a lack of confidence amongst clinicians in investigating and managing menopause in psychiatric patients; up to 41% of psychiatrists reporting feeling “not confident at all” in responding to the hormonal health of female service users. We aimed to evaluate the acceptability and efficacy of a specialist service for menopause and menstrual disorders amongst patients in secondary mental health care.

We devised and ran a Menopause and Menstrual Health Clinic offering email advice, case discussions, and assessments. The clinic is staffed by a consultant with special interest in the field, admin, and with MDT discussion input from Community Gynaecology. We have administered tailored teaching sessions to clinical services across the trust. Pre- and post-intervention survey data has been taken from service users, clinicians, and teaching recipients.

Initial feedback from teaching sessions shows improvement in knowledge and confidence (both 100%, n=12) and a positive impact on clinical practice (100%, n=10).

In the first eight months of operation, the clinic received 43 referrals from 37 referrers across primary and secondary care services. Early quantitative and qualitative feedback from patients and clinicians is positive. 100% of clinicians (n=9) who have responded to date find the clinic has improved the care they offer their patients, naming the “expert advice”, “comprehensive feedback”, and holistic reviews offered as key components of the clinic’s efficacy. 100% of clinicians and patients surveyed found the clinic easy to refer to or attend.Six-monthly follow ups from initial reviews are ongoing, but 100% (n=3) of patients surveyed to date have found treatment changes advised by the clinic to have had a positive impact on their mental health.

Preliminary data suggests the clinic is beneficial to clinicians and patients, with strengths including discussion of novel treatment options, holistic assessment of needs, and open dialogue between professionals regarding hormonal symptomatology and management. Delivering teaching sessions for colleagues to introduce a hormonal lens to formulation and management plans further extends the reach and effectiveness of the clinic. Ongoing work is needed to embed this awareness in routine psychiatric practice, through the expansion of teaching provision and increasing the profile of the clinic’s criteria and referral process. Future research should consider the need to embed consideration of hormonal status into mental health assessments, as a step towards addressing inequitable health outcomes for women.”

Neurodevelopmental disorders, including ASD and ADHD, are lifelong conditions that typically present in childhood. Early identification and timely diagnosis are essential to facilitate access to appropriate support, reasonable adjustments and evidence-based interventions to improve long-term outcomes. In recent years, health services across Wales have reported a substantial increase in referrals for neurodevelopmental assessment. This trend has been observed in ABUHB, placing increasing pressure on neurodevelopmental diagnostic services and contributing to prolonged waiting times.

The purpose of this service evaluation is to examine patterns in neurodevelopmental referrals and diagnoses amongst young people within ABUHB, and to assess whether existing diagnostic pathways meet expected quality standards. The evaluation aims to describe referral volumes, waiting times and diagnostic outcomes for the young people referred for neurodevelopmental assessments. In addition, it seeks to identify trends over time in the volume and nature of referrals, including demographic characteristics, and to assess service performance against national and local guidance, including NICE recommendations and Welsh Government neurodevelopmental targets.

To achieve these aims, a retrospective review of routinely collected service data from ABUHB’s neurodevelopmental pathway was undertaken. Quantitative analysis was used to evaluate referral rates, time from referral to assessment and diagnostic outcomes. Observational learning complemented the quantitative findings through attending neurodevelopmental assessment clinics and MDT meetings, providing insight into the clinical decision making, referral pathways and multidisciplinary working. Engaging with cliniciansinvolved in assessment further contextualised the findings and enabled deeper understanding of perceived challenges, service pressures and examples of good practice.

This service evaluation demonstrates increased demand for neurodevelopmental assessment, alongside extended wait times and variation in diagnostic outcomes across the pathway. Service data demonstrates a substantial rise in accepted referrals over time, rising from 1535 to 2221 between 2021 and 2023, with sustained high referral volumes after. These findings highlight areas where current practice aligns with recommended standards, and areas where service delivery may be constrained by capacity and resource limitations. The clinical observations provide valuable context regarding the impact of rising referral volumes on patient-centred care.

In conclusion, this service evaluation will provide a structured, data-informed overview of the current performance and pressures within the neurodevelopmental diagnostic services within ABUHB. Through integrating quantitative service data with qualitative clinical observations, the project aims to generate evidence-based recommendations to support service improvement. This evaluation highlights the role of service evaluation in supporting reflective clinical practice and continuous quality improvement within child and adolescent mental health services.

The aim of this service evaluation was to assess baseline mental health awareness, openness to discussing mental health issues, recent experiences and perceived barriers to seeking help among construction workers, and to identify preferred workplace interventions to inform targeted mental health support initiatives.

An anonymous survey was conducted at a single construction site. Participants completed a questionnaire assessing mental health training exposure, confidence in recognising mental health issues in themselves and in others, openness to talking about mental health problems, awareness of mental health support services, perceived barriers to seeking help, recent mental health experiences and preferred support interventions. Responses were analysed using descriptive statistics.

The survey was completed by 18 construction workers at a single site. Only 56% had received a form of mental-health training. Awareness of support services was variable with 72% knowing about Samaritans, while 56% were aware of the NHS urgent mental-health helpline and the Construction Industry Helpline. Stress at work was reported by 78% of respondents, and approximately 66% experienced low mood, anxiety or sleep disturbance. The most common barriers to seeking help were the belief that others would not care (39%) and stigma or taboo (33%). Preferred interventions included supervisor mental-health training (50%), short educational mental health talks (44%) and mental health champion programmes(39%).

A significant number of construction workers in this survey reported recent experiences with stress, depression and anxiety, alongside gaps in mental health training and awareness of available support. Stigma and belief that others would not care were identified barriers to seeking help, reinforcing the impact that culture and society plays on these perceived barriers. Participants favoured practical, workplace based interventions, particularly supervisor training, brief educational sessions and peer support initiatives. These findings support the implementation of targeted on-site mental health initiatives to improve engagement and accessibility of support within this high-risk occupational group.

The ethos of this project was that regular users of mental health services have complex needs, often falling through the cracks of service provision, which can result in poor and inconsistent care. In the context of our work, these high intensity users (HIU) are defined as having five or more referrals to acute psychiatric services within 90-days. Our aim was to improve the patient experience through working holistically, in a co-produced manner, within a whole system approach, as endorsed within NHS Right Care, Right Person and The Mental Health Crisis Care Concordat.

Co-production with:

• • Staff: HIU leads have been empowered to adapt overarching processes to their local population. Staff feedback has been considered.

• • Patients/carers: Focus groups were conducted with lived experience representatives, with ongoing input at system-wide interface meetings.

• • External stakeholders: Workshops were conducted with statutory and non-statutory partners.

Resulting in:

• • HIU leads in acute and community directorates, supported by clinical lead.

• • Multi-agency professional meetings to inform safety planning.

• • Specific HIU safety plans, coproduced as therapeutic tools. These plans empower and support clinicians to provide consistent and safe care, with a focus on working with emergency services.

• • Monthly, system-wide HIU interface meeting with external partners.

• • Information sharing with our system-wide partners.

• • Trust wide promotion and resources.

Within the HIU cohort, there was a reduction in the average number of ‘acute’ referrals per month from 80 between August-December 2024, to 28 between August-December 2025. With a notable reduction in 136 referrals from 9 in August 2024, to approximately 2 per month in December 2025. There was also a reduction in the number of admissions to acute wards from an average of 8.8 between August-December 2024, to 3 between August-December 2025, with variation in the average length of stay. There were several ‘good news stories’ of successful collaboration with individuals who were previously struggling to engage with community mental health services. Staff have provided positive feedback, reflecting on the benefits of joint working and that the HIU project is “valuable to get to know patients with long history in services but are not engaging well’.

The partnership has demonstrated value for patients and professional across the system, through providing a coordinated approach to crisis care. Testimonials from partners highlight this: “it shows how Police and mental health services can work together to create a more compassionate, joined-up approach to crisis care, one that listens, responds, and supports rather than reacts or restrains.”

There is clear evidence that Black men are disproportionately detained under the Mental Health Act (MHA). Our aim was to explore and characterise the clinical, social, organisational and structural factors contributing to this phenomenon, by examining the pathways to compulsory admission among Black adult males, and to generate hypotheses to inform future research and service improvement.

We completed a thematic analysis of Structured Judgment Reviews (SJRs) of a consecutive series of Black adult male patients detained under the MHA within a single NHS mental health trust. The MHA team provided ten consecutive cases organised by date of detention; two cases were excluded due to being minors, leaving eight cases. The reviews were completed by trained clinicians using NHS SJR methodology, to apply structured judgment and qualitative narrative across phases of care. We identified themes relating to routes to detention, (dis)engagement with services, quality of care and social context.

Most patients had psychotic diagnoses (schizophrenia or BPAD), with histories of multiple detentions. Patient-related themes included: disengagement from CMHT services, poor medication adherence, and substance misuse. Several patients experienced significant social adversity, including homelessness, socioeconomic deprivation, exploitation and limited support networks. Migration-related stressors, trauma and language barriers were also evident.

Regarding organisational factors, inpatient care was generally timely and of adequate or good quality, with appropriate multidisciplinary involvement. Transitions from inpatient to community care emerged as a consistent point of vulnerability. Communication difficulties between services, missed opportunities for assertive follow-up, inconsistent provision of interpreters, and delays in initiating substance misuse interventions were recurrent. In several cases, rapid relapse occurred within months of discharge, leading to repeated crisis presentations and subsequent detention.

Our analysis of the themes suggests that compulsory admission under the MHA disproportionately affect Black males due to cumulative interactions of clinical complexity, social deprivation and system-level gaps in care continuity, rather than care quality alone. Although our findings cannot establish generalisability or causation, they are supportive for the hypothesis that earlier, more tailored and integrated community care may reduce detention for Black men. Future work could practice on larger samples and lived-experience perspective to inform culturally responsive service models and ongoing MHA reform. The Trust’s Quality Committee welcomed the report, endorsed further exploration of the key theme, and agreed the recommendations would be progressed through relevant governance committees.

To determine if treating ADHD in a busy inner city GP practice reduces the workload of GP’S and reduces frequency of missed appointments

Data was collected from a GP surgery in Belfast which prescribes ADHD medication according to Shared Care Guidelines. Patients were excluded if they had been on ADHD medication for less than 12 months (as of November 2024) or if they had received a diagnosis from childhood. 19 Patients were found to fit the criteria. Data was collected to compare the number of missed appointments pre vs post ADHD diagnosis and treatment, as well as comparing the number of consultations which patients required related to their mental health.

Results from this Audit found that there was no significant difference in the number of appointments which patients missed in the 12 months before ADHD treatment and diagnosis compared to after. On the other hand, it was found that the number of GP Consultations related to Mental Health almost halved (37 to 19) in the 12 months after ADHD treatment and diagnosis compared to the 12 months before.

Findings indicate that the diagnosis and treatment of patients with ADHD, reduces the burden which they place on Primary Care services, not only in time spent with the GP but also contacting receptionist, practice nurse prescriptions etc, never mind the benefits for the patient and their loved ones.

A prescribing model was co-developed with consultant psychiatrists and pharmacist peers to establish the pilot clinic in June 2024. The pharmacy prescriber clinic was set up with an aim to reduce appointment wait times and improve efficiency. This study evaluated the pilot pharmacist prescriber clinic within a perinatal community mental health team from June 2024 to June 2025 using continuously collected quantitative and qualitative data. Patients and relatives attending face-to-face appointments were invited to complete anonymous feedback forms. The pharmacist held weekly clinics, providing pre-conception and follow-up appointments, managing urgent patient calls, and responding to queries from general practitioners (GPs), local mental health teams (LMHTs), consultants, and perinatal community psychiatric nurses (PCPNs). Clinical supervision was provided after each clinic by a perinatal consultant psychiatrist.

A quality improvement approach was used through the evaluation of the problem (longer wait times), stakeholder engagement, and continuous measurement in the planning and design of the pilot clinic. Data was collected on all consultations and interventions. Appointment wait times were the main outcome measure. Feedback was sought from patients, relatives, and perinatal colleagues.

Pre-conception wait times decreased from an average of 43.7 days (6.2 weeks) to 15.6 days (2.2 weeks). Across the study period, the pharmacist conducted 86 interventions: 20 pre-conception consultations, 10 follow-ups, 5 patient calls, 11 GP queries, 3 LMHT queries, 33 consultant/resident doctor queries, 3 PCPN queries, and 1 referral query. A total of 17 feedback forms were completed (11 patients, 5 partners, 1 supporter). Respondents unanimously agreed they were treated with dignity and respect, received the information they required, and found the pharmacist polite and approachable. Sixteen rated the consultation “very helpful”, and one rated it “quite helpful.” All rated the service as excellent. All respondents strongly agreed that they were provided with all the information they wanted and felt they needed. Colleague feedback highlighted that the clinic shortened wait times, improved consultant capacity to manage other complex issues, improved patient care and safety, provided comprehensive and valued information, and facilitated robust care planning. Consultants also reported that pharmacist clinic letters served as exemplars for training resident doctors and non-medical prescribers.

The pharmacist-prescriber clinic significantly reduced pre-conception wait times, released consultant time, and enhanced both patient care and safety. Initially launched as a pilot, the clinic has continued due to its demonstrable benefits, although future fundingarrangements remain under discussion.

To evaluate patient activity, clinical outcomes, and occupancy trends in a specialist inpatient psychiatric rehabilitation service over six years, with the goal of informing service delivery and quality improvement. The service (Maple House, Warrington) is a 23 bed high dependency rehabilitation unit for men with complex mental health needs due to mental illness and/or acquired brain injury.

A retrospective evaluation of routinely collected clinical data from April 2018 to April 2024 was undertaken. Key indicators included referrals, admissions, discharges, length of stay (completed and ongoing cases), patient demographics, diagnostic profiles, Mental Health Act status, discharge destinations, and clinical outcomes. Descriptive statistics were calculated, including median and mean length of stay, admission and discharge rates, and outcome distributions. Ongoing occupancy and patient length of stay were analyzed to identify trends in service utilization.

- Referrals and Admissions: 76 referrals were received, of which 38 were admitted (50%).

- Discharges: 23 patients were discharged during the period (42.4% of admissions). Completed cases had a median length of stay of 746 days (approximately 25 months), in line with the planned treatment and rehabilitation pathway of 18–24 months.

- Demographics and Diagnoses: Patients were men, mainly in the age group of 20-40 years, with complex psychiatric conditions, including schizophrenia (51%), Schizoaffective disorder(11%), intellectual disability/Autism(11%), bipolar affective disorder(7%), organic personality disorder due to acquired brain injury(7%), and comorbid substance misuse in 26% of cases.

- Clinical Outcomes: Most patients showed measurable improvements in functional abilities, risk reduction, and engagement, with 70% discharged to supported or independent living.

- Occupancy Trends: The unit frequently reached full capacity, with several ongoing cases exceeding three years of admission as of April 2024, highlighting challenges in managing long-stay patients.

The service delivers structured psychiatric rehabilitation for patients with complex needs, achieving clinical, functional and risk reduction outcomes largely within the intended treatment timeframe. Findings highlight areas for ongoing monitoring, including long-stay cases and occupancy pressures. This study is relevant considering the ongoing ACER study (Killaspy et al., 2021–2026) investigating the clinical and cost-effectiveness of in patient rehabilitation across the UK, reinforcing the need for further systematic evaluations in this area.

To ensure content of letters to GPs contain, diagnosis, treatment plan and staff involved

To see if letters are copied to patients

To see if clinic letters are sent out within a week

To see if GP letters are copied to patients

A review of three months clinic letters at an old age psychiatry service north of London was carried out to see if the letters were sent out within a week, copied to patients and included relevant information like diagnosis and management plan. A proforma was designed to collect the relevant information.

In the period 1st May to 31 July, 163 clinic letters were sent out. The mean age of patients was 76.4 year and there were 96 (58.9%) female patients. In terms of diagnoses in the letters, 79 (48.5%) had dementia, 52 (31.9%) had depression and 14 (8.6%) had psychotic disorder (schizophrenia or delusional disorder). A management plan was included in 153 letters and 160 clinic letters were copied to patients or their carers.

11 of the 163 (6.7%) clinic letters were sent later than 7 days of clinic appointments

Areas of Good Practice:

All clinic letters except three were copied to patients

Over 90% of clinic letters were sent within a week of clinic appointment

Areas of Improvement:

To achieve the desired goal of 100% of clinic letters being sent out within a week.

It is expected with improving information technology, letters will be uploaded onto patients’ primary care records electronically and become immediately accessible to both patients and general practitioners once sent. This is already the case in many practices locally and will give a more accurate picture of when clinic letters are received. The disadvantage will be for those patients and carers who do not have internet access or IT skills to access their primary care records