bluuebunny/crossref_metadata_2025_split huggingface dataset:
IRAMP: Investigation of Risk Assessment and Management Processes Using Staff Focus Groups
Authors: Sunderland Kay , Drysdale Emma , Gillatt Brian , Mackenzie Alan , McCahon Paula 
Published: August 2024

AimsTo investigate risk assessment and management processes across a health board in the context of the implementation of a new risk screening tool and policy through use of staff focus groups to identify how teams make decisions related to risk and gain an understanding of how the new CRAFT tool is used.In mental health services, risk assessment and management are key responsibilities for clinical staff. A risk management tool that is structured and evidence-based aims to assist staff in managing risks including violence, self-harm, suicide and self-neglect.It is not clear whether risk tools have clinical utility in influencing risk-related decision making and previous reviews within the health board indicated that risk policy was not being adhered to, prompting a review of the policy. Furthermore, policy recommends service user and carer collaboration with staff in all areas of mental health in Scotland but despite these recommendations there is little evidence to suggest they are routinely involved in risk assessment and management processes.The present study is an opportunity to explore how teams think about and discuss risk management.MethodsA qualitative analysis was carried out of data from two staff focus groups. These groups were identified by contacting interested teams by email. Groups comprised clinical staff from different disciplines within the MDT including medical and nursing staff. Staff were questioned about their understanding of risk, thoughts regarding risk assessment and their experience of being trained in and using the CRAFT tool.ResultsThemes emerging from the data indicate that staff felt the CRAFT had limited clinical utility or impact on their assessment of risk but may prove useful for communicating decisions about risk between staff and services. However, concerns were raised that the format of the tool made it difficult to complete and read, meaning that important information may not be adequately communicated. Staff reported feeling inadequately trained in the use of the CRAFT tool and felt there were inconsistencies in its use across the health board.ConclusionStaff focus groups have identified challenges with the completion of the current CRAFT tool and expressed a need for better training in order to improve consistency of use across the health board. An update to the tool is due to be rolled out across the board in an effort to address these issues and improve risk assessment completion on the whole.
Assault Profile and Psychiatric Morbidity in Children With Sexual Abuse: A Community Based Cross- Sectional Study From an Urban Law-Enforcement Centre in India
Authors: Thatavarthi Lakshmi Keerthana , S Sireesha , M Aparna 
Published: August 2024

AimsThe extent and nature of child sexual abuse (CSA) and its consequences with respect to psychiatric morbidity is still poorly described in children. This was a community based cross sectional study to describe the social demographic profile and identify psychiatric morbidity in children with CSA and to further examine the association between the sexual assault profile and the psychiatric illness present.MethodsThis study includes 100 children aged between 6–17 years ascertained as sexually abused at the time. The setting was BHAROSA centre, which is a society for protection of women and at-risk children with funding from the Department of Women and Child Development Telangana state, India. Simple random sampling was used to choose the participants and a pre-tested semi structured questionnaire was used to assess the sexual assault profile. The Developmental Psychopathology Checklist (DPCL) which is the Indian adaptation of Child behaviour checklist was used to understand the associated psychopathology. The prevalence of psychiatric morbidity was discerned by the Diagnostic Statistical Manual Text Revision (DSM V-TR).ResultsThe average age for the first CSA encounter was 10.87 years. Most often the perpetrator was found to be an acquaintance (66%) of the child's family. ‘Vaginal/anal penetration’ (55%) was the most common form of abuse. In half of the cases there was a significant delay of two days-two weeks between the last episode of abuse and its discovery. 12% attributed themselves fully responsible for the abuse. 23% reported unsupportive reactions from the caregivers such as being dismissed or being blamed themselves for the abuse. More than half (53%) had at least one psychiatric disorder with post-traumatic stress disorder (PTSD) being the most common (28%) followed by conduct disorder (21%) and depression (17%). 28% had quasi psychotic symptoms and 25% non-specific somatic symptoms. 12% reported suicidal thoughts/ideation. 5 children tested positive for HIV and 2 were pregnant. Children who experienced ‘Vaginal/Anal penetration’ and those who pretended the act did not take place were found to have statistically significant rates of depression, PTSD and suicidality.ConclusionAll children and adolescents who have been sexually abused must be evaluated for psychiatric morbidity regardless of their social demographic and abuse profiles. Additionally, all parents and caregivers should be sensitised on the fact that the majority of the perpetrators are acquaintances to the subjects. Coping strategies of the children especially self-blame and poor social support exert direct negative effects on victims’ adjustment.
Time From Referral to Discharge From High Secure Care: Challenges for Flow Through the Forensic Estate
Authors: Third Gavin , Rees Cheryl , Thomson Lindsay , McIntosh Lindsay Gilling 
Published: August 2024

AimsThe Independent Forensic Mental Health Review (Scottish Government, 2021) highlighted an issue with timely transitions through and out of Scottish forensic inpatient services. Concerns were raised regarding the impact of transfer and discharge delays upon patients. As part of a wider service evaluation examining the pathways forensic mental health patients navigated through secure inpatient care, this study aimed to identify the requirements, processes and time-frames involved in transfer from The State Hospital (TSH), which provides male only, high secure care to Scotland and Northern Ireland.MethodsData for 69 patients noted on TSH transfer list (2017–2019) were collected. In addition to patient demographic, clinical and forensic variables, data was gathered about use of appeals against excessive security under section 264 and 265 of the Mental Health (Care and Treatment) (Scotland) Act 2003.ResultsForty-nine (71.0%) patients were referred to medium secure care, 6 (12.2%) to low secure care and 14 (20.3%) for return to prison. Schizophrenia was the most common primary diagnosis (43, 62.3%), with 75.5% (37) of those referred to medium secure care vs 21.4% (3) returning to prison having received this diagnosis. There were statistically significant associations in terms of time between referral and transfer between individuals who had a primary diagnosis of Schizophrenia/Schizoaffective disorder (no 114, yes 388.5 days; Median) and whether they had lodged a section 264 appeal (no 109.5, yes 469.0 days; Median) or section 265 appeal (no 134.5, yes 517.0 days; Median) against excessive security. There were no significant differences in days from referral to transfer/discharge based on behaviour leading to admission or the number of formal attempts to transfer during current admission. Twenty (40.8%) patients referred to medium secure services made a successful section 265 appeal which resulted in a ruling that they should be transferred within three months. Seven (35%) of these patients were transferred inside three months.ConclusionPatients are waiting significantly variable lengths of time from referral to transfer depending on the service they are being referred to. The use of section 264 and 265 appeals against excessive security was implicated in a greatly increased length of time to transfer. Patients considered to have the most serious chronic mental health conditions are waiting the longest time for transfer with potential implications for their mental health. Patients’ human rights are potentially affected due to continuing to be placed in conditions of excessive security for more than a year following decision to refer.
A Feasibility Study of Floatation-REST for Fatigue: An Idea That Was Worth Floating
Authors: Todd James , Critchley Hugo , Cordova Michael , Eccles Jessica , Colasanti Alessandro 
Published: August 2024

AimsFloatation-REST (restricted environmental stimulation therapy) has shown promising potential as a therapeutic intervention in psychiatric conditions such as anxiety and anorexia nervosa. We speculate that the sensory deprivation might act as a kind of interoceptive training. Within our lab, interoceptive trait prediction error has been used to predict states of anxiety in autistic adults. There is also emerging research conceptualising interoceptive mismatches potentially playing a role in fatigue. Our aim was to run a feasibility study assessing the tolerability of Floatation-REST for participants with disabling fatigue. We also aimed to establish the feasibility of gathering data on mechanistic measures, such as heart rate variability (HRV) and interoception, during floatation.MethodsParticipants were recruited via online advertisements and were screened to check they scored at least 36 on the Fatigue Severity Scale (FSS). Pertinent medication changes and previous float experience within the last 6 weeks were amongst the exclusion criteria. Baseline measures included: Modified Fatigue Impact Scale (MFIS); Body Perception Questionaire; hypermobility questionnaire and Tellegen Absorption Scale. Participants completed four 90 minute sessions of floatation-REST across a 2–6 week period with 1 week of ecological momentary sampling (EMS) before and after. Immediate pre and post float measures included testing interoceptive sensibility, accuracy and awareness. HRV was measured during floatation. Change in energy was measured by retrospective subjective assessment, changes in validated fatigue scales and EMS.ResultsBaseline MFIS scores (median = 67.5; range = 55–77) indicated a high degree of severity of participant fatigue. 15 participants were recruited to the study. 13 participants started the float intervention and 11 completed all four sessions. No drop out was due to poor tolerability. Most adverse events were mild, expected and related to the pre/post float testing. HRV data was successfully captured throughout all sessions. Participant surveys described improvements in energy levels, sleep and relaxation and 73% “strongly agreed” to an overall positive effect. Furthermore, both statistically and clinically significant reductions were noted in the mean FSS scores (56.9 to 52.6; p = 0.044) and the MFIS scores (67.0 to 56.4; p = 0.003). Detailed energy assessment was obtained by EMS with 37 to 86 data points per participant.ConclusionFloatation-REST appears to be a feasible intervention for people with severe fatigue. EMS, HRV data, interoceptive data and other measures were reliably recorded. Reported subjective benefits were supported by an improvement in objective fatigue scores, though the lack of a control group makes these improvements speculative at present.
Lessons From a Crisis: A Thematic Analysis on Occupational Stress in Staff in an Acute Paediatric Teaching Hospital in Ireland
Authors: Ward Shay , Donohue Grainne , McNicholas Fiona , Murray Johanna 
Published: August 2024

AimsThe COVID-19 pandemic placed increased pressure on service provision and healthcare worker [HCW] wellness. As the pandemic recedes, staff need an appropriate response to facilitate individual and organisational recovery, to minimise long-term healthcare worker burnout and to be better equipped for future crisis in healthcare. The aim was to explore and reflect on the experiences of staff working during the COVID-19 pandemic in an acute paediatric hospital to determine an appropriate response in the post-crisis work environment.MethodsA Qualitative research design using responses from open ended questions from one hundred and thirty-three clinical and non-clinical staff (89% clinical) from an Irish paediatric teaching hospital. Reponses were thematically analysed.ResultsHCWs experienced frustration, uncertainty, anxiety and stress, during the pandemic crisis. This included communication inconsistencies, inadequate support and staffing and other resource shortages, leaving staff at high risk for long-term burnout as the pandemic recedes. Three themes were developed detailing this; 1) Support, 2) Communication and 3) Trust.ConclusionThis research supports the long-standing need to increase mental health service investment and to implement an appropriate response to regain and maintain a healthy workforce, post COVID-19. This response should address the biopsychosocial needs of the individual and healthcare organisations should work dynamically, creatively and collaboratively to ensure the psychological safety of its workforce moving forward.
MIND the GAP: Psychiatry's Scottish Trainee Enhanced Programme (STEP) to Reduce Differential Attainment
Authors: Cooper Michael , Hegde Rekha , Cheema Fahd 
Published: August 2024

AimsBuild relationship and understanding between International Medical Graduates (IMGs) and supervisors in core psychiatry through the Scottish Trainee Enhanced Programme (STEP) to help facilitate belonging and support a vulnerable group. Thus improving training outcomes.MethodsThere are various different areas to the PsychStep Programme.A handbook is distributed to all IMGs which has been created in accordance with the Royal College of Psychiatrists (RCPsych) IMG Guide.A trainee created video guide for the RCPsych portfolio is provided with the aim of this reducing anxiety around its use.A Scotland wide WhatsApp group was created for peer support.The final part of the programme was attendance of trainees and crucially supervisors at two half day sessions. Joint attendance is crucial in fostering supportive relationships. Content was delivered via workshops by IMG consultants with lived experience. Topics covered included communication skills, success factors, reflection, cultural transition and cultural competence. These sessions were evaluated using both scale questions and free text.ResultsThere were 6 participants in this programme. All participants reported on evaluation that they felt this course made them:
•Feel welcome to psychiatry.•Realise that other trainees faced the same challenges as them.•Felt supported in their Journey.All participants stated that their trainer attended the virtual sessions with them and that them being in attendance helped them understand specific challenges they would face as an IMG.Themes identified on free text feedback from trainees were advice on how to reflect and the support that is available in general. The opportunity for shared personal experiences was also highlighted as a positive.Themes identified on trainer feedback were guidance around both provision of a supportive environment and the importance of having open discussions with trainees.ConclusionThis programme has an important role in helping IMG trainees in psychiatry succeed. Success stories of IMG consultants provided knowledge and hope for them. The IMG trainees felt better able to effectively engage with supervision following participation in this programme.Outcomes from this programme to date highlight opportunities to build on this in the future. The organisers of this course hope to increase future attendance and share good practice across other specialities.
Child and Adolescent Mental Health Conditions and Crisis Management: Bespoke Education of Local Police Forces
Authors: Foster Michael , Nadir Haya 
Published: August 2024

AimsThe aim of this work was to improve police force understanding of the mental health difficulties of children and their management in challenging situations.Nationally, approximately 18% of children aged 6–16 years are likely to have a mental disorder, with the frequency increasing in regions such as North Staffordshire where there are areas of significant deprivation. During the COVID pandemic, children's wellbeing, school attendance, and isolation all worsened resulting in a tripling of urgent referrals to some crisis mental health services. Owing to underfunding and reduced resources in the NHS, the police services have had to spend more time dealing with children's mental health crises, with some forces identifying insufficient training for understanding and de-escalating these emergencies.It was hypothesized that the preparation and delivery of bespoke training sessions, coupled with pre- and post-assessments, would help enhance police understanding of the conditions and strategies in managing these crises.MethodsExtending previous approaches, each teaching session covered the presentation, diagnosis, and management of autism, conduct disorder, and emotional dysregulation in children, along with de-escalation. A pre- and post-session quiz was completed addressing each of the four topics. Data collection took place in October 2023 with 19 pairs of quizzes completed by local police and community support officers. Given the size and nature of the data, a non-parametric bootstrap resampling method was used to assess whether the teaching produced a statistically significant improvement in each topic and overall score.ResultsMean differences in scores with 95% confidence intervals (CIs) were obtained for the 19 pairs of quizzes for each mental health condition and all conditions taken together. With maximum of 16 marks possible in each condition, there were statistically significant improvements in mean scores for autism, 1.9, CI: [1.6,2.3]; conduct disorder, 2.2, CI: [1.7, 2.7]; emotional dysregulation, 2.4, CI: [2.0, 2.7]; and de-escalation, 0.9, CI: [0.5, 1.4], and for all conditions 7.4, CI: [6.5, 8.5].ConclusionBespoke children's mental health training sessions were found to deliver significant improvements in police knowledge of crisis management and de-escalation in children affected by autism, conduct disorder, and emotional dysregulation. Given the unprecedented demands on police services, training sessions of this kind could serve as a training tool to reduce both the intensity and duration of crises they have to handle. More sessions have already been requested within the authors’ local NHS Trust.
Improving Public Awareness of Climate Anxiety: A Medical Student Led Initiative
Authors: Hassoulas Athanasios , Finnie Abigail , Shore Emily 
Published: August 2024

AimsClimate change, and the effects thereof, present challenges in all domains of life. Mental wellbeing is an often-overlooked area when considering the direct and indirect impact of climate uncertainty. Worrying about the outcome of current and future climate events and experiencing distress at the perceived lack of action taken by world leaders has given rise to reports of climate anxiety. Whilst not a diagnosable psychiatric illness, individuals experiencing climate anxiety report to experience excessive worry and fear that may impair activities of daily living. In addition, anxiety over the climate and environmental matters may exacerbate existing conditions such as generalised anxiety disorder (GAD).MethodsIn an effort to raise public awareness of climate anxiety, a leaflet was designed by medical students for dissemination in General Practice surgeries, along with an interactive electronic version of the leaflet being made available for online dissemination. The World Health Organization's (WHO) guidance on health literacy in empowering communities and diverse audiences was adopted in the design of the leaflet. Key information was reported using interactive means that enabled the audience to engage with the content of the leaflet and to consider the impact of climate anxiety on mental wellbeing. A survey was embedded at the end of the leaflet, using a QR code, to collate feedback from the public and from clinicians on the usefulness and educational value of the leaflet.ResultsThe leaflet was shared with General Practitioners affiliated with the School of Medicine at Cardiff University, to disseminate at their surgeries, and was promoted by online and social media channels affiliated with the School of Medicine. Members of the public reported that the leaflet highlighted the importance of mental health considerations in relation to the climate crisis and provided a good overview of climate anxiety. Clinicians also reported the overall usefulness of the leaflet as a resource of information on climate anxiety.ConclusionClimate anxiety is a relatively new phenomenon that most people are not familiar with or know little about. Raising public awareness of the impact the climate crisis might have on mental wellbeing is crucial. Of equal importance is improving clinical awareness of climate anxiety as a risk or perpetuating factor of existing anxiety and/or mood disorders, such as GAD.
Addressing an Identified Need: Training in Serious Incidents Investigations and Coroner's Inquests for Psychiatric Trainees in Kent and Medway NHS and Social Care Partnership Trust (KMPT)
Authors: Moisan Maria , Williams Verity , Ayanda Segun , Daly Rachel , Valsraj Koravangattu 
Published: August 2024

AimsNavigating a Serious Incident (SI) investigation and participating in a Coroner's Court proceedings can pose challenges for psychiatry trainees. The Higher Training curriculum emphasizes active participation in activities that enhance patient safety and care quality. This project aims to enhance patient safety and trainee confidence by improving training on SI investigations and Coroners Court proceedings.MethodsUsing Quality Improvement (QI) methodology, in the first cycle an initial survey was distributed to all psychiatry trainees and middle grade doctors working in Kent and Medway (n = 67) to establish baseline knowledge and confidence levels in areas related to risk assessment & management, SI investigations and Coroner's Inquests.In response to the identified need for training, we organized the Initial Training Event with support from Deputy Chief Medical Officer for Quality and Safety, Patient Safety Team and Medical Education Department. The half-day, in-person event was opened to all doctors and featured 5 sessions: Serious Incident Investigation Process, Thematic Review of Suicides, Systems Engineering and Human Factors in Patient Safety, Learning from Mortality and Structured Judgement Review along with ‘Being Involved in Investigation – An Investigator's Guide’. Data from a survey of attendees (n = 47) informed the development of a tailored training session for psychiatry Core and Higher Trainees.ResultsThe initial survey received 32 responses (response rate: 47.76%). 71.88% of respondents had little to no understanding of SI investigation processes. Remarkably, 87.5% expressed strong interest in receiving training on conducting SI investigations. 90.62% were extremely or very interested in receiving training on participating in a Coroner's Inquest.47 doctors attended the Initial Training Event. 30 responded to the feedback questionnaire (47.76%). All doctors found the training useful, with over 90% rating it ‘very’ or ‘extremely’ useful. 97% felt that the training would improve their clinical practice in terms of patients’ safety. After the training, 60% understood the process of conducting an SI investigation a moderate amount; 33.33% understood the process a lot or to a great extent. Nevertheless 92.86% felt a need for additional training in SI investigations. 63.33% suggested making training available yearly, and 36.67% favoured making it mandatory training.ConclusionThis project identified a significant need for training in SI investigations and Coroner's Court proceedings among psychiatric trainees. An Initial Training Event developed from the first QI cycle survey data received positive feedback. The next phase involves developing a tailored training program that addresses identified knowledge gaps. Further considerations include making this training a regular event.