bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healing and Hope for Forced Migrants in Norwich: The SHIFA Clinic for Asylum Seekers and Refugees
Authors: Hameed Yasir , Fox Hannah , Clegg Izobel , Charamiroupa Eirini , Rayala Meghana 
Published: August 2024

AimsThe poster will discuss our Quality Improvement project around improving access to mental health assessments for asylum seekers and refugees and why this model of care proved to be useful in reducing barriers to accessing specialist mental health services for these patients.The clinic was launched as part of the Advancing Mental Health Equality (AMHE) Collaborative, which is a 3-year programme run by the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists, and Norfolk and Suffolk NHS Foundation Trust (NSFT) was one of the organisations that signed up to this initiative.MethodsThe clinic was named SHIFA, which stands for (Supporting Holistic and Integrated Forced Migrants Assessments). SHIFA means ‘Healing’ in Arabic, Turkish, Urdu, Kurdish and Pashtu (languages spoken by many patients accessing this clinic) and the name was selected in collaboration with staff and service users.What are the objectives of the SHIFA clinic?
•To offer a trauma-informed approach to the assessment of forced migrants. This is an essential objective of the SHIFA clinic as the trauma-informed approaches are guided by trust, rapport and offering person-centred care.•Reduce barriers to mental health care for people seeking asylum, refugees and people forced to migrate.•Work collaboratively across the systems to bridge the gap among different services to improve the person-centred and continuity of care and avoid the re-traumatising effect of re-telling their stories.•Co-production and putting the voice of our service users and carers at the heart of everything we do.•Share learning and embed inclusive practice within the mental health services in NSFT and other organisations.ResultsWe will provide data on patients seen in the clinic, the diagnosis and treatment. We will also give examples of the feedback we received from professionals and service users and why this model successfully provided collaborative and joint working opportunities with various services working with these patients.ConclusionThe QI project represented in this clinic has provided a local solution to meeting the needs of forced migrants in our community, reducing mental health inequalities. It ran without funding initially and was successful in receiving funding due to the clear difference it made in providing good quality care for these patients.Similar projects can be easily implemented in various mental health trusts.
Learning Disabilities: Reducing CTPLD West Psychiatry Clinic DNAs by 20% by Offering a More Person-Centred Service
Authors: MacDaid Kerenza , Hussain Labib , Maber Sarah 
Published: August 2024

AimsTo explore reasons why patients under the learning disability community psychiatry team were not attending their appointments.To explore patient preferences for type of appointments offered (F2F, telephone or video) aiming to improve access and attendance, whilst promoting reasonable adjustments for patients with learning disabilities.To improve efficiency in terms of number of patients seen and reduce wasted clinical and admin time in relation to DNA appointments, by reducing the ‘did not attend’ (DNA) rates by 20%.MethodsWith the support of the QI team using methodology including fishbone diagrams and PDSA cycles, electronic data on the number of DNA psychiatry appointments were collated from January 2022 onwards and recorded monthly.Each DNA appointment was coded with a reason given for non-attendance. The data was then reviewed and analysed to identify any common themes around non-attendance.A questionnaire was initially trialled with a small sample of patients who had not attended to explore reasons for non-attendance and preference regarding appointment type. The questionnaire was then sent to all CTPLDW patients who had missed appointments. An easy-read version was also sent to promote accessibility amongst the patient group. The data was collated and reviewed.ResultsMost common reasons for patients not attending their psychiatry outpatient clinic appointments under the CTPLDW team were identified:2022: 35 patients DNA – 28.6% citing communication/correspondence issues.2023: 30 patients DNA – 33.3% citing communication/correspondence issues.Additional reasons for non-attendance included issues with residential homes, sickness and transport.ConclusionAn anecdotally high number of DNAs were noted by CTPLDW. The data collected thus far has helped us to define and understand the issues. The main factors identified revolve around communication and correspondence of appointment times.The next step in our quality improvement project is to trial text reminders for patients and carers to assist in remembering appointments, to assess whether this change idea helps to decrease the number of DNAs.Future change ideas include development of resources to support attendance (e.g. adjusted appointment letters with QR codes for access/maps, reminder letters in easy-read format and video tours).CTPLDW would like to offer a more personalised approach with a service that promotes reasonable adjustments and reduces barriers to access, thereby reducing the number of DNA appointments.
Standards of In-Patient Medical Seclusion Reviews
Authors: Murtza Mohammed , Anjum Taha 
Published: August 2024

AimsSeclusion is a method used by mental health teams around the world to manage aggressive and disturbed behaviour in psychiatric patients in situations where there is immediate risk of harms to others.A quality improvement project was carried out over two hospital in-patient sites containing 6 wards to see if seclusion reviews were completed safely and documented appropriately according to the guidelines set out by South West Yorkshire Mental Health Trust and the Royal College of Psychiatrists.MethodsThe quality improvement project was carried out to first audit data to see if seclusion reviews were being done to the local guidelines and standards set by the Mental Health Legislation and Royal College of Psychiatrists. This was followed by training junior doctors and reauditing date to see if any improvements were observed.A retrospective quality improvement project was conducted assessing medical seclusion reviews carried out by on-call junior doctors between November 2022 and January 2023. Data was initially collected retrospectively spanning over a period of 4 weeks over the month of November 2023 including the analysis of 30 seclusion reviews. These results were presented as an audit to doctors and managerial staff at the end of November. Post training seclusion review data was collected over a period of 4 weeks over January 2023.ResultsAn overall improvement in 7/9 domains. The biggest improvement (54% rise) was checking for side effects and EPSEs which was only documented 4/23 times in the first pre-training run. 18% improvements were also noted for assessing and documenting if the patient had any distress or pain, clinical appearance in terms of the cardiac domains such as perfusion and colour of the skin and also their level of orientation in place person and Glasgow Coma Score.The only two domains in which an increase was not observed was to document if seclusion should continue and justification for why this is the case. These two domains were already at 100% and the System 1 seclusion review template prompts doctors to do this at the end of the review which is possibly one of the reasons it was done well both before and after the training.ConclusionA great deal of interest and feedback was garnered and the idea was agreed that a further audit could be carried out after providing training for the current doctors and to gather post-training medical seclusion review data for comparison.
Rapid Quality Improvement Project (RQIP): Analysis of All Referrals to the Newcastle Psychiatric Liaison Team (PLT) From the Emergency Department (ED) During April 2023
Authors: Romaine Eleanor , Flude Harriet , Taylor Katie , Brown Sarah , Donnelly Isabella 
Published: August 2024

AimsIn light of increasing referral rates, the RQIP aimed to review all referrals made to PLT by the ED during April 2023. The purpose was to identify ways to improve working practices to benefit patients, the ED team and the PLT.MethodsAll ED referrals in April 2023 were identified and the following was gathered from each record.Patient information:1.Record number, sex, ageCircumstances of attendance:2.Date/time3.Who directed patient to ED and arrival method4.Attendance reason5.Presence/absence of physical health condition requiring ED6.Intoxication on arrival and if assessment required after sobriety7.OutcomePatient involvement with other services:8.Number of previous PLT referrals in past 90 days9.Currently under care of another team, if yes, were they contacted before ED attendance10.Contact with crisis team in previous 72hoursResultsDuring April 2023 there were 356 referrals from ED to PLT. 284 represented single attendances and 72 represented repeat attendances by 44 patients. 34% (n = 123) self-presented to ED. Emergency services directed 21% (n = 75) to ED. 71% (n = 253) had physical health reasons to attend whilst the rest presented with mental health crisis alone (n = 103). 25% of patients attending ED and referred to PLT were intoxicated and a third of these did not require assessment following sobriety. 41% (n = 145) patients were open to another mental health team within the trust who could potentially have provided crisis input. Of all referrals 27% (n = 97) were signposted to other services, 26% (n = 93) left before they were seen. PLT referred 11% (n = 40) to crisis teams and 3% (n = 11) to Mental Health Act assessment.ConclusionFindings indicate that a large proportion of patients attending ED could have had their mental health needs met elsewhere in the absence of a medical reason for attending, thus potentially avoiding long waits in ED. Patients that are referred but leave before assessment, those without acute medical need to be in ED, those that do not require assessment after sobriety or those open to other planned care mental health teams may have their needs best met outside of the acute ED environment. It is hoped that community transformation work will enable community services to become more responsive to such needs.The team propose working collaboratively with the acute trust and trialling embedding a PLT clinician in the ED triage process in order to redirect patients to the most appropriate care in a timely way.
Assessing Adherence: Audit of Glasgow Antipsychotic Side-Effect Scale Completion for Patients on Antipsychotic Depot Injections at Guildford CMHRS SABP
Authors: Singh Hardeep , Syed Maryam , Mannali Vimal , Sharma Ekta 
Published: August 2024

AimsTo evaluate the current use of the GASS scale in monitoring patients on antipsychotic depot medications at Guildford CMHRS, we conducted a comprehensive assessment and compared it with trust guidelines. The guidelines recommend GASS scale completion at specific intervals: 12 weeks and 6 months post-initiation, annually thereafter, and at each dose titration.MethodsWe conducted a review of patient depot charts and SystmOne notes for individuals on antipsychotic depot medications, in accordance with trust guidelines. Cases were randomly selected from the total number of patients on these medications. Following the initial audit, which was shared at Guildford CMHRS, a recommendation was made for staff to utilize the GASS Scale during outpatient appointments and document scores on both charts and SystmOne. A follow-up audit after six months was performed to evaluate any improvements.ResultsIn the initial audit of 60 cases receiving antipsychotic depot injections, GASS was conducted in 8 cases (26.6%), with 7 cases (23.3%) completed within the last year. In the re-audit of 58 cases, GASS was completed in 16 cases (55.17%), all within the last year.ConclusionThe re-audit highlights a notable increase in completion rates, yet opportunities for improvement persist. Additional suggestions for enhancing completion encompass regular refresher courses on Trust Guidelines, ensuring Pharmacy Team adherence to guidelines for patients on antipsychotics, and motivating medics and nursing staff to complete and document the GASS Scale. Consistent re-auditing is recommended for continuous improvement.
Substance Misuse History Documentation at Admission to Secure Rehabilitation Ward Audit
Authors: Westhead Elizabeth , Sud Neeti 
Published: August 2024

AimsTo audit compliance with electronic admission documentation relating to substance use.MethodsThe initial admission forms in the electronic records of all current patients on the male ward were reviewed (n = 12). The information in core admission document was compared with other substance abuse history information on records.ResultsSeven of the twelve patients were asked about substance misuse during their admission review. 5 patients were not asked. One of these patients had no history of substance use but his alcohol use history was also unclear in other records. 9 patients had at the very least met the ICD–10 criteria of harmful use of alcohol. 11 patients had at the very least met the ICD 10 criteria for harmful use of illegal substances. Two patients had excessive amount of alcohol use to the point of dependence since teenage. Mean age of onset of both substance and alcohol use was 11, with range of 0 to 20. The most commonly misused substances were alcohol and cannabis (11 out of 12 patients). Eight patients had abused drugs other than cannabis. All but one of these then progressed to using other substances. The reasons for using substances and attitudes to substance and alcohol use were not explored in admission assessment in most cases.ConclusionAdmission assessment to a rehabilitation ward is also an opportunity to screen for any barriers to recovery as well to use brief motivational interviewing intervention if appropriate clinically. There is a need to improve the quality of our admission assessment in relation to substance use history.Most of our patients had a very early onset of alcohol and substance use, as young as age 8. Apart from one outlier, all had started using substances and alcohol by age 15. This raises concerns regarding missed early prevention and safeguarding opportunities.
Eating Disorders Intensive Treatment (EDIT) Subteam: Shoring Up MDT Working to Turn the Tide for Patients at Risk of Hospitalisation
Authors: Jingren Alyssa Tan , Morton Katherine , Nugent Kelly , Weir Nyree 
Published: August 2024

AimsPresentations of severe Eating Disorders (ED) to the Tertiary Eating Disorders Specialist Service (TESS) in Lanarkshire have increased in recent years. Our criteria has also expanded to include severe Avoidant-Restrictive Food Intake Disorder (ARFID), increasing demand for a multidisciplinary team (MDT) approach for patients at high physical risk with less typical ED presentations. Medical Emergencies in Eating Disorders (MEED) recommends MDT working and development of pathways to support these patients.The “EDIT subteam” was thus developed in March 2023, comprising: TESS psychiatrist, TESS GP, dietician, assistant practitioner, and TESS psychologist.For TESS patients at high physical risk, high risk of hospitalisation, and who would benefit from a trial of “stepping up” treatment, we aimed to employ coordinated MDT intervention to 1. optimise community treatment, 2. regularly review risk and 3. reduce need for hospital admission.MethodsEach patient was discussed at a weekly MDT meeting attended by EDIT subteam, where risk assessment and management plan was agreed.6-month review was conducted using meeting minutes, staff survey and group discussion, with consideration given to: number of patients prevented from requiring hospital, number of patients admitted to hospital and consideration if different levels of intervention could have prevented this, staff satisfaction and review of the MDT complement.Results22 patients – 17 female, 5 male – were included on EDIT for the first 6 months. At point of step-down from EDIT, 13 had ongoing TESS community input, 5 were admitted to hospital, 3 were discharged from TESS and 1 transferred to Community Mental Health Team.Most EDIT patients received input from multiple domains of the MDT. Given baseline low admission rates and complexity of patient presentation, we were unable to determine how many hospital admissions were prevented, but consensus was that overall, a higher level of care was provided. It was not felt that different levels of intervention could have prevented any of the 5 admissions. Staff feedback was positive: EDIT improved communication, provided job role diversification, contained and shared risk, improved awareness of care plans and resulted in better-considered onward referrals.Areas for improvement included a lack of Occupational Therapy and nursing, and concern about EDIT patients skipping waiting lists.ConclusionThe EDIT subteam provides an avenue for high risk patients to be regularly discussed in an MDT setting – although impossible to empirically quantify if admissions were reduced, consensus within TESS was that the introduction of EDIT has improved community treatment for this group of patients.
Reasons Why Patients Are Turned Down From Treatment at a Personality Disorder Service: Implications for Referrers and Personality Disorder Services
Authors: Krishnan Suvitha , Ibrahim Kemal , Agyeman Josephine , Reid Harry , Lee Tennyson 
Published: August 2024

AimsPatients referred to a Personality Disorder (PD) Service are frequently not offered treatment. This has profound implications for patients (who feel dismissed or rejected), referrers (who are perplexed as they have clearly diagnosed a PD) and the PD services themselves (their raison d'etre being to treat PD patients). A systematic search identified no literature on reasons for non-acceptance. This study aimed to describe reasons for not offering therapy in patients, after a specialist assessment.MethodsWe conducted a case series of 50 patients assessed in a specialist PD service. We collected data from routine service notes, using thematic analysis to identify categories of the reasons identified for treatment unsuitability.ResultsReasons for assessing treatment unsuitability (in descending order) were:
1.(20%) – Lack of engagement (e.g. repeated non-attendance of appointments) and motivation to change (e.g. externalising all responsibility, or believing they completely lacked agency in their actions).2.(18%) – Extremely harmful substance misuse or dependence.3.(13%) – The underlying diagnosis (e.g. not meeting diagnostic criteria for a personality disorder or a severe psychopathy) and level of severity (e.g. too mild for a specialist service).4.(11%) – Identified areas of psychological work has very little to no relation to interpersonal difficulties or relationships.5.(11%) – A comorbid eating disorder (e.g. BMI < 17.5).6.(9%) – Another service identified as being more appropriate (e.g. another psychological service).7.(8%) – Risk of aggression to the therapist.8.(5%) – Comorbid axis I disorder being the primary problem.9.(5%) – Extreme self-harming behaviours requiring crisis interventions.ConclusionReferrers
1.To accept that many patients with PD will fail to actively engage in psychotherapy.2.To consider whether severity is of a level requiring specialist PD treatment; or if the patient needs a forensic psychotherapy service rather than a non-forensic PD service.3.To consider whether the comorbid conditions (e.g. dependent alcohol use) are in fact the primary diagnosis and thus require treatment before the PD service intervention.PD services
1.Need to develop novel interventions to help patients become more active and engaged in the assessment and thus progress onto treatment.2.Need to inform referrers on their criteria for not offering treatment, allowing referrers the ability to gauge more accurately when to refer the patient.
An Older People's Functional Mental Health Ward: A Year in Figures
Authors: Rhodes Nicholas , Donaldson Andrew , Sunderland Kay , Dillon Shaina , Otaniyen Patience 
Published: August 2024

AimsWe aimed to review various health outcomes for patients admitted to an older adult psychiatry ward specialising in functional illness, over a one year period.In 2020 the Mental Welfare Commission for Scotland highlighted a concern about the lack of evidence and data surrounding admission to older people’s functional mental health wards. We aimed to review this for North Lanarkshire and provide a comprehensive overview of our in-patient population that will aid in service review and improve care.MethodsWe reviewed the electronic notes of all patients (total: 99) admitted to the ward over a one year period. Extracted data included demographics, medications, mental health act status, discharge destination and readmissions.ResultsWe found the average age was 73 years old and the median length of stay was 33 days (mean 63). Patients were admitted with a wide range of diagnosis including (most common to least): mood disorders, psychotic disorders, dementia, substance misuse and ARBD, delirium and personality disorders. 30% of patients required detention under the mental health act during their admission, but this fell to only 7% on discharge. 51% of patients were discharged on an antipsychotic. The majority of patients were discharged home; within a year 34% were readmitted to psychiatry and 40% required a medical admission.ConclusionWe found that our demographic information was broadly consistent with the mental welfare commission's findings. However there is a significant variation in length of stay shown by the difference in the mean and median, due to a small number of significantly longer admissions. Notably there were numerous admissions with a dementia as a primary diagnosis, on a functional ward. In this age group it was significant that a high proportion of patients were prescribed antipsychotics. Further work is required to better understand these findings.