bluuebunny/crossref_metadata_2025 huggingface dataset:
“It's Changed My Mind-Set About the Idea of Motherhood”: An Online Perinatal CFT Group Service Evaluation
Authors: Douzenis Joanna , Lashari Mahnoor
Published: August 2024

Aims

We aim to systematically document our reflections regarding the establishment of a perinatal-focused Compassion Focused Therapy (CFT) group within an expanding service. It aims to highlight specific outcomes and client experiences resulting from group completion.

Methods

Synthesizing information from established CFT Group protocols across various National Health Service (NHS) contexts, scholarly investigations, and our CFT training, this study instituted a 10-week perinatal-CFT group intervention. Recruitment targeted individuals already engaged in our services, resulting in the referral and screening of eleven potential participants. Nine eligible individuals provided informed consent, with seven successfully completing the program. Assessments, including the Clinical Outcomes in Routine Evaluation (CORE-10), Postpartum Bonding Questionnaire (PBQ), The Forms of Self-criticizing/Attacking & Self-reassuring Scale (FSCRS), and Maternal Antenatal Attachment Scale (MAAS), were administered pre- and post-group. Quantitative findings were analysed and compared, supplemented by qualitative insights distilled from thematic analyses of feedback forms and post-group reviews with each participant.

Results

Though we had a small number of participants (n = 4) who completed the pre and post measures and the post group review, we received overall positive feedback for the group intervention. During the post group review and from their feedback forms, participants expressed the value of the group experience and found the discussions and exploration of CFT concepts to be helpful in reflecting on their self-critical thoughts.

On the Core-10, there was a reliable and clinically significant change for 75% of participants. Two participants completed the PBQ, and both showed a reliable but not clinically significant change in scores. We had one antenatal client who showed a reliable but not clinically significant change on the MAAS.

The FSCRS comprises three scales: Inadequate Self (IS), Reassured Self (RS), and Hated Self (HS). On the IS subscale, a reliable and clinically significant change was observed for 75% of participants. The HS subscale showed a reliable change but lacked clinical significance for 50% of participants. No reliable change was observed in the RS scale for any participant.

Conclusion

While the study's results are not generalizable due to the small sample size, positive feedback suggests the well-received nature of online perinatal CFT groups. Despite a preliminary evidence base, this paper contributes reflections and experiences, highlighting the potential effectiveness of online CFT groups in the perinatal period. These findings underscore the need for further research and exploration in this promising therapeutic approach.
Outcomes of Treatment With Long-Acting Buprenorphine Injection in Individuals With Opioid Use Disorder Attending a Rehabilitation Center in the UAE
Authors: Tolba Hossameldin , Foad Wael , Ameri Abdulrazaq , Abdullah Saeed , El Hayek Samer
Published: August 2024

Aims

Opioid use disorder (OUD) is a global burden with significant morbidity and mortality. Standard of care often includes integrated treatment programs combining psychosocial interventions and Medication Assisted Therapy (MAT) which includes methadone, Buprenorphine (BUP) and Naltrexone. BUP, a partial u-opioid receptor agonist, has shown to increase patient treatment retention, reduce relapse, and improve quality of life. BUP Oral formulations can be associated with misuse, diversion, and non-adherence. Despite availability, many individuals don't receive adequate MAT treatment or discontinue medications prematurely, substantially increasing their relapse risk. Subcutaneous Long-Acting BUP (SC LABUP) injectable formulations have been associated with improved access, less burden of adherence, and greater abstinence in OUD patients. From this perspective, the OUD program at Erada Center maintains affected individuals on weekly or monthly SC LABUP injections. Our study aims to evaluate abstinence and treatment retention in Erada Center patients who are maintained on LABUP injections.

Methods

We conducted a retrospective cohort study of all individuals following at Erada Center from January 2023 until January 2024, who were maintained on weekly or monthly LABUP injection. 174 individuals were identified, with diagnosis of OUD as per ICD–10 criteria, and receiving LABUP injection during inpatient admission or outpatient follow up. Primary outcomes were abstinence period (defined as negative urine drugs test apart from q-BUP), and retention in treatment (defined as compliance with attendance with OUD program). These were assessed at three time intervals: 24, 36, and 48 weeks from taking the first LABUP injection.

Results

174 individuals were maintained on LABUP injection. Participants were all males, aged 18–65 years old, and polysubstance users with opioids being their drug of choice.

70 patients completed at least 24 weeks and received at least 2 doses of LABUP. Out of those, 53 achieved full abstinence and retention in 24 weeks (75.71%), 32 patients achieved the same for 36 weeks (45.71%), 25 patients achieved the same through 48 weeks (35.71%). Reasons for being lost to follow-up included relapse, incarceration (military service or custodial sentence), or drop out for no identifiable reasons.

Conclusion

To the best of our knowledge, this is the first study in the UAE and Arab world looking at the outcomes of individuals with OUD maintained on LABUP injection. Results highlight a notable abstinence and retention rates as above. Further studies should look at reasons for relapse and loss for follow-up.
Service Evaluation of Diagnostic Evolution in Psychiatric Patients at Benazir Bhutto Hospital: Comparing OPD and ER Admissions
Authors: Gul Naima , Nizami Asad
Published: August 2024

Aims

This project evaluated the accuracy and evolution of psychiatric diagnoses in patients admitted through the Outpatient Department (OPD) and Emergency Room (ER) at Benazir Bhutto Hospital. It aimed to understand the factors contributing to diagnostic changes, especially the impact of comorbid conditions and interdisciplinary discussions.

Methods

Over an eight-month period, this study reviewed 200 patient records from the psychiatric department. It compared initial psychiatric diagnoses from OPD and ER admissions with final diagnoses at discharge. The evaluation examined the influence of ward round discussions, serial mental state examinations, and newly identified comorbid medical conditions, such as thyroid disorders and neurological issues, on diagnostic changes.

Results

Analysis showed that 38.2% of ER admissions had a revised diagnosis by discharge, compared with 22.5% from OPD. Initial diagnoses primarily included major depressive disorder (30.1%) and bipolar disorder (27.2%). By discharge, increases were observed in personality disorders (up by 18.3%) and substance use disorders (up by 14.7%). Comorbid medical conditions were newly diagnosed in 26.8% of patients. Factors influencing diagnostic changes included ward round discussions (57.3%), serial mental state examinations (40.2%), lab findings (33.5%), and medical/interdisciplinary consultations (29.6%).

Conclusion

The service evaluation at Benazir Bhutto Hospital reveals significant diagnostic evolution in psychiatric care, more pronounced in ER admissions. The identification of additional disorders and comorbid medical conditions highlights the necessity for comprehensive, ongoing psychiatric assessment. Lab findings and interdisciplinary consultations played a crucial role in refining diagnoses, suggesting the importance of an integrated care approach. Recommendations include improving initial diagnostic processes in ER settings and strengthening interdisciplinary communication to enhance accuracy in psychiatric diagnosis and patient treatment outcomes.
Psychostimulant Prescription in Children and Adolescents With Attention Deficit Hyperactivity Disorder: Evaluating the Current Practice in Al Ain, United Arab Emirates
Authors: Javaid Syed Fahad , Al Ahbabi Aysha Ali , Afzal Ayesha , Al Ahbabi Noura Ali , Al Ahbabi Mohammed Ali
Published: August 2024

Aims

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by the core symptoms of hyperactivity, impulsivity, and associated functional impairment. Psychostimulants are the most commonly prescribed medication for ADHD in children and adolescents. The use of psychostimulants in children and adolescents requires close supervision in a specialist clinic. The decision to commence psychostimulants should be made jointly with the young person, their parents, carers, and healthcare professionals. It is critical to provide age-appropriate information and discuss treatment's possible benefits and side effects.

This audit aimed to appraise the psychostimulant prescribing practice in children and adolescents in psychiatric outpatient clinics in Al Ain Hospital, United Arab Emirates. We analyzed compliance against the standards set out in The National Institute for Health and Clinical Excellence (NICE) Guideline 87 concerning the diagnosis and management of ADHD in children and young people.

Methods

This hospital-wide audit involved a retrospective review of case notes. A questionnaire was developed to capture the required information anonymously. The audit sample comprised 366 service users with a diagnosis of ADHD followed up in the child psychiatry clinic between January 2018 and December 2019. We chose this pre-Coronavirus Disease 2019 (COVID-19) period when services ran as usual. Data collection took place between September and November 2023.

Results

Out of 366, 298 (85%) patients were males, with 181 (55%) being Emirati citizens. The sample age ranged between 5 and 17 years, with a mean of 9.8 years. Psychostimulants were prescribed in 327 (89%), with methylphenidate being the most commonly used medication. All but one case had documentation of discussion about medications' indications and side effects. However, only 40 (12%) cases had a discussion documented about the importance of following a healthy lifestyle, while 5% had no discussion about the right to revisit their decision about the treatment.

Conclusion

This audit has identified areas for improvement in practice, including the need to develop local guidance on prescribing psychostimulants in children and adolescents with a diagnosis of ADHD. We recommend enhanced staff training to improve the quality of discussion with the young person and their family before starting psychostimulant therapy, including clear documentation of the decision-making process. We suggest electronic reminders to inform the patients about the importance of following a healthy lifestyle. We will re-audit the practice after one year of implementing the above action plan.

No financial sponsorship has been received for this evaluative exercise.
Reviewing the Use of a Fibroscan® Machine in Belfast Trust Addictions Service
Authors: Johnston Benjamin , Toal Helen , Watson Joy
Published: August 2024

Aims

Belfast Trust Addictions Service was among the first addictions teams in the UK to get their own Fibroscan® machine, in March 2021. In the two preceding years (2019–2020), only 32% of patients referred by addictions to hepatology for hepatitis C virus (HCV) attended their appointments.

Patients under the addictions service are known to access healthcare services poorly while being at increased risk, with a clear need to improve their access to appropriate care.

We aimed to review how the Fibroscan® machine has been used in the addictions service, and if there has been an impact on how the patient cohort access healthcare.

Methods

We reviewed our case records of all patients offered a Fibroscan®, and whether they attended the appointment, and reviewed indications of each scan in the three following categories. Firstly, for those with alcohol misuse. Secondly, for HCV cases in which Fibroscan® results help decide treatment choice. Thirdly, ‘other’ – for example, consultant discretion due to LFT results.

Results

308 patients were offered Fibroscans® between March 2021 and February 2023.

238 patients attended their appointments, of which 194 were for alcohol misuse, 43 for HCV and 1 ‘other’.

70 patients did not attend their appointments, of which 67 were for alcohol misuse and 3 ‘other’.

Scans for HCV were completed ad hoc (i.e. without an arranged appointment) so are not included in attendance rates. The attendance rate for scheduled Fibroscan® appointments (for alcohol misuse and ‘other’) was 74%.

Of the 194 patients scanned for alcohol misuse, 40 were then referred to hepatology with likely cirrhosis.

Conclusion

238 patients underwent a Fibroscan®, leading to 40 hepatology referrals for likely cirrhosis, and 43 patients being offered appropriate HCV treatment.

Crude DNA rates appear greatly improved – 74% attendance at our Fibroscan® appointments vs 32% attendance at hepatology referral appointments.
Evaluating Current Practice of Prescribing as Required Medications for Psychiatric Inpatients
Authors: Lalli Naveen , Abu Olabisitaiye , Tariq Safyan , Perla Vijay , Kar Nilamadhab
Published: August 2024

Aims

Pro re nata (PRN) medications are commonly prescribed for psychiatric patients on admission, often at maximum daily dose (MaxD). We intended to evaluate prescribing patterns for PRN medications, their MaxD, and rationale, specifically in the first seven days in the hospital, along with any concerns of associated physical illnesses.

Methods

All the inpatients on a specific date, admitted to adult and old age wards of a general psychiatric hospital, for at least 7 days, were recruited for this service evaluation. Data regarding the prescribing of promethazine, lorazepam, zopiclone as PRN, patient demographics, and psychiatric and physical diagnoses were collected using inpatient drug cards and electronic patient notes.

Results

Out of 52 inpatients, 14 were excluded (4 admitted for < 7 days, and 10 had missing data), leading to a sample size of 38 patients. On admission, a considerable proportion of patients were prescribed promethazine (82%), lorazepam (76%), and zopiclone (50%). More than half (63%) of patients on promethazine were started on 100 mg MaxD, of which 13% had reasons for prescription, and 33% had reasons for the MaxD were noted. None of the old-age patients was prescribed 100 mg of promethazine. During first 7 days, patients used on average 15%, 14% and 29% of the total prescribed dose of PRN promethazine, lorazepam and zopiclone; and 35%, 45% and 47% of patients did not use any PRN drugs. Only one patient used 100% of the available PRN lorazepam and zopiclone. Patients with current illicit substance misuse, used PRN slightly more frequently; promethazine (16% v 12%), lorazepam (20% v 14%) and zopiclone (46% v 24%) compared with those with no misuse. With a current risk of aggression or agitation, all female patients were prescribed PRN promethazine or lorazepam, compared with 86% of male patients.

In regards to British National Formulary (BNF) cautions of associated physical illness, one patient with glaucoma, and one epilepsy was prescribed promethazine; three patients with respiratory condition were prescribed PRN lorazepam; and six patients with depression and four with current drug user were prescribed PRN zopiclone.

Considering diagnoses, promethazine, lorazepam and zopiclone were used by varying proportions of the patients: schizophrenia (10%, 3%, 0%), bipolar affective disorder (0%, 14%, 57%), depression (27%, 11%, 38%), personality disorder (15%, 28%, 48%) respectively.

Conclusion

Psychiatric inpatients were prescribed MaxD of PRN medications more than what is being administered. Documentation of rationale for prescribing PRN medications and dose is needed.
Patient Outcomes in Crisis Resolution and Home Treatment Service: A Retrospective, Observational Study in Wolverhampton
Authors: Misra Anurag , Raja Usman , Kar Nilamadhab
Published: August 2024

Aims

Crisis Resolution Home Treatment Team (CRHT) provides short-term treatment for psychiatric patients in the place of residence, dealing with mental health crises, risks, deterioration, and preventing hospital admissions. This team works round the clock, seven days a week. This study aimed to analyze the clinical outcomes of the service provided by the CRHT in Wolverhampton.

Methods

In a retrospective, observational, explorative study design, data was collected from the electronic medical records of 100 (54 female and 46 male) consecutive patients who were treated under the general adult (age range 18–65 years) CRHT from 1st December 2022. We collected outcome variables such as symptomatic improvement, change in risk status, days of treatment under CRHT, and discharge destination.

Results

In the sample, 76% had one psychiatric diagnosis, and co-morbidities were present in 20%, with 4% of patients having no syndromal diagnoses. The most common primary diagnosis was personality disorder (24%), followed by psychotic disorders (22%), anxiety disorders 21%, and depression (20%). Overall risk status of red changed from 87% at admission to 17%, at discharge; risk to self from 43% to 17% (p < 0.01), risk to others from 11% to 1% (p < 0.01), respectively. The mean length under care of CRHT was highest with anxiety disorder (27.7 ± 18.2 days), followed by personality disorders 23.7 ± 17.9 days. Age and number of days under CRHT were negatively correlated, suggesting younger age was linked to higher number of days (p < 0.05). Most (71%) patients showed an improvement in their mental health, 15% deteriorated and got admitted to the psychiatric hospital, 9% did not engage and 5% were considered not suitable for care under CRHT for various reasons such as having no fixed abode. Most (80%) patients were discharged back to the community following the CRHT period.

Conclusion

Despite the limitation of subjective clinical assessments, the results suggested that the CRHT was effective in considerable proportions of patients with symptomatic improvement and a decrease in risk level, with a small proportion being admitted to a psychiatric ward. There is a need for objective evaluation of risk and symptomatic change using validated instruments and assessing patient experiences about the services.
Clinical and Non-Clinical Complaints Towards a Mental Health Service in the West of Ireland Over a Seven-Year Period
Authors: O'Malley Andrew , Walsh Elaine
Published: August 2024

Aims

To examine whether the rate of clinical and non-clinical complaints towards a mental health service (MHS) in the west of Ireland has changed over the preceding seven years. We aim to clarify the pathways for managing clinical and non-clinical complaints locally and compare with other MHS nationally. We aim to capture the nature of complaints, potential factors in any change in rate and quantify associated workloads via survey of senior clinicians involved in managing complaints.

Methods

We obtained anonymous data from a local database maintained by administrative staff regarding annual complaint numbers for the previous seven years (2016–2022). Data separating clinical and non-clinical complaints were available for the previous four years only due to previous recording practices. Current complaint pathways were captured via administrative staff. A survey via telephone or email of Executive Clinical Directors (ECDs) typically involved in complaint management was conducted.

Results

Annual rates of complaints have increased in the past four years, with these representing higher totals than any of the three previous years (2019–2022, n = 27,23,23,46 v. 2016–2018, n = 21,12,14). A significant increase in rate is noted in 2022 (n = 46) representing at least double the rate of five of the preceding six years. Clinical complaints are more predominant than non-clinical across a four year period (mean = 59% annual total) but no significant change in rate was noted. Rates of complaints are perceived to have increased in the previous five years by ECDs (n = 4). Repeat complainants are perceived to be common (n = 4). Workload regarding complaints is reported to be variable between services (n = 2, 0–4 hrs/week v. n = 2, 4–8 hrs/week). A clear appeals pathway is unavailable regarding clinical complaints across MHS (n = 4). A disparity between MHS around clinical complaints structures and recording practices between services is noted.

Conclusion

Overall rates of complaints towards MHS have broadly increased in the last four years, with a significant increase in 2022. There appears to be a significant disparity in structures between both clinical and non-clinical complaints pathways and between individual MHS. Further research in this area and a standardised national framework for management of clinical complaints is needed.
A Survey of Referrals to Psychiatric Intensive Care Unit (PICU): Patient Characteristics and Outcome
Authors: Satisha Shantala , Pettifor Emily
Published: August 2024

Aims

The project aims to evaluate the referrals from North Kent for admission to our PICU from April to November 2021.

Hypothesis:

There are very few surveys of PICU referrals. We expect more referrals for younger men with psychotic illnesses and comorbid diagnoses; to be for aggressive behaviours; and most will be admitted to acute wards with ongoing support from the PICU liaison team.

Background

Our PICU services in the trust include one 12-bedded male PICU, 5 contracted female PICU beds and the PICU liaison service. PICU liaison team ‘gatekeep’ the PICU beds for patients meeting the admission criteria and supporting the other referrals’ admissions to non-PICU acute beds by working closely with the staff and patients on these wards.

Methods

Data was collected for all referrals for PICU admission made to one of the three PICU Liaison practitioners in North Kent from April to November 2021, recording the demographics, clinical information and outcomes.

Results

There were 126 referrals in this time period, of which 68% were males. 38% were aged 18–30 and 25% were 31–40 years old.

43% of referrals were from inpatient acute wards, 21% from community, 21% from other settings and 7% from Places of Safety. 75% of the referrals were detained under the Mental Health Act.

The primary diagnosis was Schizophrenia in 25%, Bipolar Affective Disorder in 25%, Schizoaffective Disorder in 13%, Personality Disorders and Substance misuse related disorders were 7% each. 32% of the referrals had a comorbid diagnosis; 43% of which was substance use related, 23% had personality disorder and 34% had other conditions including neurodevelopmental disorders.

42% had previous admissions to PICU and 52% had forensic history.

Reason for referral was aggression in 76%; 10% did not have any indications for PICU and 18% was for current or recent prison stay.

30% of the referrals were admitted to PICU and 58% were either admitted to or remained on the acute wards with support from PICU Liaison Team. While 5% were diverted to the forensic pathway, 7% remained in the community.

Conclusion

In conclusion, the data shows patients referred for PICU admission were more likely to be young men with aggressive behaviour and a primary psychotic illness, using illicit substances. Most referrals came from the inpatient wards as is to be expected. They were also more likely to have previous PICU admissions and a significant forensic history.
The National Centre for Gaming Disorders – the Demographic Profile and Clinical Characteristics of Individuals Accessing Our Service
Authors: Piper Theodore , Silva Youngs Michelle Da , Tomy Haby , Lockwood Rebecca , Bowden-Jones Henrietta
Published: August 2024

Aims

Gaming Disorder (GD) was recognised in the addiction field by the International Statistical Classification of Diseases and Related Health Problems in 2018. The National Centre for Gaming Disorders (NCGD) is the first NHS clinic to accept referrals from adults and young people who are struggling with the characteristics of GD. The NCGD opened in 2019. Since then, we have received over 1,000 referrals from either gamers, their family members, or from parents seeking support. The team is multidisciplinary and led by Addiction Psychiatrists and Consultant Psychologists.

This service evaluation aims to understand the demographics, clinical characteristics, and gaming behaviours and trends of those with a GD who are accessing our service.

Methods

The data included in this service evaluation is based on 380 gamer referrals. Data was collected through our referral form.

Results

Demographics: The average age of gamers at referral was 19 years, with 60% of gamers aged between 13–18 years old. Male gamers represented 90% of the sample, with the remaining 10% made up of gamers identifying as female (9%), trans, or other. People who identify as White (British, Irish, or Other) represent 74% of referrals. The remaining 26% are from individuals who identify as Asian or Asian British, Mixed, Black or Black British, or of other ethnicities. Individuals based in London, or the South-East of England make up 60% of referrals. Comorbidities: 1 in 10 gamers had been formally diagnosed with a neurodevelopmental disorder at the time of referral. 1 in 8 gamers had an existing mental health condition. Gaming Trends: The three most popular games played were Fortnite, Minecraft, and Call of Duty. Our sample spent on average 10 hours per day gaming. In-game purchases were present in 17% of gamers. The average in-game expenditure at the point of referral was £4,500. In our sample, 46% were aggressive and 30% were physically violent to family members when interrupted from gaming.

Conclusion

As of date, we have had 530 gamer referrals, and we are continuing to extract relevant information on the demographics and characteristics of individuals with a GD. Our data suggests that the typical gamer accessing our service is male, young, white, and from London. The most popular game played is Fortnite. A substantial proportion of our sample are aggressive or physically violent to family members when their gaming is interrupted, whilst others are at risk of spending thousands of pounds on in-game purchases.
West London Maternity Trauma and Loss Care Service 2022/2023 Evaluation
Authors: Reed Jasmine , Van Rhijn Sanne , Khossravi Hadiss
Published: August 2024

Aims

The Maternity Trauma and Loss Care Service provides specialist care to women and birthing people who are affected by birth trauma, baby loss and severe fear of childbirth. The service has an integrated team of specialist midwives and psychological practitioners. This evaluation is the first, to our knowledge, to describe the challenges and successes of setting up a Maternal Mental Health Service as depicted in the NHS Long Term Plan.

Methods

The sample includes all women and birthing people who were referred to the service over the 12-month period from 1st April 2022 to 31st March 2023.

A mixed-methods design was used to explore and interpret the delivery of the service. Descriptive data was used to describe basic service information: client demographics, time from referral to assessment and numbers accessing treatment. Quantitative data from pre and post clinical measures to look at symptom change over the treatment period. Qualitative data to capture the experience of clients.

Results

The service received 254 referrals between April 2022 and March 2023. For primary referral reasons of accepted clients, 92 clients (50%) were referred due to perinatal trauma, 65 clients (35%) were referred for perinatal loss, 26 clients (14%) for Tokophobia and 2 were referred for other reasons (1%). Three quarters of referrals were accepted and 99 (53%) were pregnant at the time of referral. 53 clients (29%) were postnatal, 32 clients (17%) were post-loss and one was pre-conception.

Of the interventions offered, 49% were offered a midwifery intervention, 31% a psychology intervention and 18% were offered midwifery and psychology treatment. A small number attended groups. 36 clients referred during this 12-month period completed treatment.

PTSD Checklist for DSM-5 scores and Clinical Outcomes in Routine Evaluation scores indicate that service users experienced a reduction of symptoms between the start and end of treatment. There was an average reduction in scores on the PTSD-checklist of 17 and on the Clinical Outcomes in Routine Evaluation of 6.4. 17 clients completed the service satisfaction survey, all of which were positive about the service and its impact on wellbeing.

Conclusion

The Maternity Trauma and Loss Care service continues to fill the gap identified in the long-term plan providing a much needed integrated service to women and birthing people who experience trauma and loss on their reproductive journeys. Areas identified for service development include further developing a pathway for peer support and partners.
Older Adults Mental Health (OAMH) Services Across Wales – A National Service Evaluation Survey
Authors: Romeh Amr , Chance Patrick , Varanasi Amrita
Published: August 2024

Aims

Theoretically, OAMH services would be similar across all Welsh health boards but the reality can differ. To my knowledge, such data about OAMH services across Wales does not exist in a structured way. So I aim to explore these similarities/differences across different Welsh health boards.

Methods

A 20-question google forms survey was sent to 65 doctors from the seven Welsh health boards including long-term trust-grade doctors, middle-grade/SpRs and consultant psychiatrists. It is a box-ticking survey with comment fields for sharing potential thoughts.

Results

Response rate is 50.7% (33/65) with representation from all health boards. Consultants represent 72.2% of responses.

There is some variation in MDT members. Large variation shows in number of organic and functional beds. 33.3% have wards with mixed-type patients. 66.7% have separate wards for each cohort of patients. 30.3% have no inpatient duty but those who have (69.7%), show a varied number of inpatients. Only one sector has long-stay beds.

63.6% indicate that outpatient duty is divided into functional and memory services. Number of clinics differs hence varied numbers of patients.

57.6% have support of COTE on request, some have their regular attendance and some struggle to have their support. 66.7% indicate that care-coordinators are CPNs, otherwise they are OTs, social workers, psychologists or consultants.

75.8% find it better to have one team providing care for the same patient in the community and as inpatients; one major factor being continuity of care.

72.7% have medical students shadowing them in a structured way.

63.6% do not have specialized clinics in the community, others state they have clinics for lithium, clozapine, depot, S117 after-care, antipsychotic review, MCI or neuropsychiatry.

60.6% of liaison services are old-age specific. Some comments state that even in ageless services, they have an older adult psychiatry consultant. One comment states that there are designated nurses to each age group but the consultant is not “old-age trained”.

90.9% of memory services are run by psychiatric service; 9.1% by other departments.

Conclusion

Variations are not only across different health boards but also in-between sectors in each health board. Responses indicate variation in structure of inpatient, outpatient, liaison service and community specialized clinics. There are different levels of support from COTE. Structured medical students’ placements are shown in majority of responses. Finally, satisfaction of subconsultant-level doctors is clear by their wish to continue in the same field.
A Survey Into Child and Adolescent Mental Health (CAMH) Staff Wellbeing Within a Trust in England
Authors: Shamim Iqra , Sundhar Reka Ajay , Panesar Kiran
Published: August 2024

Aims

Sickness absences within the NHS have been on the rise with 27 million days across 2022, 22% of which were due to mental health and wellbeing related issues. The 2022–23 report on progress in improving NHS mental health services found that increased workload and staff shortages within the mental health sector was leading to concerns of staff ‘burnout’ and higher rate of staff turnover. There is an indication that CAMHs staff are at higher risk of poor wellbeing despite limited research in the UK. The audit aimed to gain insight into the wellbeing of staff working in CAMHs within the trust according to NICE Mental Wellbeing at Work (NG212) and highlight areas of concern and propose recommendations to improve staff wellbeing.

Methods

Anonymous self-report questionnaire, based on a validated tool recommended in the NICE NG212 guidance, was disseminated across four boroughs within the trust to measure wellbeing in the workplace. The survey had 19 questions, 17 requiring scores on Likert scales and 2 descriptive questions, aimed to gain information on the five drivers of wellbeing in the workplace (health, relationships, environment, security, and purpose).

Results

A total of 123 responses were analysed. Across all four boroughs, physical health scored worse than mental health. 44.7% of respondents felt they had inadequate facilities in the workplace to support their health and wellbeing. Further, 32.5% of responses disagreed/strongly disagreed that change was managed well in their organisation compared with 25% who agree/strongly agree. Key words such as staff-appreciation and team-building days recurred in qualitative responses across the trust. There were further site-specific differences. Research shows that provision of workplace exercises can be safely used for the promotion of employees' physical and mental health. Cost-effective strategies such as staff-appreciation and gratitude can improve job satisfaction thereby promoting staff retention. To consider elements of face-to-face contact with colleagues could also have a positive impact on psychological wellbeing due to more productive meetings; increased networking; increase of engagement and job satisfaction.

Conclusion

The CAMHS staff wellbeing survey provided useful insight into staff perception of their wellbeing at work. Repeating the survey, after implementing recommendations, would help identify important determinants. Despite the survey being limited to the specific trust, further research into CAMHs staff wellbeing across the UK could help facilitate improvements and help with staff retention.
Follow Up After Hospital Discharge in Older Adult Psychiatric Patients
Authors: Sunderland Kay , Rhodes Nicholas , Donaldson Andrew , Dillon Shaina , Otaniyen Patience
Published: August 2024

Aims

To identify if patients discharged from an older adult psychiatric ward were followed up in line with national recommended guidelines. Current National Institute for Clinical Excellence (NICE) guidelines recommend follow up and final discharge letters (FDLs) being available within 7 days of discharge.

Methods

A record search was conducted to identify all patients discharged from one ward during a one year period.

Each patient's notes were reviewed to identify what follow up they had in place and how long it took for this to be implemented. We also examined the time taken for a final discharge letter (FDL) to be made available to their General Practitioner (GP).

Results

We identified 99 patients who were discharged from the ward within the specified period.

The mean time taken for patients to be followed up after discharge was 9.72 days. In 63.16% of cases this follow up was provided by Community Psychiatric Nurses (CPNs), with 51.58% being reviewed in medical clinic. A further 9.47% had their initial follow up with an occupational therapist, 4.21% with a psychologist, 4.21% with the addictions team, 4.21% with care home liaison, 2.11% with social work, 2.11% with continuing care and 1.05% with rehab.

FDLs were sent to GPs, on average, 13.6 days after patients were discharged.

Conclusion

Within our data set a few outlier values markedly increased the mean for both outcomes. Using median figures, average follow up time fell to 6 days, meeting national guidelines, and FDL time fell to 8 days, exceeding recommendations by just 1 day.

Within our department, measures have since been put in place to ensure secretaries are reminding medical staff of the recommended time frames for final discharge letters and it should be noted that an immediate discharge letter (IDL) is routinely sent to GPs containing key clinical information prior to patients being discharged.

The results show that our current practice does fall somewhat short of matching national guidelines and further work should be done to investigate how we can improve standards.
Audit for Patients Who Are Discharged on Community Treatment order (CTO) in North East Part of Essex: Exploring the Section Paperwork and the Readmissions in 2 Year Period
Authors: Ahmed Bushra , Pal Hem Raj , Alhadi Rashed
Published: August 2024

Aims

•

To find out discrepancies around community treatment order section paperwork and renewal hearings.

•

Explore if CTO is helpful in delaying relapse of mental illness.

Methods

All inpatients from general adult male and female wards in the North East Essex area in the last 3–5 years who were detained under section 3 of the Mental Health Act and were discharged on a Community treatment order were included. All included patients were followed up for a period of two years and data was reviewed to know if the standard guidelines regarding the CTO paperwork completion and renewal hearings were followed.

Data about episodes of further recalls to hospital, further revocation or discharges on CTO during that two year period for these patients is included.

Information about the timely filling of the CTO forms and uploading on the system upon readmission is explored wherever applicable.

Finally, the time duration between discharges and each readmission is explored.

Results

Total no. of patients: 13, Male: 10, Female: 3

Out of the 13 patients,

One had 4 readmissions in the consequent two year period (Days since last discharge – 158, 80, 14, 365 days), duration of each admission: (39, 9, 71, 53) days.

Two had 2 readmissions (on days 623 and 80: On day 65 and 9), Duration of each stay (6 and 90 days; 80 and 164 days).

Four patients had 1 readmission (on days 683, 133, 30, 723) and duration of stay is (14, 33, 1510 and 1460 days).

Six patients never had any admission.

As for the tribunal hearing, one patient's tribunal hearing was missed, one of them did not attend, one had his CTO rescinded and one was admitted soon after. Rest of the patients had their regular timely hearings and were regularly reviewed in the community.

Out of 13, only 3 patients had appealed against the CTO, had tribunal hearing.

Out of 13 patients, only one patient had his CTO lapsed and he had two readmissions during the 2 years follow up.

Delay in admission following recall was due to section 135 being issued.

CTO3 paperwork was missing in two cases.

A second CTO3 or recall notice was issued in 4 cases, in 1 case, reason was not documented, in 2 cases, patient agreed for informal stay but later did not comply with care plan. In one case, reason was not documented.

Conclusion

CTO paperwork are missed in rare cases and could be avoided by reminders from Mental Health Act Office.

CTO renewal hearings take place regularly as per mental health act guidelines, though in rare cases, meeting is missed. This could be avoided by having patients discharged on CTO to be booked for timely reviews beforehand.

The audit is too small and is inconclusive to indicate if CTOs prevent readmissions and relapses and hence future study with more sample size is called for.
Audit of High Dose Antipsychotic Therapy (HDAT) Prescribing Among Inpatients in East Suffolk
Authors: Ruhi Shamim , Alase Anne , Aregbesola Motolani , Khan Quratulain , Rizvi Fariha
Published: August 2024

Aims

High doses of antipsychotic therapy (HDAT) are often prescribed in secondary mental health services and has been the subject of many audits and service improvements. This interest is largely due to the increased morbidity and mortality related to HDAT, and strong advocacy for clear rationales to guide this decision. There is a need for continuous review and monitoring to prevent unnecessary prescribing.

Our audit was used to determine the prevalence of HDAT in East Suffolk inpatient settings and assess whether review planning and monitoring of HDAT was practiced.

Standards for antipsychotic dosage were established using British National Formulary and Maudsley Prescribing Guidelines for Psychiatry.

Methods

Retrospective data was collected using electronic records of patients 18 years and above who were discharged from inpatient psychiatric wards located in East Suffolk between 1st July and 31st December 2021.

Data available included discharge medication letters, discharge summaries and inpatient clinical notes.

Results

A total of 256 patients were discharged from East Suffolk wards in the 6-month period between 1st July and 31st December 2021.

Majority of the patients (80%) were above 65 years of age with more than half of patients being male 114 (56.3%).

Ninety-seven (37.9%) patients had a diagnosis of schizophrenia or schizophrenia-like and delusional disorders, while approximately 25% of the audited population had a mood disorder.

9% had a singular diagnosis of personality disorder.

One hundred and sixty-six (64.6%) patients were on antipsychotic medications and two (1.2%) patients were discharged on HDAT.

Conclusion

High dose antipsychotic prescribing was not as prevalent as initially assumed. This audit noted only one of the two patients on HDAT did not have the appropriate monitoring form completed.

Good clinical practice recommends the need for the completion of a high dose antipsychotic therapy (HDAT) form for each patient, which would allow proper monitoring.
High Dose Antipsychotic Therapy Prescription Amongst Patients Admitted to the Psychiatric Intensive Care Unit (PICU), Mill View Hospital, Hove
Authors: Awolaran Dorcas , Monir Samina
Published: August 2024

Aims

Acutely ill patients on PICU are likely to be on High dose antipsychotic treatment (HDAT), which poses a risk to their physical health. Current guidelines require that appropriate criteria be met before prescription, and close physical health monitoring after prescription of HDAT. This audit aims to assess practices regarding prescription of HDAT to patients on PICU, Mill View Hospital, Hove according to standard guidelines.

Methods

Ten of the 38 patients admitted to PICU at Mill View Hospital between January and June 2023 were on HDAT and thus were eligible for this audit. The revised prescribing observatory for mental health topic 1h 3e audit tool was used to collect data regarding the patients. Data was collected from the clinical records including electronic, paper notes and uploaded drug charts and forms.

Results

The age range was between 21–56 with an average age of 35. Eight of the 10 patients were white British, 2 were of another ethnic group or ethnicity unknown. All the 10 patients had clinical reasons for HDAT prescription clearly documented at the start of the treatment which ranged from cross titration of antipsychotics to treatment resistance to standard treatments.

Of the 10 patients on HDAT, 6 of them had documented clinical review in the 3 months, 1 had documented clinical review in last 3 to 6 months, 3 had no clearly documented review of clinical response in the last year.

Only 7 out of 10 had their temperature, pulse, blood pressure, body mass index and electrocardiogram (ECG) clearly documented. Seven of the 10 patients had their full blood count, urea and electrolytes, liver function tests, blood glucose, plasma lipid tests done and clearly documented in last year. Eight of the 10 patients had their serum prolactin checked while none of the patients had their creatinine phosphokinase checked and clearly documented in the last year. Only 2 of the patients had clearly documented examination of extrapyramidal side effects (EPSE) in the last one year.

Conclusion

This audit demonstrates that although clinical reasons for HDAT prescription were documented for all patients, current standard guidelines for HDAT prescription regarding regular review and physical health monitoring were either not being met, or not clearly documented.
Compliance With a Biopsychosocial Assessment Template When Assessing Presentations of Self-Harm or Suicidal Ideation by Liaison Psychiatry Practitioners in Dorset Healthcare: A Clinical Audit
Authors: Azlan Aryn , Gale Kirstie
Published: August 2024

Aims

To evaluate whether a comprehensive biopsychosocial assessment is performed for patients presenting with self-harm or suicidal ideation in clinical practice, following National Institute for Health and Clinical Excellence guidelines 225 (NG225). We assessed Dorset Healthcare Liaison Psychiatry practitioners' compliance with a standardized biopsychosocial assessment template.

Methods

A standardized biopsychosocial assessment template, aligned with NG225, is utilised in all Dorset Healthcare Liaison Psychiatry services for conducting initial assessments. Included data were the initial assessments of adult patients presenting from 01/08/2023 to 30/09/2023 for the following indications: 1) a suicide attempt, 2) a self-harm incident, or 3) suicidal ideation. Any initial assessment that did not use the standardised template was excluded. Retrospective analysis of Rio records assessed compliance with each heading on the biopsychosocial assessment template.

Results

A total of 60 records were included from Dorset Healthcare Psychiatry Liaison Services. Only one heading, the “Presenting Situation”, was documented in all assessments (100%). Psychiatric headings on the template showed high compliance: “Mental State Examination” and “Risk Summary” were each documented in 98% of assessments, and “Psychiatric Formulation” in 92%. The “Carer/Parent's Understanding of the Assessment” was the least assessed (40%). Other significant headings that showed moderate compliance were, “Safeguarding Concerns” (71%), “Physical Health History” (75%) and “Social Situation” (81%).

Conclusion

Our findings emphasize the need for more comprehensive biopsychosocial assessments in Dorset Healthcare Liaison Psychiatry services. While Liaison Psychiatry practitioners exhibit proficiency in evaluating psychiatric aspects, there is reduced compliance in assessing social aspects, notably in assessing family understanding. Future qualitative analyses will evaluate practical barriers and human factors affecting compliance with specific headings. Moreover, data collection can expand to encompass additional Mental Health services in a wider catchment area, including settings such as community and inpatient facilities.