bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detentions in BSMHFT (Birmingham and Solihull Mental Health Foundation NHS Trust) - Covering the Birmingham and Solihull Geographical Area Under the Mental Health Act Between 2018 to 2021
Authors: Maganty Dinesh , Harsh Rajendra , Cleverley Tom 
Published: June 2022

AimsTo continue to monitor trends in detentions under the Mental Health Act based on race, age, gender, and sexuality during the COVID-19 Pandemic to consider if there were any specific areas that would need to be addressed.MethodsWe investigated available mental health detention documents stored in mental health legislative office, Birmingham and Solihull mental health foundation NHS Trust.ResultsWe found that detentions under Section 3 of the Mental Health Act have increased very gradually over the last three years (2018 to2021). However, there has been gradual reduction in detentions under Section 3 within the white population beginning in 2019 and continuing with a marked acceleration in reduction during the two peaks of the pandemic. This is marked in the 66yrs plus age group. As the pandemic has eased this reduction has stopped and reversed with increased section 3 admissions in last few months in this population. The detentions in the black and Asian population have followed a reverse pattern, with marked increase during the pandemic peaks in 2020/2021 and a marked fall as the pandemic has eased.Conclusion1.Mental health act detention data during the Pandemic shows that the pandemic has disproportionality impacted black and Asian population of all ages and Elderly white population.2.During the pandemic there has been a marked increase in detentions under Section 3 of the Mental Health Act (for treatment) in the Black and Asian population with a marked reduction in the white population. This difference is stark in the working age population.3.This highlights:
a.The need for a well-functioning community based health and social care offer to reduce detentions in the black and Asian population.b.Return of admissions under the mental health act of white elderly post vaccination (which are vast majority white) shows a reversal of the trend of this group not accessing inpatient treatment fully during the pandemic.4.Community Treatment Order (CTO) detentions in the Black and Asian population continue to increase through the pandemic disproportionately5.There is no material change during the pandemic, in short term detentions (section 2, 5(2)) or other inpatient detentions under the Mental health act6.There are no significant trend changes noted based on gender or sexuality or age during the pandemic in BSMHFT (Birmingham and Solihull mental health foundation NHS Trust).
An Evaluation of the Prescribing of High Dose Antipsychotic Therapy and Combination Antipsychotic Therapy to Inpatients on the General Adult Wards of Mersey Care NHS Foundation Trust
Authors: Campbell Louise , Holmes Harry , Hyland Declan 
Published: June 2022

AimsHigh dose antipsychotic therapy (HDAT) is defined as “a total daily dose of a single antipsychotic which exceeds the upper limit stated in the SPC or BNF or a total daily dose of two or more antipsychotics exceeding the SPC or BNF maximum using the percentage method. Previous audits have looked at HDAT on both a national level (the Prescribing Observatory for Mental Health) and within Mersey Care NHS Foundation Trust. This audit aimed to identify the proportion of patients subject to HDAT and review combination antipsychotic strategies and consideration of Clozapine in patients subject to HDAT.MethodsIn August 2021, data were collected from the eight inpatient wards in Mersey Care NHS Foundation Trust. This involved using the Electronic Prescription and Administration system to identify those prescribed antipsychotics. Following this, the patient's electronic record was scrutinised for documentation of the rationale for HDAT, combination antipsychotics and consideration of Clozapine.Results129 inpatients were identified as being prescribed antipsychotic medication. 21 (16.3%) patients were prescribed combination antipsychotic therapy, with four of these patients (3.1%) being prescribed HDAT. For these four HDAT patients, there was no recorded documentation of discussion of the option of Clozapine. The most common antipsychotic combination was Paliperidone depot with oral Risperidone. 38 out of 129 (29.5%) patients had been considered for Clozapine. Reasons for Clozapine being refused included the patient declining, concerns about non-concordance with oral medication, patients having had a neutropenia on an FBC, the patient being reluctant to have regular blood tests and a patient's comorbidities.ConclusionWhen comparing the proportion of patients subject to HDAT (3.1%) to the previous Trust audit in December 2020 (9.1%), there is a recurrent theme that antipsychotic prescribing practice in Mersey Care is safe, with minimal HDAT. Of note, the figure is significantly lower than the proportion of HDAT patients identified in the 2012 national study (28%). In this audit, none of the patients on HDAT had documented consideration of Clozapine. Three of the four patients were soon to be no longer subject to HDAT which may explain this result. Compared to the Trust's HDAT audit in 2020, the percentage of patients on combination antipsychotic therapy has stayed largely the same - 16.3% compared to 17.4%. The Trust needs to strive to continue minimal HDAT prescriptions and ensure that, in those patients subject to HDAT, there is consideration of and documentation of Clozapine being considered.
Evaluation of Early Neuro-Imaging Requests for Dementia Diagnosis in Wolverhampton Memory Assessment Service (MAS)
Authors: Prasanna Aparna , Mandair Kuljit , Ling Clare 
Published: June 2022

AimsThe Wolverhampton Memory Assessment Service (MAS) is nurse led and accepts referrals from primary and secondary care settings. There has been a rapid rise in the number of referrals as well as an increase in demand to provide a timely diagnosis. This poses a challenge to meet the national aspiration of referral to diagnosis in 6 weeks. The aim is to improve access to neuroimaging in order to avoid delays to diagnosis and management.MethodsIn January 2022, a retrospective sample of three groups of newly referred patients to MAS between 1st June-31st October 2021 was selected, each group consisting of 15 patients.A dedicated tool was used to collect data. MAS follows NICE standards for neuroimaging in dementia guidance.In Group 1 scans were not requested at referral but were requested after initial nursing assessment, in Group 2 scans were available at initial referral and in Group 3 scans were requested by the MAS Consultant Psychiatrist upon receipt of referral.ResultsIn group 1; 47% of patients have still not had a scan (with a waiting time of approximately 6 months) and 73% have not been given a diagnosis. Three patients were given a diagnosis due to exceptional circumstances and therefore the results of these patients can be disregarded.In group 2, all (100%) patients had a scan either prior to the referral (73%) or requested by GPs at the time of referral (27%). 80% of patients have been given a diagnosis. The average days from referral to diagnosis was 82 days. Patients not given a diagnosis yet was due to cancellation/awaiting appointments.In group 3, all (100%) patients have had a scan and 67% of patients have been given a diagnosis. The average days from referral to diagnosis was 102 days. Patients not given a diagnosis yet was due to cancellation/awaiting appointments.ConclusionImplementing a pathway whereby clinicians can either have access to prior neuroimaging or refer appropriate patients for scans at the point of referral, significantly reduces waiting times to diagnosis and management within a timely manner.This reduces carer burden and provides increased support from appropriate services as well as reducing the chances of patients ending up on crisis pathways.There is a need to implement an integrated care pathway that is responsive and accessible to all patients.
Implementation of an App Based Communication Platform, “Consultant Connect", to Improve Physical Health Outcomes for Patients at a UK Mental Health Trust
Authors: McMullen Isabel , McGrath Raymond , Ang Karen , Fairbairn Elli , Williams Julie , Reddy Prashanth , Sevdalis Nick , Gaughran Fiona 
Published: June 2022

AimsPatients with mental health disorders are known to have worse physical health outcomes. ‘Consultant Connect’ (CC) is an app-based communication platform which aims to improve patient outcomes and experience, by offering clinicians direct access to consultants working in a partnership acute Trust, so they can seek advice and guidance for their patients’ physical health problems. This creates whole system efficiencies by avoiding unnecessary referrals to an Emergency Department or outpatient clinics. This poster describes the implementation of CC in a large UK Mental Health Trust. Initially designed for GPs, this is the first time a UK Mental Health Trust has used CC.MethodsConsultant Connect was launched in the Mental Health Trust's inpatient services in June 2020 as part of a Trust-wide programme of work aiming to improve the physical healthcare of mental health patients. In July 2021 it was rolled out across all services, including all community services. All platform activity was monitored and the implementation team collected data to determine: a) origin of call, b) which specialty was required, c) numbers of calls successfully connected, and in a subset of calls d) outcome of call. In addition, 183 call recordings were analysed, to identify clinical training needs and inform further development of the platform.ResultsIn the period June 2020 – December 2021, there were 1422 use episodes of the CC platform by Mental Health Trust clinicians. There were 401 Trust registered downloads of the CC App by the Trust clinicians. 53 different clinical specialties were contacted, with cardiology (414 calls), diabetes and endocrinology (243 calls), and haematology (124 calls) the most frequently called. 68% of queries received a response. 48% of calls had an outcome recorded, with 70% of these resulting in the physical healthcare being delivered by the mental health team, following the advice received (i.e. referral or admission avoided, or the patient treated out of hospital).ConclusionCC is being progressively embedded into clinical practice and has become a well-used pathway for mental health clinicians seeking immediate clinical advice from acute hospital Consultant colleagues. Further qualitative and quantitative work is planned with mental health clinicians, patients and carers to better understand their experience and determine if it improves care from both the clinicians’ and patients’ perspective.
Evaluating a Pilot Group Based Mental Health Promotion Programme Adapted for Young People With Intellectual Disabilities: The “Healthy Me” Programme
Authors: McDermott Emma , Jenkins Naomi , Hanna Heather , Morgan Tammy 
Published: June 2022

AimsA mental health promotion programme called ‘Healthy Me’, was a collaboration between Action Mental Health (AMH) MensSana, Child and Adolescent Mental Health Services (CAMHS) in the Southern Health and Social Care Trust and the Royal College of Psychiatry (RCPsych) in Northern Ireland in 2014. Adapting ‘Healthy Me’ for delivery in special schools was recommended in evaluation of this pilot programme. A co-produced pilot adapted ‘healthy me’ programme, for young people with ID was taken forward by Action Mental Health (AMH) MensSana and Intellectual Disability Child and Adolescent Mental Health Service (ID CAMHS) in the Southern Health and Social Care Trust (SHSCT). To determine the feasibility of adaptation and delivery of the programme for the needs of the ID population. To inform changes to be made before wider roll-out. To promote children's social and emotional well-being and emotional literacy through the teaching of problem-solving, coping skills, conflict management and managing feelings. To evaluate the effectiveness of this intervention with children being able to retain learning, information and ideas.MethodsEvaluation
•Pre programme quiz July 2021 (young people)•Post session 1–5 quizzes (young people)•Post programme quiz October 2021 (young people)•Simple visual blob tree (young people)Outcome Measures
•Pre programme initial outcome measure (parent) The Mood, Interest and Pleasure Questionnaire-short form (MIPQ-S) July 2021•Pre programme initial outcome measure (parent) non standardised, based on the strength and difficulties questionnaire (SDQ) and the Child and Youth Resilience Measure-Revised Person Most Knowledgeable version (PMK-CYRM-R) July 2021•Post programme repeated outcome measure (parent) MIPQ-S October 2021•Post programme repeated outcome measure (parent) Based on SDQ & PMK-CYRM-R October 2021ResultsSix participants identified at outset and four attended and engaged consistently, young people aged between 14 and 17 years. Participants were supported 1:1 to fill in a simple evaluation forms after sessions rating their enjoyment and what they had learnt. Repeating the MIPQ-S with parents highlighted some improved scores indicating positive affect and elevated interest and pleasure.ConclusionThe programme will be offered to in the next stage of the pilot to Special Schools in NI. It is hoped to show that similar positive gains can be made in the school settings for children and young people with intellectual disability in terms of promoting positive mental health and social and emotional well-being.
Rapid Tranquilisation Use in Working-Age Adult Inpatients
Authors: O'Neill James 
Published: June 2022

AimsThis study aimed to review if clinicians varied significantly in choosing rapid tranquillisation agents when using consistent clinical guidelines, analysing the rationale behind decision-making. It also aimed to assess confidence across varying grades and clinical experience, and to evaluate efficacy of current trust guidelines. We hypothesized that less experienced clinicians would be less willing to prescribe antipsychotics for rapid tranquillisation, and that current guidelines did not allow for consistent and uniform prescribing.MethodsA qualitative survey was distributed to 165 clinicians within one mental health trust, including core psychiatry trainees, trust-grade doctors, higher trainees, staff-grade doctors & working-age adult consultants. This survey included a fictional but commonly occurring scenario which clinicians responded to with the aid of current trust guidance. Respondents were then asked to justify their choice and to rank their confidence in prescribing rapid tranquillisation, along with rating how useful the guideline was in aiding their decision. Thirty-six participants responded to this survey, with a response rate of around 22%. There was even representation across clinical grades.ResultsClinicians of all grades were equally willing to prescribe antipsychotic agents for rapid tranquillisation. Higher psychiatric trainees reported greatest self-confidence when prescribing tranquillisation, with consultants surprisingly lower in confidence. Intramuscular olanzapine was most favourable, but significant variability was observed in suggested management between clinicians. Main themes for suggested amendments to the guideline included clarity, when to use the various options, further specification on dosage ranges and options for specific instances, such as if a patient is antipsychotic naïve or there is minimal physical health information.There was marked variability in choice of agent. The majority of clinicians felt that early commencement of antipsychotic was beneficial in acutely unwell patients, although the merits of initially assessing medication-free were also raised. Key themes for tranquillisation choice included a need for a prior electrocardiogram to prescribe intramuscular haloperidol, the potential lack of efficacy with aripiprazole, the risk of respiratory depression with concurrent olanzapine and lorazepam, and a surprisingly high proportion of respondents opting for combined use of haloperidol plus a further sedative.ConclusionLess experienced clinicians were not found to lack confidence to prescribe antipsychotics for rapid tranquillisation. However, clinicians responding to the same clinical scenario using the same guideline resulted in marked variability in choosing rapid tranquillisation agents. This highlights a need for clearer guidelines and education on this matter to ensure a consistent treatment approach to tranquillising medication.
What Is the Future of Primary Mental Health Care?: A Post COVID-19 Service Evaluation
Authors: Zarif Ahmad , Nazir Imaduldin , Mahmod Azad , Bibi Hajira , Rasheed Reshma , Patel Anjali , Shanthakumaran Yathorshan 
Published: June 2022

AimsDuring the COVID-19 pandemic, many service lines needed to be transformed to enable more telemedicine and virtual consultations. This enabled seamless care across many service boundaries as all services adapted to operate virtually. During COVID-19, the mental health of many patients deteriorated. With easing of restrictions, we wanted the patient voice to be heard and to ensure our service was patient-centred. We undertook a service evaluation to understand our patients preferences. Our cross-sectional study evaluated patient preferences for their care which we felt was important as earlier during pandemic, patients did not have the choice to choose between virtual vs face-to-face consultations. We felt this was important to our patients so they could exercise choice of consultation and this would enable the patient voice to be heard.Methods591 patients across three practices in primary care were identified from the Serious Mental Illness (SMI) and on the depression register. They were asked about their preference of care: telemedicine vs face-to-face consultations. Using a simple questionnaire, in order to record their preference on the patient screen. Of these a total of 495 patients (83%) participated in the study.ResultsOf the 495 respondents, 308 (52%) declined virtual telemedicine consultations and 175 (29%) patients were content with virtual consultations. Of the 175 patients who wanted telemedicine were 20 to 40 years of age. Reasons given included convenience (allows family and work commitment) and overall time management (reluctancy to travel). The 308 patients (52%) wanted face-to-face consultations because they wanted human contact, validation of their mental health problems, reassurance and were uncomfortable about discussions on the phone. They also had poor mobility especially the elderly who chose traditional models of care.ConclusionAs services are restored to the new norm of patient care, patient choice should remain paramount if services are to remain patient centric. During the COVID-19 pandemic, many services transformed to virtual consultation of necessity without recognising the impact on patients themselves. Patients with serious mental health and depression are inherently vulnerable and our evaluation goes to show that despite the popularity of telemedicine. Patient choice should enable patients to access face-to-face care for greater patient satisfaction.
Audit on the Quality of Outpatient Letters From Cherrywood Clinic
Authors: Akhtar Armaan , Badshah Faisal 
Published: June 2022

AimsLetters between secondary and primary care are an integral part of continuity of patient care. It is crucial letters are comprehensible, focused and useful. The quality of letters can be of a variable standard, we aim to see if the letters sent from Cherrywood clinic are in line with the Royal College guidance.MethodsData were collected manually by 2 doctors using dictated clinic letters and patient notes, from the 3 community teams. 20 outpatient letters were sequentially selected from each team from the 1st to 31st of March 2017; 60 letters in total. The letters were divided equally between consultants and junior doctors. In the team where there were 2 Consultants; 5 letters of each were taken, and in the team where there was a junior doctor and a specialist registrar, 5 letters from each were taken. The data were collated onto an Excel spread sheet and analysed.
1.Demographic Details including Name, Date of Birth, Address and the Date of Appointment2.Who was the patient been seen by; Consultant or Junior doctor (FY/GPST/CT/SPR)3.Current diagnosis4.Current medication including doses5.Mental State Examination (MSE) findings6.An update of the current problem(s)7.Current/relevant Risks8.Plan/recommendations9.Follow-up plansResultsOf the Consultant letters the diagnosis, medication and dosage was mentioned in 93%, 93% and 90% respectively. Mental state was found in 66%, risks in 83% and follow-up plans in 96%.Most of the content derived from the registrar letters were unremarkable; with 80% in MSE in the 5 audited letters.In the Junior doctor letters; the diagnosis was mentioned in 88% of letters, medication and dosage 76%, mental state 100%, risks 80%, follow-up 100%.ConclusionOur letters are largely meeting the Royal College standards, more than 85% of the data were up to the standard. The main area's to improve are;
–Documentation of the MSE.–The medication and the dosages.–Diagnosis.–Risks should always be present.The areas which require improvement are the areas which are essential for GPs to safely manage psychiatric patients in the community.