This re-audit aimed to evaluate the Ageless Psychiatric Liaison Service (PLS) by: (1) assessing older adult (OA) and working age adult (WAA) referrals in terms of source, triage, assessments, and outcomes; (2) evaluating psychiatric admissions, including reasons for admission, senior medic involvement, observation levels, medical clearance, and bed management; and (3) appraising alternatives to admission, such as referrals to Crisis House and Home Treatment Teams (HTT).

A retrospective review was conducted over three months (April–June 2025) using electronic psychiatric (SystmOne) and hospital (EPIC) records. A random sample of 50 patients (25 OA, 25 WAA) was selected, with two young-onset dementia cases included in the OA group. Data were extracted systematically using a structured Excel sheet capturing referral details, clinical assessments, management, and outcomes.

WAA presentations predominantly involved acute psychiatric crises, including self-harm and suicidal ideation, with short hospital stays (mostly 1–2 days) and low observation requirements. Referrals were primarily crisis-driven, with 88% medically optimized for discharge at the time of referral, and were largely managed through a nurse-led model by Band 6 and 7 nurses. Most WAA patients were discharged to community services, including HTT, CMHRS or GP with only a small proportion requiring acute hospital admission.

In contrast, OAA presentations were more complex, involving cognitive, behavioural, and medical comorbidities, resulting in longer and more variable hospital stays and needing one-to-one nursing in nearly half of cases. Management was multidisciplinary, involving old age specialists, Band 7 nurses, and PLS medics in 92% of cases. Half of OAA patients were referred to CMHT-OP for ongoing management, while 20% awaited psychiatric admission due to limited bed availability. Delays in transfer to psychiatric beds ranged from 23 hours to 21 days, reflecting a scarcity of psychiatric beds.

The re-audit highlighted effective nurse-led crisis management for WAA, whereas OAA patients presented with complex needs requiring multidisciplinary input and longer hospital stays. The lack of an established older adult crisis pathway contributes to reliance on CMHT-OP and prolonged admission. These findings underscore the need for tailored crisis pathways and resource allocation to better support the complex needs of older adults while confirming the efficiency of current approaches for working-age patients. The PLS ageless model and mix of clinicians of various experience and background need to reflect the patient population that is served. There is a clear need for WAA and OA specialism within the ageless model.

Patients with Emotionally Unstable Personality Disorder (EUPD) are frequently admitted to acute psychiatric wards during periods of crisis. However, concerns have been raised regarding prolonged admissions, delayed discharge, and potential iatrogenic effects of high-containment care. This service evaluation aimed to compare length of stay (LOS), observation requirements, and discharge outcomes for patients with EUPD versus non-EUPD patients admitted to an acute female ward, and to explore factors contributing to prolonged admission.

A retrospective service evaluation was conducted of all admissions to a 15-bed acute female psychiatric ward over a 12-month period. Patients with an ICD-10 diagnosis of EUPD (n=19) were compared with non-EUPD admissions (n=54). Data were extracted fromclinical records, incident reports, and discharge documentation, including LOS, observation levels, incident patterns, and placement outcomes. One fully anonymised illustrative vignette was included to demonstrate a commonly observed clinical trajectory. No patient-identifiable data were collected.

Patients with EUPD demonstrated substantially longer admissions than non-EUPD patients, with a median LOS of approximately six months (range 3–18 months), compared with 4–8 weeks in the non-EUPD cohort. Nearly all EUPD patients required enhanced observations, including one-to-one nursing, at some point during admission, often recurrently. Attempts to reduce observation levels were frequently followed by behavioural escalation, particularly during periods of planned discharge or placement identification. Placement pathways were commonly delayed or disrupted due to ongoing risk behaviours, high observation requirements, or withdrawal of placement offers following incidents. These patterns were consistently observed across the EUPD cohort and contrasted with shorter, more linear admission pathways in non-EUPD patients.

Prolonged acute inpatient admissions among patients with EUPD appear to be driven less by illness severity and more by systemic and environmental factors within high-containment settings. Risk-averse observation practices may unintentionally reinforce dependency, contribute to behavioural escalation around transitions of care, and impede discharge planning. These findings highlight the need for alternative models of crisis support, clearer step-down strategies, and greater caution in interpreting functional assessments conducted within acute inpatient environments.

The use of seclusion in intellectual disability services presents significant ethical and emotional challenges for staff. While the impact of restrictive practices on patients has been widely explored, there is limited literature examining the potential for moral injury among staff involved in delivering seclusion. This service evaluation aimed to explore the nature of moral injury experienced by staff involved in seclusion within an intellectual disability assessment and treatment unit (ATU), alongside perceived contributing factors, available support, and coping strategies.

An exploratory mixed-methods service evaluation was conducted in an intellectual disability assessment and treatment unit. Anonymous staff surveys were used to collect both quantitative and qualitative data. Quantitative data were gathered using a modified moral injury rating scale to explore levels of moral distress and wellbeing. Qualitative data were obtained through free text responses exploring staff experiences of seclusion, including ethical dilemmas and emotional responses. Quantitative data were analyzed descriptively, and qualitative data were analyzed using thematic analysis.

Findings suggest that staff involved in the use of seclusion may experience features consistent with moral injury. Key themes included the emotional impact of enforcing restrictive practices, perceived lack of autonomy within organisational systems, repeated or prolonged use of seclusion, and limited opportunities for structured debriefing and reflective practice. Staff described tensions between professional values and organisational demands, alongside variable access to psychological and supervisory support.

This service evaluation highlights moral injury as a potential occupational risk for staff involved in seclusion within intellectual disability services. Addressing moral injury through reflective spaces, supervision and organisational support may be important in promoting staff wellbeing, reducing burnout, and maintaining standards of patient care. Further work is warranted to better understand moral injury in restrictive practices and to evaluate interventions aimed at mitigating its impact.

Maternal health encompasses wellbeing before, during, and after pregnancy, with thepostnatal period critical for physical and psychological recovery. Prevalence of postnatal depression (PND) is higher in Pakistan (28-63%) compared to the United Kingdom (UK) (15-20%).

This study aims to compare PND prevalence among Pakistanis, British Pakistanis, and the wider UK population in line with three objectives:

1) Exploring cultural factors influencing PND

2) Identifying factors driving higher prevalence in Pakistan

3) Evaluating support structures while proposing culturally sensitive interventions

This study combines a comparative narrative review of secondary sources with primary qualitative input. Epidemiological data and government reports were synthesised to compare prevalence and healthcare systems. Additionally, clinician perspectives were collected as a podcast providing cultural context. Short films were also interpreted to illustrate societal attitudes towards maternal mental health and explore lived experiences.

PND is influenced by the biopsychosocial model with cultural stigma, somatisation, and barriers to care being key drivers in Pakistan. Severe workforce shortages (0.19 psychiatrists per 100,000 compared to 11 per 100,000 in South London), high home birth rates (63%), and lack of routine postnatal checks exacerbate risks. Traditional practices like Chilla offer post-partum support but should be supplemented with structured services similarto the UK which provide postnatal checks and specialist mother and baby units (MBUs), although access remains unequal across the UK. Funding disparities persist with Pakistan allocating only 0.4% of its health budget to mental health compared to 8.1% by NHS England. These systemic gaps highlight the need for integrated and culturally sensitive approaches that address both clinical and societal factors of care.

Improving maternal mental health requires strategies combining psychiatry, public health, and cultural awareness. Recommendations include tailored cultural psychiatry training for UK professionals, increased funding for maternal mental health in Pakistan, and stigma reduction campaigns. Bridging clinical care and lived experience can reduce inequalities and enhance maternal wellbeing globally.

• • To evaluate the referral patterns and uptake of the ECT service in relation to patient demographics and diagnosis.

• • To assess referrers’ experiences of the ECT referral process and identify barriers influencing referral quality and access.

• • To determine patient outcomes following ECT and evaluate the overall effectiveness of this treatment modality.

A retrospective longitudinal design was used. Case records for all patients referred for ECT between 01/04/2022 and 31/03/2023 were reviewed, forming a complete 12 month cohort. Demographic, clinical, and referral information was extracted from electronic patient records, and each case was followed for two years to assess longerterm outcomes. Data were collated using a structured Microsoft Excel tool prior to analysis.

Seventy patients were referred during the evaluation period. Forty nine completed treatment (69%), eight declined despite being assessed as suitable, and twelve referrals were screened out–primarily due to administrative errors where ECG referrals were mistakenly submitted as ECT requests. Referrals were predominantly female (48 vs. 22 males), with most patients aged 55 or older. Ethnicity analysis showed a majority of White British patients (n=48), with lower representation from minority ethnic groups. Most referrals originated from the MHSOP inpatient acute team (n=26). Waiting time analysis showed that 36.2% of patients waited more than 10 days from referral to treatment. Diagnostic profiles were dominated by severe depressive episodes, particularly psychotic depression (n=19). Short term outcomes were strong, with 73.5% maintaining improvement at one month. The highestrelapse risk occurred between 1–6 months, with maintained improvement falling to 49% at six months. At two years, 51% remained well, although attrition increased to 20.4%.

A robust continuation plan is needed between the 1 to 6 months post ECT which is consistent with known patterns where ECT response can fade. Also in practical terms, the post ECT outcome data points to it being effective for acute episodes, but maintenance of gains is not automatic and depends on timely continuation pharmacotherapy, structured relapse-prevention planning, psychological and social supports, and for some patients, continuation/maintenance ECT. Service level findings indicate opportunities to improve referral accuracy, reduce pathway delays, address demographic disparities, and strengthen patient education and referrer training to enhance accessibility, efficiency, and clinical effectiveness

This study aimed to quantify the clinical performance of the Tryweryn ward (PICU) in Heddfan Psychiatric Unit, Wrexham, North Wales against the data available nationally in the 2021 National Survey of PICUs. Our objective was also to evaluate how unit infrastructure; specifically, the presence or absence of a dedicated on-unit seclusion suite affects the frequency of restrictive physical interventions (RPI) in the two PICUs in North Wales (Tryweryn ward with no seclusion suite and Taliesin ward with a dedicated seclusion suite).

A retrospective analysis was conducted on admission data over an 18-month period (N=190) at Tryweryn ward (PICU) in Wrexham. Data collected was on gender, legal status, diagnosis, and length of stay (LoS) and discharge/transfer destination. These were compared to nationally available data in previously published literature from PICUs in England. Additionally, a 13-month data (August 2024–August 2025) compared the number of restrictive physical intervention episodes in Tryweryn ward PICU with no seclusion suite versus such episodes in Taliesin Ward (PICU with dedicated seclusion suite).

Tryweryn Ward PICU data demonstrated high alignment with nationally available data for mean LoS (36.55 days vs. national 36.57 days) and primary diagnosis, with 58% of patients admitted in psychotic crisis. Gender distribution showed a higher female representation (37%) compared to the 20% national average. Legal acuity was high, with 88% of patients detained under Section 2 or 3 of the Mental Health Act.

Comparative data on restrictive practices revealed a significant disparity:

• • Seclusion: The PICU with dedicated seclusion suite (Taliesin Ward) recorded 22 such episodes, whereas the unit without (Tryweryn) recorded only 2, utilizing off-unit Section 136 suites or transfers out of the unit for such a need.

• • RPI: The ward with seclusion suite recorded 352 total RPI incidents versus Tryweryn ward incidents (139 incidents).

• • Monthly Variation: In the final month of the data collection, RPI incident number peaked at 82 incidents in the PICU with seclusion, compared to 7 in the PICU without.

Our PICU with no seclusion suite facility in North Wales effectively mirrors the nationally available data regarding intensive care psychiatric practice. The utility of seclusion suites remains debatable on the issue whether such suites contribute to any reduction in restrictive physical intervention practices or not.

Recreational ketamine use and treatment-seeking for associated complications is increasing in England. Complications of ketamine dependence can be debilitating, leading to continued dependence and surgical intervention. However, treatment remains under-researched, with lacking understanding of those seeking treatment or requiring specialist inpatient detoxification. This study aims to analyse demographic and clinical characteristics of an inpatient ketamine detoxification population in the north of England between January 2016 and September 2025, with the aim to inform public health strategies and aid prevention efforts.

This retrospective cross-sectional study was conducted using routinely collected clinical data for patients that attended for ketamine detoxification at the Chapman Barker Unit (CBU), a regional specialist inpatient detoxification treatment service in Greater Manchester, UK. Patients were identified using clinical logbooks and the Patient Registration and Information System (PaRIS). The primary analysis included 59 patients admitted for ketamine detoxification. Comparative analyses were conducted between the ketamine-only detoxification patients (n=23) and the ketamine plus polysubstance detoxification patients (n=36) to explore the relationship between ketamine dose and physical harms.

Ketamine detoxification admissions increased between 2016 and 2025. One third occurred between January and August 2025. Most patients were male, younger, WhiteBritish, heterosexual, single and unemployed with traumatic experiences and criminal justice involvement. Mean age of ketamine use was 18 years with 5.2 years of usage. Most inhaled ketamine, and mean daily usage was 5.4g, with higher dose in those experiencing lower urinary tract symptoms. Anxiety, depression, suicidal ideation and past suicide attempts were common, along with concerning urological pathologies in particular ketamine bladder syndrome, cystitis, nasal damage and hydronephrosis. Cravings and anxiety were common withdrawal symptoms. Alanine transaminase (ALT) levels increased from admission to discharge. Ketamine-only detoxification patients were more likely to be single, use higher ketamine doses, inhale ketamine, experience depression, have ketamine bladder syndrome and hydronephrosis. PTSD was more prevalent in polysubstance patients. Diazepam reducing regimes were the standard detoxification approach. Most patients completed detoxification.

Ketamine detoxification admissions are increasing, with a predominantly young population with prolonged high-dose ketamine usage, associated urological pathology and hepatic injury. Specialist inpatient detoxification is successful, and further evidence-based treatment and relapse prevention protocols are required. Targeted public health campaigns should raise awareness of the physical, psychological and social harms associated with ketamine dependence.

To assess the impact of a pilot project, which aimed to improve access to emergency healthcare for inpatients of mental health hospitals, by collecting qualitative feedback from clinicians and patients.

Patients admitted to mental health inpatient wards often have significant chronic health comorbidity and a reduced life expectancy by 15-20 years with challenges in the provision of physical health care in these settings. A pilot project ran between December 2024 – May 2025 whereby the Psychiatric duty doctor discussed patients with acute physical health needs with the Remote Access Emergency Coordination Hub (REACH), rather than calling 999. The patient was either conveyed to the ED, the Physician Response Unit (PRU) was dispatched, or they were managed with alternative follow up arranged by the REACH. REACH received 62 phone referrals in 6 months and of these only 14 were ultimately conveyed to ED.

Feedback was gathered during the 6 month pilot project by disseminating questionnaires to the REACH, PRU and mental health clinicians. General comments were organised into themes. Appropriate patients who had contact with the pathway were contacted via telephone, 3 patients were able to provide feedback.

Key themes that emerged were; high quality appropriate referrals, good clear handover, good approach to security and safety, clearly communicated plans from PRU, integration between physical and mental health care, importance of access to ED senior clinician, increasing scope of service and improving patient care.

Patient recollection of been seen by PRU was limited due to them being acutely unwell at the time.

This is an important service, integrating physical and mental health care to improve outcomes for a vulnerable group of patients. The process of referring to REACH was clear and the plans well communicated. The majority of the emergency department team felt the referrals from the psychiatry duty doctor were appropriate, of good quality and received an adequate handover. It is important for PRU staff to be met by a staff member from the mental health unit to ensure safety and security. Poor patient recollection of the service highlights the medical and psychiatric complexity of the patients PRU/REACH were contacted about.

This service evaluation reviewed the distribution of intramuscular and intranasal naloxone between January 2025 and January 2026 within Richmond Community Drug and Alcohol Services, as part of a harm reduction approach for people with opioid use disorder. Naloxone is a well-established opioid antagonist used to reverse opioid-related respiratory depression in emergency situations. The evaluation was particularly relevant to the London Borough of Richmond upon Thames, where drug-related deaths continue to occur despite lower prevalence overall, and where polysubstance use and exposure to potent synthetic opioids increase the risk of overdose among people accessing local services.

A retrospective review of anonymised naloxone distribution records was undertaken, capturing all kits issued over the 12-month evaluation period. Data included the total number of kits provided and the formulation supplied, either intramuscular or intranasal. Naloxone was offered in line with UK national guidance to people using opioids alone or with others, individuals who inject drugs, those assessed as being at increased risk of overdose, and people likely to witness an overdose. Distribution was supported by brief, practical harm reduction advice. This focused on using low doses and increasing gradually, especially when using a substance for the first time, allowing time for effects to be felt, and recognising that drugs may act at different speeds or vary in strength despite similar appearance. Individuals were also encouraged to inform others when using substances, access buddy or telephone support if using alone, and seek emergency medical help when concerning symptoms occurred. Findings were summarised using descriptive analysis.

During the evaluation period, a total of 237 naloxone kits were distributed. Of these, 75 kits (31.6%) were intramuscular naloxone, and 162 kits (68.4 %) were intranasal naloxone. Intranasal naloxone accounted for the majority of kits provided. This reflects its ease of administration, lower risk of needlestick injury, and suitability for use by people without medical training. Distribution occurred within a population characterised by established opioid dependence, where polysubstance use and exposure to synthetic opioids were an identified risk.

This evaluation supports sustained naloxone distribution as an effective harm reduction measure, with intranasal naloxone facilitating wider access and rapid overdose response. Given its short duration of action, repeat dosing and urgent medical assessment remain essential, particularly with long-acting or synthetic opioids.

Prolonged waiting times for ADHD assessment in child and adolescent mental health services (CAMHS) present a significant challenge. While outsourcing can address immediate waiting list pressures, it may simply shift the bottleneck back to the core CAMHS service. This service evaluation aimed to examine the effectiveness and cost implications of the in-house waiting list model in West Galway CAMHS, with a view to informing management decisions on developing and appropriately resourcing the team for sustainable long-term service delivery.

This service evaluation reviewed CAMHS patients from West Galway who were awaiting ADHD assessment between January 2025 and January 2026. A random sample of 30 patients managed via the in-house waiting list initiative was compared with 28 patients managed through an outsourced model. Outcomes assessed included time to assessment, discharge to GP (without transfer to core CAMHS), diagnosis rate, and subsequent need for CAMHS follow-up. Data were analysed using simple descriptive comparisons to explore differences in service outcomes between the two models.

Direct comparison of time to assessment was limited by differences in team structure and staffing: the in-house waiting list team was newly established and consultant-led, while the outsourced model comprised a well-established external agency with longstanding experience in the UK. Notably, 70% of patients in the in-house team were discharged back to their GP without transfer to core CAMHS, compared with 0% in the outsourced group. Consequently, only 30% of in-house patients required ongoing CAMHS follow-up, versus 100% in the outsourced model. Diagnosis rates are currently being further analysed to examine the detection of comorbidities. These preliminary findings suggest that while outsourcing addresses immediate assessment capacity, the in-house model may offer opportunities for developing a sustainable, consultant-led service with longer-term oversight, provided adequate resourcing.

This service evaluation highlights that a well-structured in-house waiting list team has the potential to improve downstream flow to the core CAMHS service, reducing the secondary bottleneck and minimising repetition of work through clear, consultant-led care plans. Effectiveness is dependent on having the right staffing skill set and staff-to-patient ratio, as limitations in these areas impact throughput, consistency, and the ability to meet service expectations across teams. These findings suggest that appropriately resourced, consultant-led in-house services could provide sustainable improvements in assessment and care delivery, supporting the case for expanding the service.

There are significant challenges to providing psychiatric care to people on the migratory route in Central America, including the low probability of face-to-face follow-up. However, there is a clear need for psychiatric care, for both pre-existing psychiatric conditions, and new onset conditions, some related to stressors experienced on the migratory route.

There is no literature providing clear guidance as to how to provide psychiatric care to people on the move. Therefore, this quality improvement project had the following aims:

1. To provide clinicians with greater clarity as to whether to offer psychiatric medication to people on the move

2. To improve continuity of care for people on the move taking psychiatric medication

Through a consultation process, four Médecins Sans Frontières (MSF) psychiatrists created five flowcharts to aid clinicians in assessing the benefits and risks of providing psychiatric treatment to a person on the move, in collaboration with the person. The flowcharts were piloted by clinicians, evaluated, and improved in a second cycle of change.

In consultation with mental health teams and patients from MSF’s projects across the region, a migrant health package was created, including psychoeducation leaflets, detailed medication labels, a regional map of clinics (MSF and non-MSF) providing psychiatric care on the migratory route, and a referral form. The package was implemented across four of MSF’s project sites.

A survey revealed that the flowcharts improved clinician confidence in deciding whether it was appropriate to prescribe psychiatric medication to people on the move.

In 2023, 78 patients were provided with the migrant health package. There were challenges in assessing whether the intervention increased continuity of care, as in many cases contact with the person was lost, and currently there is no regional patient database across MSF projects. However, of the 78 patients, 21% (16) were confirmed to successfully receive follow up at a clinic further along their route.

The project provided clarity for clinicians as to when it is appropriate to offer psychiatric medication to a person on the move. Further work is needed to evaluate whether the migrant health package improves continuity of care for people on the move receiving psychiatric care from MSF in Mexico and Central America. However, at least 21% of patients provided with the package were able to access face-to-face follow up following initial contact.

Cerebral Amyloid Angiopathy (CAA) is a type of vascular disease present in more than 80% of confirmed Alzheimer’s disease patients. It is characterized by the presence of Amyloid-β protein deposited within the walls of vessels which results in various clinical presentations including vascular rupture of fragile amyloid-β laden vessels. Over the past 5 years, there has been a reported significant increase in publication, diagnoses, and referrals of CAA.

In our memory service, features of CAA including peripheral microhaemorrhages and superficial siderosis were reported in 28% of MRI’s requested in the past year, with CAA specifically mentioned in 50% of those. This therefore poses several challenges on a memory service regarding how these should be interpreted and how they may affect the patient’s management plan, including how the patients stroke primary prevention should be reviewed in this setting, which will be outlined in this poster.

CAA and Alzheimer’s disease (AD) frequently co-occur due to their shared proteinopathy and both diseases share impaired clearance through perivascular drainage pathways as a primary pathogenic mechanism. However, they differ in location of protein deposition and peptide composition. Their clinical overlap is critical for memory services, as CAA accelerates cognitive decline through mechanisms such as white matter structural disconnection and microinfarction, even in the absence of acute haemorrhage.

The emergence of anti-Amyloid monoclonal antibodies also makes CAA awareness mandatory. These treatments can trigger Amyloid-Related Imaging Abnormalities (ARIA), which represent an iatrogenic form of CAA-related inflammation. Pre-treatment screening with MRI is essential and current guidelines suggest that patients with features of CAA including microbleeds and cortical superficial siderosis should generally be excluded from these AD therapies due to high ARIA risk.

For patients diagnosed with CAA, aggressive vascular risk factor control is paramount to reduce recurrent haemorrhage risk. In patients with probable CAA, clinicians should exercise caution with anticoagulants, statins, and regular NSAID use, as these may exacerbate haemorrhagic risk in high-burden, and antiplatelet treatment for primary prevention is not recommended. This suggests improved collaboration between stroke and cognitive specialists is necessary to manage the complex balance between ischaemic prevention and haemorrhagic risk.

Increasing awareness of CAA among doctors, including within memory services, is vital for accurate diagnosis, risk stratification, and the safe implementation of emerging AD therapeutics. This poster outlines the current evidence on the pathophysiology of CAA, including its overlap and differences with AD, and its current and future implications focussing on a memory service.

Administration of clozapine is challenging in treatment-resistant schizophrenia (TRS) patients who refuse to take it orally; enforced treatment with clozapine, either naso-gastrically (NG) or intramuscularly (IM), may be required in such situations. There are a few existing case-series and reports in this area. This service evaluation aimed to add to this pool of data and to understand the illness profile of patients who received IM clozapine, tolerability, their longer-term outcomes etc.

The evaluation was of a retrospective longitudinal observational nature and included all patients under the care of Mersey Care NHS Foundation Trust who were prescribed IM clozapine from 01/01/2017 till 31/12/2023. Pseudonymised data was derived from the patient records.

The sample included a total of 30 patients. All patients suffered from chronic psychotic illnesses. Average duration of psychotic illness prior to being prescribed IM clozapine was 19 years. 80% of patients were in seclusion or segregation at the time of IM clozapine being prescribed. Over 40% patients suffered from cardiometabolic or other physical comorbidities. 21 of the patients (70%) belonged to the initiation group and were prescribed IM clozapine to initiate and establish the patient eventually on oral clozapine. 10 (47.6%) of them accepted oral clozapine without receiving any injections. 9 of the patients (30%) belonged to the maintenance group and were prescribed IM clozapine as an adjuvant to maintain their compliance. A total of 428 doses of IM clozapine were given in the study to 17 patients, and each dose was given as 1-2 injections. 7 patients (41.2%) who received IM clozapine developed injection-site nodules or lumps without abscess; average number of doses received was 43. 10 patients (52%) required restraints by PMVA-trained staff; these were uneventful. Around 90% of patients in the initiation group were established on oral clozapine at end of follow-up. Around 2/3rds of patients in the initiation group who established on oral clozapine had seclusion/ segregation terminated, moved to lower securitymeasures and were on clozapine at time of discharge.

Administration of IM clozapine is fairly safe and well tolerated and it should be prescribed in patients earlier in their course of treatment-resistant-schizophrenia where oral compliance is not possible: nearly half of initiation group accepted oral clozapine without a single IM injection, improvement in patient outcomes was noted and majority were established on oral clozapine. Rotation of injection sites is recommended to prevent and avoid injection site nodules.

Insomnia is common in people with neuropsychiatric conditions and causes distress, cognitive difficulties, and functional impairment. Although NICE recommends behavioural interventions such as CBT-I as first-line treatment, no structured non-pharmacological insomnia programme currently exists within neuropsychiatry services in Kent. To address this, we developed the Triangle of Sleep: a clinician-led, structured psychoeducationprogramme delivered in a guided self-help format, integrating sleep hygiene, daytime routine restructuring, and mindfulness body scanning.

Patients were invited to three weekly 1-hour clinician-led online group sessions combining psychoeducation, discussion, and reflective between-session tasks. Outcomes were measured using the Pittsburgh Sleep Quality Index (PSQI) at baseline and 2-month follow-up. Demographics (age, gender), diagnoses, and baseline sedative/activating medications were recorded. Two cohorts have completed the programme (October 2025; January 2026), with a final cohort scheduled for March 2026.

Cohort 1 (n=3):

Patient 1: 41-year-old female with functional neurological disorder, non-epileptic attack disorder, chronic fatigue syndrome, fibromyalgia, migraine, and past depression/anxiety (pregabalin, nortriptyline, fluoxetine, tapentadol). Baseline PSQI showed poor sleep maintenance, prolonged wake times, and frequent nocturnal symptoms (pain, nocturia, jerky leg movements). Post-intervention, sleep duration increased 4→5 hours and wake time shifted earlier (12pm→11am). Sleep quality remained “fairly poor,” but she reported “slight improvement.” Jerky movements and nocturnal confusion reduced from “≥3 times/week” to “1–2 times/week.”

Patient 2: 54-year-old female with functional neurological disorder, fibromyalgia, chronic fatigue syndrome, migraine, depression/anxiety features, and OCD (no sedative/psychotropic medication). Baseline PSQI indicated fragmented sleep, contributed by pain and nocturia (≥3times/week). After the programme, sleep latency reduced (20→15 min), sleep duration increased (8→8.5 hours), and subjective sleep quality improved (fairly bad to fairly good), though pain/nocturia persisted.

Patient 3: 36-year-old male with relapsing-remitting multiple sclerosis and mixed anxiety/depressive disorder (gabapentin, sertraline, carbamazepine, baclofen) did not complete PSQI but reported improved sleep routine/initiation and reduced daytime cognitive fatigue.

Cohort 2 (n=8): baseline data collected; follow-up PSQI due March 2026.

This is the first clinician-led structured psychoeducation sleep programme in Kent’s neuropsychiatry service. Early findings suggest feasibility, acceptability, and potential benefit for sleep onset/maintenance and subjective sleep quality. PSQI data highlight persistent contributors (pain, nocturia, motor symptoms) needing integrated management alongside behavioural input. In Patient 1, improvements in jerky movements and nocturnal confusion coincided with concurrent attendance to the non-epileptic attack disorder group in our service, suggesting possible synergistic benefit. Future work could adapt this p into a web-based platform with AI-support to improve scalability where specialist sleep provision is limited.

Aggression in psychiatric inpatients is a frequent challenge that threatens staff safety and patient well-being. Although guidelines recommend verbal de-escalation as the first-line approach, restrictive practices such as chemical and physical restraints are often overused.

A retrospective review of patient records was conducted at the Services Hospital Lahore psychiatry ward (January–June 2022). Data were compared against NICE NG10 and Maudsley prescribing guidelines.

A total of 30 inpatients were included (66.7% male, mean age 35.4 ± 11.6 years). Diagnoses included substance-related disorders (50%), schizophrenia/psychosis (40%), mood disorders (10%), and dissociative disorders (10%). All patients (100%) were managed with chemical restraints as first-line intervention; 20% also required physical restraints. None received verbal de-escalation first. Reasons included fear of patient violence (40%), rapid availability of medication (40%), and lack of staff training (20%).

There is systemic over-reliance on chemical restraints in this setting, with minimal use of evidence-based de-escalation. Staff training and guideline adherence are urgently required.

The purpose of this thematic review was to analyse and explore the underlying factors contributing to differences in mortality rates among service users from different racial and ethnic groups within South West London and St George’s Mental Health NHS Trust (SWLStG), specifically in ethnic minority groups. By systematically examining deaths occurring under the care of the Trust, the review aimed to identify recurring themes, potentially to inform recommendations to reduce inequalities and improve patient safety.

Information was collected on all reported deaths between February 2025 and April 2025 of service users under the care of the Trust’s mental health services. A total of 145 deaths were reported and included in the review. Incident reports were extracted from Ulysses. Demographic and clinical information was checked and verified using RIO, including recorded ethnicity, progress notes, and relevant clinical and risk assessment documentation.

Of the 145 deaths reviewed, most occurred among White British (66%) or “other white” service users (10%), and of confirmed or suspected suicides, 73% were from white British or “other white” service users. 6.21% of service users’ ethnicity was unknown. Most deaths (84%) were due to natural causes, often at relatively older ages and in the context of significant physical health comorbidity. A proportion of deaths occurred following loss of contact with services, due to patient disengagement or during transition between mental health teams. There was limited information available for some deaths, making cause and circumstance unclear. Variation in service engagement and clinical documentation was observed across teams. Most service users had a documented mental disorder, most commonly cognitive decline or dementia (27%) and mixed anxiety and depression (25%). Among patients who died by possible suicide, 31.8% had a history of drug or alcohol dependence. No clear ethnicity-specific themes were identified, with interpretation limited by the small sample size.

This review highlights that most deaths among mental health service users were due to natural causes and were associated with physical health comorbidities. Recurrent themes included disengagement from services, communication gaps during care transitions, and variable documentation. Although ethnic minorities were a small proportion of the sample, evidence of lower access of these populations to mental health services remains relevant. Improving consistency of ethnicity recording, clinical documentation, engagement with service users, as well as strengthening communication between services, is indicated.

Background

Psychotherapy competencies form a core part of psychiatry training, yet access to psychotherapy-related learning opportunities is often limited, particularly within inpatient psychiatric settings. Trainees and students working on inpatient wards may have fewer opportunities to observe or practise psychologically informed approaches, despite the centrality of formulation, therapeutic relationships, and reflective practice in this context. Teaching models that offer exposure to applied psychotherapy-related skills across varied training grades may help address this gap in everyday inpatient care.

Aims: To evaluate a regular lunchtime, case-based discussion group designed to support the development of psychotherapy-related core psychiatry training competencies, and to explore participants’ perceptions of its usefulness, educational impact, and influence on engagement with psychiatry as a specialty.

A fortnightly 50-minute lunchtime case-based discussion group was established at an inpatient psychiatric hospital in Leeds and was open to medical students and resident doctors of mixed grades. Sessions were centred on cases brought by participants, with facilitated discussion focusing on psychological formulation, therapeutic relationships, and the application of psychotherapy-related concepts to inpatient clinical work. Anonymous post-session feedback was collected using Likert-scale measures assessing perceived usefulness, impact on engagement with psychiatry, and influence on interest in psychiatry as a specialty. Participants also indicated which psychotherapy-related core psychiatry curriculum key capabilities they felt were addressed during the group. Data were analysed descriptively.

Across four fortnightly groups, a total of 13 participants completed feedback. Mean ratings were high across all measured domains, with an average score of 5.8 for perceived usefulness, 5.7 for increased engagement in psychiatry, and 5.4 for increased interest in psychiatry as a specialty (Likert scale 1–6). Of the 16 psychotherapy-related core psychiatry curriculum key capabilities listed, participants reported that an average of 10 were met per group, indicating broad perceived alignment with curriculum requirements.

This evaluation suggests that a regular, lunchtime, case-based discussion group may offer a feasible and acceptable way of supporting the development of psychotherapy-related competencies within an inpatient psychiatric setting. By providing trainees and students of varied grades with structured exposure to applied psychotherapy-related skills in the context of inpatient work, such groups may help bridge the gap between formal psychotherapytraining and everyday clinical practice. As a low-resource and inclusive teaching model, this approach may usefully complement existing training pathways.

Mindfulness, Meditation and Yoga have an evidence base for improving emotional regulation – with little research looking at the impact on a Borderline Personality Disorder (BPD) cohort. We investigated whether a supplementary session programme could improve emotional regulation and thus symptomatology in BPD service users.

Our initial objective is to identify whether there is an evidence base to support the need for a ‘Mind, body connection’ programme. The subsequent objective is to further develop and improve the ‘Mind, body connection’ programme in response to feedback from the service users.

AIM 1. To establish whether there is benefit from a ‘Mind, Body connection programme’.

AIM 2. To establish further understanding of the holistic effects of the ‘Mind, body connection’ programme for service users.

Future AIM 1. To identify direct benefits of Yoga, Mindfulness and Meditation in BPD populations.

Future AIM 2. To develop a science backed programme to provide a supportive therapeutic practice for BPD patients.

A Thematic analysis was conducted to investigate the ‘Mind, Body Connection’ sessions with service users attending a bi-weekly Therapeutic Community at the Personality Disorder Hub. A 50 minute tape-recorded, in-depth, semi-structured interview took place which was then transcribed to allow for coding.

The theme of 'Greater Capacity to stay present' summarises how greater 'emotional regulation' and 'body awareness' can develop. Both ‘body awareness’ and emotional regulation’ proved to be double edged swords. By developing greater awareness of how your body holds emotions, participants reported greater ability to focus on the body and stay in control of emotions, but also a greater awareness of pain. Service users oppositions - transitioning from a state of doing to a state of being and difficulty around ‘self-dismissing’. Results were bidirectional - higher levels of emotional dysregulation impaired mindfulness practice but increased frequencies of mindfulness practice to >3 times a week was statistically significant in reducing emotional dysregulation symptoms.

The ‘Mind, Body Connection’ programme has a positive impact on service users – but significant support should be provided for its associated challenges. Recommendations; increasing the frequency of Yoga, Mindfulness and Meditation practice to>3 times per week, at home resources and guidance change to the management of BPD (development of patient informed supplementary sessions). Practice in the present underscores the ability to stay present in higher states of arousal in the future. Further research should investigate the process of ‘self-dismissal’ as a regulation adjacent skill.

Stable housing is a key determinant of mental health outcomes. Discharge from acute psychiatric inpatient services into temporary accommodation may reflect system pressures and can threaten recovery, continuity of care, and social stability. Despite this, limited data is available on discharge to temporary accommodation among psychiatric inpatients.

This service evaluation aims to describe patterns of discharge to temporary accommodation from acute adult inpatient psychiatric wards within one NHS Trust during the 2023–2024 financial year. We identified the types of temporary accommodation used, associated psychiatric diagnoses, and patient demographics.

All patients discharged from acute adult inpatient wards to temporary accommodation between April 2023 and March 2024 were identified. We reviewed electronic patient records to identify primary diagnosis, discharge destination, and patient demographics. Temporary accommodation was grouped into categories including bed and breakfast (B&B) or hotel, supported living, care homes, and other temporary housing. Descriptive analysis examined distributions across accommodation type, diagnosis, and demographics.

During the 2023–2024 financial year, 146 patients were discharged from acute adult inpatient mental health wards to temporary accommodation. Psychotic disorders were the most common diagnosis (n=77), followed by personality disorders (n=38) and non-psychotic affective disorders (n=16). The remaining patients had diagnoses including dementia, anorexia nervosa, substance use disorders, or no recorded mental disorder.

Over half were discharged to B&B or hotel placements (n=77). Other discharge destinations included family or friends (n=27), interim housing (n=14), supported living (n=9), care homes (n=8), or no fixed abode (n=5). A small number were discharged to other temporary arrangements.

Patients with psychotic disorders formed ~50% those discharged to B&B or hotel accommodation (n=38), followed by patients with personality disorders (n=27). Of those discharged with no fixed abode, 3 had a diagnosis of personality disorder, 1 had a psychotic disorder, and 1 had a substance use disorder.

Over half of patients discharged to temporary accommodation were placed in B&B or hotel settings, with psychotic disorders comprising ~50% of these patients. This highlights a notable amount of patients with severe mental illness being discharged to temporary, non-therapeutic accommodation. Patient discharge is a complex interplay of system pressures, clinical presentation and social support, yet stable housing is vital in holistic, patient-centred care. These results identify a need for further review of discharge pathways and raises the importance of the biopsychosocial model in understanding the relationship between mental health and social context.

The aim was to analyse and identify key themes in all reported “near miss” ligature incidents in South West London and St George's Mental Health NHS Trust between July-September 2024. The hope was to hereby uncover patterns to inform evidence-based changes and to drive improvements in patient safety, standards of care, patient experience and clinical outcomes in the Trust.

The total number of ligature-related incidents (from Ulysses) was 96 and 83 were included in the review. 13 incidents were excluded due to missing RiO number. Data was collected from RiO progress notes, demographic tab, inclusion records ad risk assessments by three resident psychiatry doctors. Data collected included demographic details, diagnosis, location of incident, level of observations, mental state at the time of the incident, ligature method, Mental Health Act status, substance misuse, number of previous admissions, and previous ligature incidents. The data collection tool was piloted and areas of unclarity discussed by all three data collectors and consensus reached.

Diagnostically, neurodevelopmental conditions were present in 65.1%, Emotionally Unstable Personality Disorder (EUPD) diagnosis in 53.0%, depression in 34.9%. In terms of other clinical risk factors: 89.2% had multiple psychiatric diagnoses, 73.5% were detained under the Mental Health Act (MHA), the mean number of psychiatric admissions: 4 ± 4, 51.8% were noted as aggressive, alcohol misuse was a factor for 18.1%, drug misuse for 15.7%. Looking at self harm history, 95.2% had a current history of deliberate self-harm (DSH), 98.8% had a historical risk of DSH, 94.0% had previously tied a ligature, and 97.6% had used alternative methods of self-harm. Social and Demographic Factors: 85.5% were unmarried, 79.5% were unemployed, 49.4% were on long-term sick leave, 24.1% lived alone, and 1.2% were homeless.

Thematically, there was notable over-representation of women and girls in reported incidents. nearly two-thirds of incidents involved individuals with a neurodevelopmental diagnosis (e.g., ASD, ADHD), and around half had an EUPD diagnosis.

Recommendations:

1. Improve Incident Documentation: develop clear guidelines to help staff include critical details.

2. Address Observations-Related Incidents: Reinforce active engagement and proximity. Observing staff to conduct environmental review including blind spots and support with co-developed shared ligature care plans which are regularly reviewed.

3. Strengthen Environmental Safety: Continue minimising ligature points, securing hazardous items (BP machine cables).

4. Support for Neurodevelopmental Diagnoses: provide targeted training for staff.

5. Support for EUPD: promoting DBT-informed approaches on wards.

7. Involving Patients in Next Steps: engage service users in future planning and prevention strategies.

8. Providing Holistic Debriefing for both patients and staff impacted by these incidents.

This work was presented in the Trust Learning and Improvement Group and an improvement plan developed.