bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality Improvement Project on Standardising GP Discharge Summaries in Liaison Psychiatry Services for Older People in Nottinghamshire Healthcare NHS Trust
Authors: Tan Sue Fen , Wilson Sarah , Lander Robin
Published: August 2024

Aims

Discharge letters to general practitioners (GPs) are pertinent in summarising patients' care in secondary healthcare settings and communicating follow-up management plans for continuity of care. 26 GPs from 13 GP surgeries in the West Midlands thought that discharge letters lacked important information and standardisation. We developed a quality improvement (QI) project to standardise GP discharge summaries within the liaison psychiatry services for older people in Nottinghamshire Healthcare NHS Trust. We aimed to ensure that 100% of GP discharge letters are written in a standardised format and meet the mandatory subheadings within six months.

Methods

A comprehensive literature search was performed, and we invited six GPs across Nottinghamshire to comment on the quality of anonymised discharge summaries written by our colleagues. After discussing the findings with our stakeholders, we developed a new discharge summary template with the subheadings of ‘Reason for Liaison Psychiatry Involvement’, ‘Summary’, ‘Diagnosis (if applicable)’, ‘Risk Formulation’, and ‘Treatment or Plan of Action’.

We held a team meeting and distributed a guidance document with scoring criteria for each subheading for our clinical colleagues to practise for two weeks. Subsequently, 75 discharge summaries were randomly selected and independently scored across seven weeks by an internal team member and an external QI data analyst to improve inter-rater reliability. 98 discharge summaries written six weeks before the new letter template was introduced were retrospectively scored for baseline measurement.

Results

At baseline, the discharge summary scores ranged between 6 and 20 (out of a maximum of 20), depending on the individual completing them. The mean score was 12.3.

The implementation of the new discharge summary template improved the mean score to 19.0, irrespective of the author. The mean score was consistent across seven weeks.

Most of our colleagues did not face significant challenges in learning a new style of writing and for some, a standardised template reduced administrative time. The same GPs reviewed the new set of anonymised discharge summaries and were satisfied with the new summary format.

Conclusion

Formulating a standardised discharge summary template which adhered to professional guidelines was pivotal in improving the quality of GP discharge summaries. GP involvement throughout the project convinced stakeholders and colleagues to commit to a new writing template and tremendously helped achieve our project aim.
VTE Prophylaxis Quality Improvement of Service Users Data in Older Adult Mental Health Inpatient Wards in St Charles Hospital, CNWL NHS Trust
Authors: Thakaria Shreena
Published: August 2024

Aims

To reach the target of 100% for VTE (venous thromboembolism) prophylaxis data submitted for all St Charles Older Adult inpatients.

Methods

It was found at the start of the QI project, the service was at 63% (August 2023). I reviewed this data and discussed it with the ward managers of the older adult inpatient wards and implemented two PDSA cycles. I went through the ward list of service users and noted on the database who had an outstanding VTE prophylaxis check. From this, I then created a section for the nursing handovers to include whether each service user had their VTE prophylaxis forms filled in and whether VTE prophylaxis was appropriately prescribed. The wards have a weekly MDT meeting where this could be discussed and all staff could be reminded to document the VTE data on the trust data system. I rechecked the data two months later to see if the data had improved. Following this, I created a VTE poster to be distributed via email to ward staff and hung up in the ward doctors' offices to help educate staff on the importance of VTE prophylaxis. The statistics were rechecked two months later for further improvement.

Results

At the start of the QI, it was found that the service was underperforming in reaching its target of 100% of the VTE prophylaxis data entry for all service users in older adult inpatient wards. After implementing the first PDSA cycle, the data increased to 84% compliance (October 2023 data). After implementing the second PDSA cycle, the data increased to 100% compliance (December 2023 data). The data showed both implementations had a significant impact on the data input and the target being reached. The new strategy has now been firmly placed into the team working pattern as a routine measurement and continues to be actively utilised.

Conclusion

In an older adult inpatient ward setting with service users who have co-morbidities, reduced mobility and risk of dehydration from self neglect, it is vital they are assessed appropriately for VTE risk factors and prescribed the appropriate prophylaxis. Once this was highlighted to the ward staff and an easy system of the PDSAs were implemented, the team are now able to actively input the data and provide optimal care for the service users.
Improving Clinical Communication With the Doctor On-Call: A QI Project
Authors: Verrall Henry
Published: August 2024

Aims

Clear, accurate and efficient clinical communication between wards and on-call doctors is vital for good patient care. Issues were raised locally regarding the quality and content of these calls, and a QI project devised to assess the issue and implement meaningful change.

Methods

An initial QI Audit was undertaken, using Likert scale questionnaires to rank areas of concern. These were sent to all the doctors currently manning the on-call rota, and doctors who had previously covered these on-calls. Responses were used to gauge the key concerns, and a blank space and multiple choice question on possible contributors to the issues were included.

A communication prompt was designed that tackled the key issues highlighted by the audit. A clear flow-chart ensured that safe and sensible steps were taken to maximise the efficiency of a necessary call. A summary of the SBAR communication tool was also included to encourage structured handover. These prompts were cheap and easily affixed to ward telephones and were laminated and wipe-clean. Implementation was agreed with and supported by the senior nursing team.

A post-QI questionnaire was then sent out one month after the intervention, getting feedback from the junior doctors covering on-call shifts in that time.

Results

Questionnaire Likert scales measured either Frequency (1-Very Rarely – 5-Very Frequently) or Quality (1-Poor – 5-Excellent), and a mean of the scores was taken for each question.

The initial audit (n = 14) included all the doctors currently on the on-call rota (n = 7). Key issues raised were Average Call Quality (2.2/5), how frequently recent NEWS scores were available (2.3/5), and how frequently key clinical information was on hand during the call (1.9/5). Many trainees were made to feel uncomfortable or like they were being difficult for requesting more information (3.2/5). And calls were often noted to not be relevant (3.9/5) or were confusing/unclear (3.9/5).

A second questionnaire was completed 1 month post-intervention by the doctors working the on-call rota in that time (n = 6). 100% reported some improvement, 33.3% reported significant improvement. Improvements included average call quality (4/5), frequency of recent NEWS (3.7/5), and availability of Key clinical information (3.5/5).

Blank space feedback highlighted the tool's clarity and simplicity.

Conclusion

This QI project was able to highlight and address a key issue in clinical care in a simple, and very low cost manner. Improvements were demonstrated after one month of intervention, and a more in-depth trust-wide rollout of the project is being discussed.
Clinical Effectiveness and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada
Authors: Awara Mahmoud
Published: August 2024

Aims

People with severe and persistent mental illness (SPMI) present unique challenges in mental healthcare due to the enduring nature and complexity of their conditions. The study focuses on evaluating the clinical effectiveness and cost implications of a multidisciplinary community psychosocial rehabilitation team catering to individuals with SPMI in Nova Scotia, Canada. The investigation seeks to contribute valuable evidence to the limited literature on community psychosocial rehabilitation in the Canadian context.

Methods

The study adopts a retrospective approach, analyzing data from patients referred to community rehabilitation between 2016 and 2017. The assessment centers on the year before and after patient engagement with the community rehabilitation team. Clinical effectiveness is evaluated through measures of inpatient service use (admissions, length of stay) and emergency department (ED) visits. The Canadian billing system of Medical Service Insurance (MSI) is employed to examine the cost of acute service utilization.

Results

Results demonstrate a statistically significant reduction in mean admission rates and length of stay in the post-rehabilitation year compared with the pre-rehabilitation period. A substantial percentage of patients experienced no inpatient admissions or ED visits in the post-rehabilitation year. The analysis reveals a significant net reduction in hospital days, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation in the context of SPMI.

Conclusion

The study suggests that community rehabilitation contributes positively to the clinical outcomes of individuals with SPMI, showcasing reduced inpatient service use and associated costs. The findings underscore the importance of further research into community psychosocial rehabilitation in the Canadian setting and emphasize the economic implications essential for demonstrating the efficiency of mental healthcare services.
Treatment Trajectories of Young People With Emotion Dysregulation Engaging in Dysregulated Behaviours: An Exploratory Study
Authors: Baykeens Bibire , Di Simplicio Martina
Published: August 2024

Aims

Dysregulated behaviours are prevalent amongst young people worldwide. Emotional dysregulation plays a key role in these behaviours. Several psychiatric disorders have significant elements of emotional dysregulation, making it a potentially effective transdiagnostic therapeutic target. Dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT), and schema therapy (ST) can effectively manage emotional dysregulation, however access may be limited in clinical practice.

We aimed to explore whether young people with emotional dysregulation engaging in dysregulated behaviours receive support for emotion regulation. We hypothesised that those with emotionally unstable personality disorder (EUPD) will have a higher prevalence of self-harm, disordered eating, and/or substance misuse and more referrals for DBT, MBT, or ST than those with bipolar disorder, autism, attention deficit/hyperactivity disorder (ADHD), schizophrenia, or schizoaffective disorder.

Methods

De-identified clinical records from the West London NHS Trust on 2,413 16- to 25-year-olds with an ICD–10 diagnosis of EUPD, bipolar disorder, autism, ADHD, schizophrenia, and/or schizoaffective disorder were obtained through Akrivia. Chi-squared tests were performed.

Results

Young people with bipolar disorder had the highest prevalence of self-harm, disordered eating, and substance misuse (88.35%, n = 182), χ2 (4, N = 3138) = 39.14, p < 0.001, but the lowest number of references to DBT, MBT, or ST. Those with EUPD had the highest number of references to DBT, χ2 (4, N = 2585) = 886.75, p < 0.001, MBT, χ2 (4, N = 2585) = 81.63, p < 0.001, or ST, LR (4, N = 2585) = 21.03, p < 0.001.

Conclusion

There could be an unmet need for psychological interventions for young people with bipolar disorder. A more transdiagnostic approach to offering psychotherapies that target emotional dysregulation should be applied in clinical practice.
Parent Experiences of a Pilot Functional Neurological Disorders Clinic at Great Ormond Street Hospital (GOSH)
Authors: Eilon Talia , Evans Sacha , Pujar Suresh , Orme Lily , Smith Abbie
Published: August 2024

Aims

There are a shortage of specialist services available for Functional Neurological Disorders, especially within the paediatric population. Patients and families often find themselves falling within the borderland between medical and psychiatric services. Functional symptoms can cause significant morbidity and disruption to the lives of children and young people, impacting their access to education and social lives. Early diagnosis and explanation of FND is a mainstay of treatment, and is associated with positive outcomes. A Functional Neurological Disorder pilot MDT clinic was set up within Great Ormond Street Hospital, with the aim to provide a one-off therapeutic assessment and psychoeducation. We surveyed families who attended the clinic to assess their experiences and outcomes.

Methods

A pilot clinic was set up for patients referred within GOSH with a confirmed diagnosis of FND. The Multidisciplinary team consisted of a CAMHS psychiatrist, paediatric neurologist, physiotherapist and occupational therapist. Patients received a one-off outpatient consultation to discuss FND symptoms and background history. Clinicians provided psychoeducation for patients and families about the diagnosis and devised treatment plans including follow-up assessments, onward referral to local services and a consultation with teams where appropriate. A follow-up survey was conducted using semi-structured telephone interviews and patient satisfaction questionnaires. Questionnaires were scored using a Likert rating scale (1: very dissatisfied – 5: very satisfied). Parents were asked about their understanding of the FND diagnosis and about their experiences of support from local teams.

Results

25 patients diagnosed with FND were referred to the clinic. Of those, 20 patients took up the consultation. Patients presented with range of functional syndromes. 15 families consented to follow-up interviews. Parents rated their experience at the FND clinic highly (median score 5 – very satisfied). They were very dissatisfied with follow up care (median score 1). Only one patient remained under CAMHS at the time of follow up. 3 families had sought support privately. Parents subjectively rated their children's symptoms at follow up as: much worse (3); a bit worse (1); the same (7); a bit better (2) and much better (2).

Conclusion

Patients and parents demonstrated high levels of satisfaction with the one-off therapeutic assessment. The majority of parents reported that the GOSH consultation helped them to understand the diagnosis of FND. All families felt they had received inadequate support from primary care, local CAMHS services and schools. Patients who struggled to access support from CAMHS/ school were less likely to experience any improvement in FND symptoms and had poorer levels of functioning.
A Cross-Sectional View on the Comprehensive Multi-Disciplinary Model of Care for a Peri-Natal Mental Health Service Within a Tertiary Women's Hospital in Western Australia
Authors: Goel Chinar , Goel Prisha
Published: August 2024

Aims

King Edward Memorial Hospital (KEMH) is the largest tertiary women's hospital in Western Australia and a tertiary referral center for complex pregnancies, for example, adolescent pregnancies (12–19 yr olds), pregnancies with obstetric complications or fetal anomalies, statewide drug and alcohol antenatal service and preterm births. With 6000 births annually, this women's hospital does not only provide obstetric care, but also looks after gynecology, oncology and chronic pain patients. We would like to share the model of care for our women's mental health service which provides statewide Childbirth and Mental illness (CAMI) service looking after women with chronic enduring mental illness, statewide drug and alcohol antenatal service (WANDAS), adolescent model of care and our service for all other women attending this tertiary hospital within a unique consultation liaison model.

Methods

Our team comprises 3.0 full time consultant psychiatrists, 2 Psychiatry trainee registrars, 5 clinical psychologists, 2 triage nurses and administrative staff. In total, we had 1959 referrals to our service in 2022–23 financial year. These women had varying amount of input from our service during their treatment in hospital: one assessment with advice and signposting to brief therapy, up to a fully comprehensive Multidisciplinary Team (MDT) care as provided by an adult community mental health service. In addition to comprehensive assessment, MDT interventions include risk assessment, pharmacological interventions, psychological interventions, working alongside child protection services, infant mental health and attachment work.

Results

Our most common diagnostic categories included post-traumatic stress disorder (10%), adjustment disorders (10%) followed by Generalized anxiety disorder and recurrent depressive disorder (6% each). Our key performance indicators include: number of consumers (541 in 2022–23) that received comprehensive intervention from us in last 12 mths, consumer and carers’ feedback and rate of completion of outcome scale at point of admission and discharge from service. These figures have remained consistent for the last 5 yrs.

Conclusion

Our hybrid model of care is unique as it incorporates a consultation liaison and a community mental health care model for women attending our hospital. This allows us to provide a safe, specialized, timely service to women in their most vulnerable period of life.
The Evaluation, Review, and Recommendations, Regarding Referrals to a West Yorkshire Specialist Forensic Community Team
Authors: Gow Laura
Published: August 2024

Aims

In the United Kingdom Specialist Community Forensic Teams (SCFT) are a new national development, aiming to enable and support earlier discharge from secure hospitals, and provide treatment to patients on a forensic pathway, in a community setting.

This project's ambition was to yield data to support future development of the service. The following research question was developed, as a focus for the project:

‘In order for patients to be cared for as close to home as possible and for forensic services to reduce the length of inpatient stay, when should a patient be referred to a Specialist Forensic Community Team?’

Methods

The project was accepted by Cardiff University and South West Yorkshire Foundation Trust as a service evaluation.

The project methodology considered the impact of trauma throughout, given the forensic setting and high prevalence of trauma in individuals accessing forensic services.

A questionnaire was developed, which covered several relevant themes regarding the service, including the research question, and was distributed to patients, professionals, and referrers, either using, or associated with the team.

The total number of participants recruited was n = 45. These were made up of service users (n = 17), referrers to the service (n = 10), and other professionals (n = 18).

Results

Participants felt they understood the purpose of the SCFT, placed importance on being involved in service evaluation, and were confident their responses would influence service development.

Reasons to refer to the SCFT were the perceived helpfulness of the team, supporting transitions, risk management, teamwork, therapeutic alliance, quality, and clinical knowledge.

Results favoured multi-disciplinary team agreement as being an important factor in the timing of SCFT referral. Upon admission, or granting of unescorted leave, were also cited as appropriate times to refer to the service. Clinically appropriate timing, individual needs, and service user motivation were additional indicators for SCFT referral.

Conclusion

The West Yorkshire SCFT offers previously unavailable pathways from secure services into the community. The clinical model uses a trauma-informed, formulation-driven, collaborative approach to care, treatment, and risk management, which participants found favourable. Improved community pathways and connections offer a sense of improved hope, and a feeling of being helped, which is supportive of personal recovery.

There are recommendations which suggest that a community pathway agenda, embedded into services from admission, will support clinically appropriate timing of SCFT referral, and should be a decision which is made collaboratively, with patients, carers, and the multidisciplinary services around them.
Mind Over Menopause: Bridging the Gap in Mental Health Care
Authors: Thatcher Alexandra , Graham Catherine , Denton Grace , Kearly-Shiers Katherine , Manley Kristyn
Published: August 2024

Aims

The effect of menopause on mental health is increasingly well recognised. Studies assessing peri- and post-menopausal women report higher incidences of depression and anxiety. Without recognition and treatment, the negative impact on mental health during menopause can lead to long-lasting effects on quality of life. NICE and the British Menopause Society (BMS) guidelines recommend cognitive behavioural therapy (CBT) and an individualised approach, for women experiencing depression and anxiety as a result of menopause. The aim of this project was to collect data relating to the provision of mental health interventions (and how they are accessed) for women seeing menopause specialists across the UK. This data can then be used to inform and promote improvements in the delivery of care for menopause mood symptoms.

Methods

An expert panel of psychiatry, gynaecology and general practice clinicians designed an online survey which considered NICE/BMS guidance, the current evidence base and local referral/funding pathways. This was piloted on health care professionals in primary and secondary care before review by BMS Council Members. A link to the survey was distributed via email to members of the BMS on one occasion.

Results

139 responses were received from menopause specialists across the 15 UK Deaneries. 71% worked in primary care and 29% in secondary care. 65% of clinicians offer CBT for mood symptoms but 99% reported suboptimal provision of this intervention. 43% of respondents reported over half of their patients with mood symptoms would benefit from psychological support, however 80% do not have a designated mental health wellbeing practitioner. 35% of specialists have referred complex patients to secondary mental health services. When asked what mental health resources would be most beneficial for their patients, 83% desired improved access to CBT, 65% psychological support attached to all menopause clinics, 53% guidance on managing mood symptoms in menopause and 39% an MDT clinic.

Conclusion

The data suggests that complex mood disorders are common in women presenting to menopause services and require non-hormonal interventions to support benefits seen with HRT. The results suggest poor provision of psychological interventions, particularly talking therapies, for women experiencing mood disorders as part of their menopause. Improved cross-specialty working and training, and improved access to CBT were identified as methods of addressing this. Locally, these results have formed the basis of a service funding bid for CBT and development of a pilot cross-speciality gynaecology/psychiatry MDT Hub.
An Evaluation of the Prevalence of Use of High Dose Antipsychotic Therapy Across the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust
Authors: Hyland Declan , Singh Roopa , Dainton Kerry
Published: August 2024

Aims

High Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.

This evaluation aimed to determine prevalence of HDAT across the 16 general adult inpatient wards and the Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust.

Methods

A list of all inpatients admitted to the 16 general adult inpatient wards and to the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was subject to HDAT and, if so, whether this was due to antipsychotic monotherapy, combination of two or more antipsychotics, or due to regular and as required (PRN) antipsychotic medication.

Results

Of the 215 inpatients on the 16 general adult wards and the PICU, a total of 29 (13.5%) patients were prescribed HDAT. Four wards had no patients on HDAT; one ward had 5 patients on HDAT. Two of the 12 patients on the PICU were on HDAT. Of the 29 HDAT patients, none were on just one regular antipsychotic, 11 were on one regular antipsychotic and one PRN, 11 on two regular antipsychotics only, 4 were on two regular antipsychotics and one PRN antipsychotic, 1 patient was on three regular antipsychotics and 2 patients on three regular antipsychotics and one PRN antipsychotic. Of the 29 HDAT patients, 14 (48%) had schizoaffective disorder, 9 (31%) had schizophrenia, 5 (17%) had bipolar disorder and 1 (4%) had emotionally unstable personality disorder.

Conclusion

Only a minority of inpatients on the general adult wards and the PICU are prescribed HDAT. There was variation in HDAT prescribing across the wards and this may reflect the degree of diagnostic variability of each ward's inpatients. In those patients that are subject to HDAT, there is a need for appropriate baseline physical investigations to be completed and for appropriate monitoring of ECG and relevant blood tests. There is a need to consider whether each HDAT patient has been considered for treatment with clozapine, if appropriate.
Patients' Experience of Using Virtual Consultations in Their Care During Their Inpatient Stay on Acute Mental Health Admission
Authors: Elshafei Ahmed , Junaid Elizabeth , Ekwere Umoh , Maheen Fatima
Published: August 2024

Aims

To obtain the views of patients regarding their experience of meetings where virtual media (video conferencing) has been used during their inpatient stay in the acute female admission ward.

Methods

Data was collected via a questionnaire. Service users who met the inclusion criteria were past and current inpatients in the acute female psychiatric ward during the last six months. The sample of the service users included in the project was selected from all applicable cases via convenience sampling – those on the ward who consented and were able to engage, as well as past inpatients whom we contacted via telephone after their discharge who met these same criteria.

Verbal consent was obtained from all the patients who agreed to participate. Data was collected and analysed using Microsoft Excel.

Results

13 patients in total completed the facilitated questionnaire which used 11 questions rated by Likert Scale as well as an open space area for further comments. Age ranges varied among participants with 39% age range 18–30, 38% aged 31–50 and 23% aged 51–65. 61% were of white British descent. Majority (38%) were admitted for schizophrenia, schizotypal and delusional disorders, 31% for disorders of adult personality, 23% for mood (affective) disorder and 8% for anxiety, dissociative, stress related, somatoform and nonpsychotic mental disorders.

Most patients rated the use of virtual consultations positively, with over ¾ of patients answering strongly agree or agree (positive response) to most questions. This included feeling able to express themselves effectively as in an in-person consultation, feeling that they received adequate care, feeling that the audio-visual quality was satisfactory and that their privacy was respected. One suggestion for improvement from the patients was to clarify the number of people in the room and how many students are present during the consultation.

Conclusion

Virtual consultations were overall well received among the patients interviewed. Interventions that facilitate timeliness and privacy in consultations as well as training for staff in verbal and nonverbal communication skills for virtual consultations would be beneficial. Further surveys in groups underrepresented in the survey such as men, older people, ethnic minority groups, people with visual or hearing impairment and other mental disorders not present in the sample would help to give further insight into how virtual consultations are received and barriers by different groups.
Developing a CAMHS Hub Crisis Management Service – the First Six Months
Authors: McDonald James , Columb David , Moriarty Laura , Verdon Clare , Murphy Katie
Published: August 2024

Aims

This poster will:

1.

Describe the establishment of an acute crisis management service within a Child and Adolescent Mental Health Service (CAMHS) in the Republic of Ireland.

2.

Summarise clinical activity during the first six months of the service and qualitative feedback from service users and clinicians on their experience of the service.

Methods

In December 2021 the Republic of Ireland Health Service Executive approved the roll out of acute crisis management services for CAMHS – known as Hubs, with a remit to provide intensive brief interventions to support young people experiencing acute Psychiatric crises. Multiple weekly appointments are provided in clinic, at home or via telehealth.

The Lucena Clinic CAMHS – based in Counties Dublin and Wicklow, was chosen as a pilot site. Staff were recruited in January 2023 consisting of:

1

FTE Consultant Child and Adolescent Psychiatrist

1

Candidate Advance Nurse Practitioner

1

Senior Social Worker

1

Senior Occupation Therapist

1

Administrator

A multi-disciplinary Steering Group was established with a view to planning clinical programs, ensuring safety and governance, procuring resources and embedding service evaluation.

The service went live in May 2023. Clinical data was gained from data entry to the service Electronic Patient Record.

Qualitative feedback was gained from service users using post-discharge questionnaires and from clinicians using semi-structured interview.

Results

1.

Between May and December 2023 the Hub received 61 referrals and accepted 35.

2.

27 of those accepted were new referrals to the service.

3.

Patients received an average of 27.1 hours of clinical intervention during their admission.

4.

Shortest admission was 10 hrs, the longest 66.5 hrs.

5.

6 young people were seen at home, totalling 41 visits.

6.

24 young people were discharged to CAMHS, 2 to GP, 2 to the clinic's Day Program, 3 required in-patient admission.

Service user feedback was positive with families highlighting ease of access to the service, intensity of intervention and a friendly environment as positives.

One parent remarked that they did not feel the Hub was the right setting for their child's care.

Clinician feedback highlighted the Hub as a positive support for community CAMHS with rapid access to intervention and communication from the Hub team mentioned as positives. One drawback identified was the intensity of intervention setting an unrealistic expectation for ongoing care.

Conclusion

The Hub appears a welcome addition to CAMHS with positive feedback from service users and clinicians. Ongoing development phase and evaluation is required.
Significant Global Improvements for Opioid Dependent Patients Receiving 8 Sessions of Flexible Trauma Informed Psychological Therapies Whilst on Long Acting Injectable Buprenorphine: 9 Month Findings
Authors: Melichar Jan , James Lucie , Tucker James , Jones Lewis , Dennie Emma
Published: August 2024

Aims

Opioid dependence is associated with adverse physical health, mental health and social consequences. Daily oral opiate substitutes offer some treatment gains but several negative associations including daily dosage fluctuations, long-term reliance on services and negative impact on ability to work.

Long-acting injectable buprenorphine (LAIB) is a new treatment option, extensively used in Wales since 2020. We have shown the many gains, including increased treatment retention, reduced service reliance, improved patient satisfaction and increased capacity for people to move on in their recoveries, are likely to be due to LAIBs unique combination of allostatic μ-opioid receptor agonism (craving reduction) and sustained κ-receptor antagonism (anxiolysis). However, ~50% experience resurfacing of mental health and/or trauma symptoms on LAIB that impedes recovery. The Buvidal Psychological Support Service, commissioned by Welsh Government, seeks to develop the evidence base for provision of rapidly accessible, tiered psychological support alongside LAIB to address this. Here we present initial 9-month findings.

Methods

Tier 1 of the service offers 8 weekly individual therapy sessions, delivered flexibly over 2–6 months, with an experienced trained therapist focused on psychoeducation, co-production of a trauma and compassioned based formulation, and the development of skills to manage current mental health or trauma symptoms.

Pre- and post-evaluation programme assessed efficacy including: EQ5D-5L, Work and Social Adjustment Scale (WSAS), Clinical Global Impressions (CGI), PRO Severity and Clinical Outcomes in Routine Evaluation –10 (CORE-10).

Results

The service launched in March 2023 with 100 referrals in the first 9 months.

35 patients have completed Tier 1, taking between 2 and 6 months to complete.

Patients who completed Tier 1 showed clinically significant reductions in psychological distress and improvements in global functioning, quality of life and perceived mental health difficulties.

These were statistically significant at p < 0.001 for all measures (EQ5D, ICECAPS, WSAS, CGI, PRO, CORE-10) (28< = n <=34).

Conclusion

Rates of retention in treatment are greater than expected amongst this complex client group and the significant global improvements support the notion that those on LAIB present with increased stability and ability to engage in therapy, and that a tiered flexible approach to therapy can promote psychological safety and engagement and sustained recovery.

We propose that a tiered trauma-focused psychology service is well placed to meet the needs of people on LAIB and should be a core component of LAIB treatment in the UK.
An Evaluation of the Costs and Benefits of the New Psychological Support Service for Patients On Long-Acting Injectable Buprenorphine
Authors: Melichar Jan , James Lucie , Greenwood Rosemary
Published: August 2024

Aims

Long-acting injectable buprenorphine (LAIB) is an opiate substitution therapy which controls cravings and other symptoms for at least 28 days. Using this medication eliminates daily visits to the pharmacy, the risk of deviation or overdose from OST and death from overdosing with opiates. Many of those on LAIB return to the lives they left before they became addicted to opiates, but some require additional support from a new bespoke psychological service.

The new service with funds for two years opened in March 2023. An evaluation of the service is required before funding ends to ensure renewal. Here we discuss the costs, benefits and assumptions we have used to demonstrate cost effectiveness.

Methods

Patients referred to the service are asked questionnaires and clinical outcomes at the start and end of the programme. We have used the EQ5D throughout as from this we can calculate the QALYs that NICE uses to value cost effectiveness. We have extrapolated that the benefit will last 4 years based on the COBALT study (Wiles 2016). We will be following the patients up at 12 months to test this but have no funds to follow up to 4 years. We have assumed that patients would have remained the same without this therapy.

Results

The service has a budget of £23,812 a month and 5.17 patients a month (n = 31 July to December 2023) completed treatment. The average gain in EQ5D utility score per patient (n = 33) at discharge was 0.234 [0.140, 0.328]. If the quality-of-life score (EQ5D) at discharge is maintained in the same way as that for CBT in the COBALT study, the total number of QALYs gained from referral to 4 years would be 0.876. The cost-effectiveness ratio is therefore £5,261 per QALY gain. If the assumptions are correct and the patients retain this benefit this could be easily offset by savings elsewhere that have not been estimated in this evaluation.

Conclusion

Our analysis shows we are cost effective, but we may be cost neutral due to the potential savings accrued due to less substance misuse – currently costed at £58K per user per year (Home Office). The use of additional questionnaires for assessing NHS resource use or criminal activity could derail the success by overburdening participants. Evaluating roll out to other sites needs to be costed and proportional.

With thanks to all who have helped with an infectious enthusiasm – we may be cost-effective.
Prevalence of Cognitive and Mood-Related Symptoms in a Large Cohort of Perimenopausal and Menopausal Women
Authors: Reisel Dan , Crockett Clair , Glynne Sarah , Kamal Aini , Newson Louise
Published: August 2024

Aims

Current NICE guidance (NG23) lists hot flushes and night sweats as the most common symptoms associated with the perimenopause and menopause. Consequently, many clinicians, and the public in general, often associate menopause primarily with vasomotor symptoms. However, psychological symptoms are also common in the perimenopause and menopause. Failure to recognise the link between menopause and mental ill-health means that many women are unable to access the support and treatment they need; women are often prescribed antidepressants and anxiolytics, but hormone replacement therapy (HRT) is more effective for symptoms rooted in hormone deficiency. The aim of this survey was to assess the prevalence of negative mood symptoms in peri- and post-menopausal women, and the response of mood symptoms to HRT.

Methods

We administered a modified version of the Greene Climacteric Symptom Questionnaire (Greene 1976) to all new patients attending the Newson Health Menopause and Wellbeing Clinic in Stratford-upon-Avon, between 1 November 2022 and 30 June 2023. Patients initiated on HRT were followed-up after 3 months and asked to complete the Symptom Questionnaire again. Data were collected from electronic health records and analysed using descriptive statistics.

Results

978 women were included in the study. All patients were started on HRT. A third of patients (32%) of patients, were also started on transdermal testosterone. None of the patients discontinued their treatment during the study period. The five most prevalent symptoms were: feeling tired or lacking in energy (96%); memory problems (93%); difficulty in concentrating (91%); irritability (90%); and feeling tense or nervous (90%). Hot flushes and night sweats were much less prominent in this cohort, ranked at 18th and 14th place respectively. All symptoms improved after treatment with HRT +/- testosterone for 3 months. Overall, ‘profound low mood’ (loss of interest in all things) improved the most (69% improvement in symptom scores), followed by ‘attacks of anxiety and panic’ (61% improvement in symptom scores).

Conclusion

Understanding and recognising the common symptoms that women are likely to experience in the perimenopause and menopause is vital to reduce barriers to appropriate care. This study suggests that cognitive and mood-related symptoms are highly prevalent and may be more common than hot flushes and night sweats. For most women, these symptoms improved after a short course of HRT. Longer follow-up is needed to assess any additional response to HRT given for longer periods, after individualisation and optimisation of the dose and regimen.
A Service Evaluation to Understand Factors Affecting Referrals to a Secondary Care Psychotherapy Department
Authors: Rees Henrietta
Published: August 2024

Aims

1.

To evaluate sources and demographics of referrals to the Northwest Surrey Psychotherapy Service, a secondary care service covering Runnymede, Spelthorne, and Woking in Surrey, England. To compare these data with local population data to assess equality of access and whether any groups are underrepresented.

2.

To evaluate what diagnoses are most frequent in those referred and the respective characteristics of those whose referrals are accepted for treatment and those who aren't.

Methods

A retrospective case note review using SystmOne of all patients referred to Psychotherapy between January 2021 and June 2021. Data were extracted by hand: demographics (age, gender, ethnicity, sexual orientation, marital status, employment status, dependents, caring responsibilities, disability, religion), diagnosis, source and outcome of referral. Reasons for referrals not progressing were correlated with current service inclusion/exclusion criteria. Demographics were compared with local population data available from ONS and Surrey County Council.

Results

Fifty-one people were referred, 10 (19.6%) males and 41(80.4%) females.

Twenty-six (51%) referrals were accepted. Amongst those referred, depression n = 15 (29%), post-traumatic stress disorder (PTSD) n = 15 (29%) and emotionally unstable personality disorder (EUPD) n = 13 (25%) were the most reported diagnoses. Persons with depression or EUPD were most frequently accepted for assessment and treatment. The most common reason for a referral not progressing was the patient experiencing active PTSD symptoms requiring prior stabilisation work n = 9 (17%) or the patient not opting in n = 5 (10%).

Referrals came from a range of sources, mostly general practitioners (GPs) n = 18 (35%) and MindMatters (primary care talking therapies) n = 8 (16%).

Conclusion

Males were underrepresented in referrals to Psychotherapy and reasons may vary. It may be beneficial for referrers to be more proactive in considering and recommending referring males for psychotherapeutic input. Other groups were not significantly underrepresented compared with local population data, including ethnic minorities and those with protected characteristics.

Psychotherapy services frequently declined those suffering acute symptoms of PTSD; there may be a need to educate referrers that this is a likely exclusion criterion. Those who were declined on this basis were signposted to services offering stabilisation work, a positive finding in terms of our service facilitating access to ongoing care.

The sources of referrals suggest that GPs and MindMatters are important partners in identifying those needing psychotherapy services. Some referrals were inappropriate, and clearer referral criteria may be helpful. Some people declined assessments or treatment, which may indicate a need for more outreach or education on the potential benefits of psychotherapy services.
Introducing the Dementia Crisis Service in East Kent: Can We Reduce Rates of Hospital Admission?
Authors: SriBalaskanda Swarupa , Veugelers Bastiaan
Published: August 2024

Aims

Admissions to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. The dementia crisis service provides a rapid response and support, in particular to carers and care providers. The team support in managing problematic behaviours to avoid the need for a hospital admission. The team can complete physical examination and bloods in the home environment, reducing the need for involvement of further clinicians.

This project aims to evaluate the effectiveness of the dementia crisis service in reducing admissions to mental health wards.

Methods

The pilot for the service began in January 2023. We looked at the number of admissions to Heather ward, an older adult mental health ward in Canterbury, East Kent (the base of the team) over a 5 month period, between August 2023 – January 2024. We compared this to admission numbers a year ago. We looked at what proportion of patients were admitted with behavioural and psychological symptoms of dementia (BPSD), over the same time period to evaluate whether the number of BPSD admissions has changed since the existence of the team.

Results

The number of overall admissions to Heather ward decreased from 43 to 32. The number of detained patients remained the same, 13 patients over the 5 month period. Looking more closely at the nature of some of the hospital admissions, a referral was not made to the crisis service for some of the admitted patients.

Conclusion

The team have been providing this service for just over a year, including the three month pilot. The limited data does not show enough evidence that the crisis service reduces rates of hospital admission. As this is a new service, there is much work to be done to increase the profile of the team. We would like to re-evaluate the admission data after more information has been disseminated to referrers about the service and the support they offer.
Naltrexone Treatment for Methamphetamine Dependence – Service Evaluation Audit
Authors: Stimson Emma , Bowden-Jones Owen
Published: August 2024

Aims

There is an emerging evidence base to support the benefit of naltrexone prescription in methamphetamine dependence. This audit assesses prescribing practice and benefit of naltrexone in a specialist NHS drug service based in West London. The process for initiation and monitoring of naltrexone in the service was compared with best practice recommendations.

A patient with methamphetamine dependence can be referred to a psychiatrist in order to consider naltrexone treatment. Naltrexone works by reducing cravings, thereby assisting with abstinence. Liver function is checked and then naltrexone is made available by an FP10 prescription. Follow up is then conducted in order to ascertain whether a continuation of naltrexone is indicated.

Methods

Patients prescribed naltrexone were identified using a hand-written prescription record. Each case file was audited for prescribing metrics, substance misuse pattern, diagnoses, past treatments, efficacy, tolerability and length of prescription. Information was manually collected from the SystmOne case notes and anonymously entered into a spreadsheet under headed topics.

Results

Data was collected from 1st April 2019 to 1st June 2023 which identified 28 patients. All patients had keyworker involvement and physical health checks. GHB/GBL was the most common comorbid substance. 18 of the 28 patients took naltrexone for longer than one week. 16 reported benefit with cravings. 6 were abstinent from methamphetamine and 10 were seen to have a partial response (periods of abstinence/lessened use). 9 of the 18 patients reported one or more side effects, most commonly nausea.

Conclusion

The service meets best practice guidelines with regards to keyworker involvement, physical checks and follow-up reviews. Improvements could be made with regards to accurate diagnostic coding. Given the prevalence of side effects, it would be important to discuss options to mitigate these, as well as the importance of continuation of naltrexone (if tolerated) for at least four weeks. The offer of written information should be recorded. The tolerability and efficacy of naltrexone is in keeping with data from randomised controlled trials, which helps to inform patients and clinicians that naltrexone is an effective, safe treatment for methamphetamine dependence.