Neuropsychiatry training in the UK currently lacks a formal scheme or qualification, and its demand and availability have not been systematically explored. We conducted the largest UK-wide survey of psychiatry trainees to examine their experiences in neuropsychiatry training.

In total, 185 trainees from all UK training regions completed the survey. Although 43.6% expressed interest in a neuropsychiatry career, only 10% felt they would gain sufficient experience by the end of training. Insufficient access to clinical rotations was the most common barrier, with significantly better access in London compared with other regions. Most respondents were in favour of additional neurology training (83%) and a formal accreditation in neuropsychiatry (90%).

Strong trainee interest in neuropsychiatry contrasts with the limited training opportunities currently available nationally. Our survey highlights the need for increased neuropsychiatry training opportunities, development of a formalised training programme and a clinical accreditation pathway for neuropsychiatry in the UK.

This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used – the Dissociative Experiences Scale – II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale – and a proforma was used to collect demographic data.

Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI.

The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.

The medical workforce in psychiatry is increasingly diverse, but not necessarily in its senior leadership in the UK’s National Health Service (NHS). We aimed to describe the characteristics of psychiatrists with board-level responsibility in mental health trusts in England in 2024, comparing the current picture with that of 2016 and 2020, using publicly available data.

The proportion of medical directors who are female has not changed, so women remain underrepresented, while the proportion who are international medical graduates has increased substantially, so they are no longer underrepresented. Although fewer in number, intellectual disability psychiatrists are underrepresented.

Greater attention will need to be paid to developing female medical leaders if representative leadership is to be achieved.

This study investigated the prevalence of advance directives among patients receiving community care within the East London NHS Foundation Trust (ELFT), and to identify factors associated with their clinical application.

We analysed data from electronic health records of 4807 patients (aged 18–75 years), managed under the Care Programme Approach (CPA) in ELFT during 2021–2022. Demographic, clinical, service-level and patient-reported measures were analysed (binomial logistic regression).

A total of 31.2% of patients on the CPA had an advance directive. Black ethnicity, treatment in the forensic service or Newham, Luton and Bedfordshire localities, housing in socio-therapeutic facilities, diagnosis of personality disorder, ten or more previous admissions and engagement with DIALOG+ were positively associated with having an advance directive. DIALOG+ is the first approach that has been specifically developed to make routine patient–clinician meetings therapeutically effective. It is based on quality of life research, utilising the DIALOG scale (a patient-reported outcome measure), concepts of patient-centred communication, IT developments and components of solution-focused therapy, and is supported by an app.

This study highlights a complex interplay of cultural, social and systemic factors that influence advance care plan status. Structured communication, stronger therapeutic relationships and staff facilitation are likely to encourage advance care planning.

The increasing recognition of neurodivergent conditions in healthcare settings in general highlights the necessity for better understanding and management in neuropsychiatric settings. This study aims to investigate the prevalence and co-occurrence of neurodivergent conditions and traits among patients with neuropsychiatric conditions. A descriptive quantitative cross-sectional study was conducted at a tertiary neuropsychiatric clinic. Participants included 166 consecutive patients, assessed using the Comprehensive Autistic Trait Inventory (CATI) and the Adult ADHD Self-Report Scale (ASRS, version 1.1), with demographic characteristics considered.

In our final analysed cohort (n = 79), among patients with functional neurological disorder (FND) 11% had a confirmed diagnosis of adult spectrum disorder (ASD), 17% were believed to have undiagnosed ASD and 55% exhibited clinically significant ASD traits on the CATI tool. Additionally, 13% had a confirmed diagnosis of attention-deficit hyperactivity disorder (ADHD), 25% were believed to have undiagnosed ADHD and 67% exhibited clinically significant ADHD traits on the ASRS tool.

The findings indicate a higher than expected prevalence of neurodivergent conditions in people with FND. Enhanced early identification and tailored treatment approaches are likely to be crucial for improving clinical outcomes and patient experiences in neuropsychiatric settings.

Non-attendance at out-patient appointments of adult attention-deficit hyperactivity disorder (ADHD) services incurs significant costs and contributes to lost service provision and unmet clinical needs. This cross-sectional study of clinical contacts, between 1 July 2022 and 30 June 2023 in a specialist adult ADHD service, aimed to identify factors, including type of consultation, associated with non-attendance.

Of 3673 organised clinic appointments, 2815 (77%) were attended: 2314 (82%) by telephone and 501 (18%) as in-person appointments; non-attendance rates were 17 and 42%, respectively. Patient characteristics associated with improved attendance included: female gender, age >30 years and presence of other psychiatric diagnoses.

This study will assist adult ADHD service providers to maximise patient attendance. The role of telephone (or virtual) clinics must be considered. Enhanced appointment reminders and improving access to services targeting at-risk groups could also improve attendance rates.

An equitable child mental health service provides access to treatment proportionally to the need of individual demographic groups. Despite qualitative and survey-based evidence of barriers disadvantaging some demographic groups, it is not well understood how these barriers translate into quantifiable inequities. We calculated the treatment access rate for English children aged 6–16 years in 2021–2022, using the patient-level Mental Health Services Data Set and Mental Health of Children and Young People Survey.

The number of primary school children in treatment needs to increase nationally by 173%, the number of boys by 65% and the number of children from a White ethnic background by 31%, to achieve equity in treatment access. There was no evidence of inequities by area deprivation.

Child mental health services in England should not only increase overall access rates, but also pay more attention to equity in access across different demographic groups.

Involvement in clinical mental health research can be a challenge for services isolated from academic institutions, limiting opportunities for patients to receive innovative interventions and for clinicians to explore interest in research. We aimed to increase mental health research capacity in Somerset NHS Foundation Trust via a range of initiatives from collaboration between a senior clinician and research and development colleagues.

Over the course of the project, the number of participants recruited to National Institute for Health and Care Research-adopted mental health and dementia research projects quadrupled over a 2-year period, from 57 to 232, and the number of projects hosted rose from 9 to 23. A total of 165 clinicians signed up to receive information about ongoing studies.

We found considerable appetite for becoming involved in research among mental health clinicians, and were able to provide opportunities for research experience as well as access to innovative studies for local patients.

This study aimed to evaluate an artificial intelligence-assisted tool for psychiatric case formulation compared with human trainees. Twenty trainees and an artificial intelligence system produced formulations for three simulated psychiatric cases. Formulations were scored using the integrated case formulation scale (ICFS), assessing content, integration and total quality. Time taken was recorded, and assessor predictions of formulation origin were analysed.

Artificial intelligence produced formulations significantly faster (<10 s) than trainees (mean 52.1 min). Trainees achieved higher ICFS total scores (mean difference 8.3, P < 0.001), driven by superior content scores, while integration scores were comparable. The assessor identified artificial intelligence-generated formulations with 71.4% sensitivity, but overall accuracy of who produced the formulations was only 58.3%.

Artificial intelligence shows promise as a time-saving adjunct in psychiatric training and practice, but requires improvements in generating detailed content. Optimising teaching methods for trainees and refining artificial intelligence systems can enhance the integration of artificial intelligence into clinical workflows.

This study investigated mental health diagnoses in autistic adults to determine whether there were any sex differences in presentation. Autistic adults attending the neurodevelopmental service at Surrey and Borders Partnership NHS Foundation Trust were included.

As part of a service audit, 150 random adults (75 males and females) were selected and their case notes were reviewed. Mental health diagnoses were common: 36% had current suicidal ideation, 20% had attempted suicide, 40% had a past or current diagnosis of anxiety and 62% had a past or current diagnosis of depression. There were more women diagnosed with an eating disorder (9% female, 0% male) and with a historical suicide attempt (21% female, 9% male). However, using a Holm–Bonferroni correction, there were no statistically significant sex differences between mental health diagnoses. Among both sexes, a significant number had been exposed to prenatal and early childhood trauma, nearly 10% had experienced physical trauma, abuse, neglect or assault, and nearly a third had been through parental separation.

This demonstrates that autistic people presenting to a National Health Service diagnostic clinic are more at risk of experiencing trauma, which subsequently increases their risk of mental illness, alongside any neurological predisposition.

This study evaluated whether brief teaching sessions on transference-focused psychotherapy (TFP) could improve psychiatric trainees’ attitudes and clinical confidence in managing patients with personality disorders. A mixed-methods design was used, combining pre- and post-training validated questionnaires with a focus group discussion. Two 4-h workshops covered TFP theory and techniques, and case discussions.

Twenty-six participants completed paired questionnaires. Statistically significant improvements were observed in overall attitudes (Attitudes to Personality Disorder Questionnaire total score, P = 0.022) and enthusiasm towards patients with personality disorders (P = 0.003). Clinical confidence (Clinical Confidence with Personality Disorder Questionnaire) improved markedly (P < 0.001). Qualitative analysis identified high acceptability, valuing TFP concepts and enhanced emotional awareness, although participants desired more practical components.

Even brief TFP training can positively influence trainees’ attitudes and confidence in treating personality disorders. Incorporating TFP-informed training into psychiatric education may reduce clinician frustration and improve therapeutic engagement with this complex patient group.

In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being.

Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance.

These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.

There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping.

A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients.

The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.

Early Positive Approaches to Support (E-PAtS) is a co-produced group intervention supporting family carers of children (0–5 years) with additional developmental needs. This study compared online (n = 10) and in-person (n = 11) groups to investigate whether mode of delivery was associated with different outcomes. Participants were 98 family carers reporting on their mental well-being, self-efficacy, child symptoms and knowledge pre and post intervention. Generalised estimating equations compared outcomes between groups, controlling for group cluster effects.

Mental well-being improved significantly across both groups (d = 0.47, 95% CI: 0.30, 0.63), as did an in-session measure concerning mechanisms of change (d = 1.28, 95% CI: 0.97, 1.59) and all other assessed outcomes. There were no significant differences in measured outcomes between online and in-person groups.

Establishing the equivalence of in-person with online groups is an important first step for improving service reach and support access for families of children with additional developmental needs.

Advances in generative artificial intelligence, particularly through large language models, like GPT-4, have opened opportunities to develop cognitive agents to enhance clinical productivity, especially in complex secondary and tertiary care settings. However, as artificial intelligence begins to occupy the cognitive space traditionally held by human clinical reasoning, transparency becomes a significant concern. Unlike human decision-making, artificial intelligence-generated outputs may not be traceable to a transparent chain of clinical reasoning, potentially impacting safety if used without adequate ‘clinician reach’ into the reasoning space of artificial intelligence.

We highlight the need for a consensus framework to guide the responsible use of generative artificial intelligence in mental healthcare, which, it is argued, has cognitive demands and features distinct from physical medicine. We propose such a framework, Clinical Reach into the Cognitive Space (CRITiCS), to support clinician involvement in the deployment of these technologies.

This paper aims to spark dialogue and interest in both the clinical and artificial intelligence development communities.