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Pharmacogenomics to optimise psychotropic prescribing : a survey of mental health professionals’ perceptions, knowledge, and educational needsA survey was conducted to determine attitudes, knowledge, and educational needs of mental health professionals regarding pharmacogenomics. We recruited 128 clinicians working in mental health in England, and we assessed their experiences using an adapted version of the “U‐PGx Clinician’s Questionnaire”. Responding clinicians had positive attitudes towards pharmacogenomics testing, although they lacked confidence in ordering and interpreting tests, for which most had never received any formal training. Only 6% of clinicians answered all 4 knowledge testing questions correctly, and barriers to clinical implementation included lack of familiarity and knowledge for several pharmacogenomics concepts, such as drug metabolism and genetics, as well as needing support from their working institution. Looking ahead, we found that accredited workshops and patient cases were preferred learning formats, and we suggest tailored education programmes to enable mental health professionals to apply pharmacogenomics in clinical practice.
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‘From band 2 to enhanced clinical practitioner apprentice’Gav Oxby reflects on his decade-long career journey in the NHS, going from a band 2 to become an enhanced clinical practitioner apprentice.
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Compassion in healthcare : a narrative review of cross-cultural perspectivesBackground: Compassion is a critical component of effective, ethical healthcare, influencing patient care, provider well-being, and organizational culture. Its expression and support vary across cultures, yet little is known about how systemic and cultural factors shape compassionate care. This narrative review examines compassion’s impact on healthcare practices across cultural contexts. Methods: A narrative review of literature published since 2020, searching PubMed, PsycINFO, Scopus and Web of Science was performed. Fifteen studies met our inclusion criteria: peer-reviewed, English-language articles that explicitly examined compassion (or closely related constructs such as self-compassion or compassion fatigue) in healthcare settings and reported empirical, theoretical, or review evidence with attention to cultural or contextual factors. Excluded were articles published before 2020, non-English reports, conference abstracts, and opinion pieces lacking empirical or theoretical contribution. Results: Compassion-focused interventions reduced fatigue and improved self-compassion and satisfaction. Cultural and systemic factors influenced how compassion was understood and applied, from Buddhist-informed to Western models. Institutional culture, leadership, workload, and spiritual care affected practice, while mental health and community care showed benefits but faced systemic barriers. Conclusion: Compassion in healthcare is shaped by individual, cultural, organizational, and systemic factors. Embedding compassion across all these levels is essential for delivering effective, person-centered care. This review contributes by synthesizing recent cross-cultural evidence, highlighting how cultural, structural, and spiritual dimensions influence compassionate care, and identifying gaps in global research. Cross-cultural awareness and structural reform are critical for sustaining compassionate healthcare. Future research should explore underrepresented cultural contexts and evaluate systemic interventions that promote compassion in diverse health systems.
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Patient and public involvement in secure mental health research : setting-specific considerations and a protocol for involvement in the CORAS study (COllaborative Risk ASsessment and management)BACKGROUND: Patient and Public Involvement and Engagement (PPIE) is important in secure psychiatric research because it can help ensure that research is relevant and meaningful, and a positive experience for those participating. However, there are significant challenges to embedding PPIE in research in secure hospital settings, including practical barriers to involvement. A lack of reporting of PPIE practices makes it harder for researchers to learn from previous projects, leading to missed opportunities to improve PPIE in secure settings, and there are no current setting-specific guidelines for best practice. The CORAS study aims to examine collaborative risk assessment within secure psychiatric settings. In this study, PPIE is fully integrated throughout the research cycle, and this protocol describes the PPIE methodology being adopted. By highlighting these approaches and principles, this protocol is intended to be used as a transferrable framework for developing best practice for PPIE in research in these settings. METHOD: This protocol describes the ways in which we will ensure that PPIE remains central to each stage of the research project, from the formation of a smaller grant application PPIE group, through to dissemination of outputs. We discuss principles of recruitment into the PPIE group, ensuring that all areas of the secure mental health pathway are represented, and formally embracing equality, diversity and inclusion principles through the use of an Equality Impact Assessment. We also describe the core activities of the PPIE group, including the co-design of the research materials, recruitment strategies and dissemination plans, how the impact of PPIE will be examined, and practical elements such as around reimbursement and ensuring the wellbeing of PPIE group members. CONCLUSIONS: PPIE in secure mental health service research is important and challenging. This protocol outlines how we will address these challenges and ensure that PPIE is fully embedded in the design and delivery of a large study in secure settings. Although the prospective nature of this protocol precludes the sharing of outcomes and learning from the PPIE, it can nevertheless serve as a transferrable framework for the development that is urgently required in this clinical research field, as well as allow transparent future reporting of what was achieved. Involving people with their own lived experience in the design and running of clinical research studies can improve the quality and impact of these studies, as well as the experience for people taking part in them. In some clinical settings this involvement might be more difficult. In secure psychiatric hospitals things like security can make it difficult for people to be involved in this way in research. There is not much guidance available for researchers on how to do this better when running studies in secure settings. The CORAS study (COllaborative Risk ASsessment and management in secure services) is a research study in these settings that is exploring how to involve patients and carers in their risk assessments and risk management plans (or safety plans). We have developed detailed plans for how to make sure that patients and carers have a central role in all areas of this study, including designing parts of the study and how best to make sure that the results of the study reach patients and carers. This paper outlines how we are planning to do this, so that other researchers designing studies in these clinical settings can understand and build on some of the practical ways of involving people with lived experience. eng publication: N/A. Competing interests: The authors declare no competing interests.
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Trust-wide quality improvement project on improving the competence and confidence of first on-call doctors in Nottinghamshire Healthcare NHS Foundation Trust (NHCFT)Aims: This project emerged in response to surveys conducted in 2022-23, which revealed first on-call doctors at NHCFT, perceived they were required to operate beyond their competency levels. Recognising this could negatively affect both patient safety, and training experience of resident doctors, we sought to improve their confidence and competence through structured support, education, and resource development. The project's aim was to ensure that no first on-call doctor would feel that they were working beyond their competency. Method(s): Cycle-1: The project began with anonymous baseline surveys using Hewson Confidence Tool, grade-specific focus groups which revealed a lack of knowledge in both clinical and practical aspects, increased stress due to untriaged workloads, and feelings of insufficient support from senior staff which contributed to widespread sense of being overwhelmed and impacted confidence and competence. Primary intervention included targeted on-call teaching sessions focussing on areas such as the role of on-call resident doctors, management of common tasks, seclusion reviews, legal frameworks, and escalation pathways. Cycle-2: Observing the positive impact on doctors' self-reported competency and confidence levels in the first PDSA cycle, Cycle 2 began with stakeholder engagement through listening events with first on-call doctors. We held discussions with key leaders, Director of Medical Education, Associate Director of Nursing, Deputy Associate Director of Physical Healthcare, ECG Trainer, Physical Healthcare Nurse, and Ward managers. Subsequently, we designed and delivered a bespoke 'First On-Call Workshop for Resident Doctors', held as two 90-minute sessions in September 2024. The workshops used interactive tools, case-based scenarios, and audio-visual aids on psychiatric medication side effects, managing psychiatric emergencies, risk assessment, escalation pathways, legal procedures e.g., Section 5(2), demonstration videos for ECG and catheterization, along with site orientation videos. Result(s): Cycle-1: Results displayed a 7% increase in confidence and competence. Cycle-2: Outcome measures displayed positive qualitative feedback and an increase in confidence in quantitative feedback by 17% in handling common on-call tasks and clinical scenarios. For sustainability, online resources and tools, i.e., workshop materials, videos, and podcasts, were made accessible and included in Resident Doctors' Survival Guide. Senior medics are now equipped with resources to facilitate these workshops, ensuring the project's longevity. Conclusion(s): This project contributed to enhancing the competence and confidence of first on-call doctors, thereby improving patient safety, and fostering a supportive learning environment within NHCFT. This initiative has underscored the importance of structured educational interventions and collaborative support systems in promoting both trainee and patient well-being.
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Quality improvement project to improve the resident doctors' out-of-hours clinical handover system at Nottinghamshire Healthcare NHS Foundation Trust (NHFT)Aims: An effective and safe clinical handover system is at the heart of safe healthcare delivery, ensuring continuity of care between clinical teams. Handovers are completed face-to-face or verbally and recorded within the NHFT's SharePoint handover system, the standard agreed upon within the Trust. This project aimed to improve the usability, access, and safety of a preexisting SharePoint handover system. Method(s): A pre-implementation survey with 30 responses from the Resident doctors showed that 90% of respondents were aware of the handover system. Still, only 60% carried out face-to-face handovers regularly, while 40% relied on other methods. 35% viewed the SharePoint handover system positively, but 50% found it inefficient, suggesting improvements. Model for Improvement Quality Improvement Methodology was used to design and develop this change project; working alongside key stakeholders (Resident doctors, Medical Education unit, Quality Improvement team and Information Technology (IT) professionals), changes were made using a Plan-Do-Study-Act (PDSA) framework to improve awareness, access, usability and accuracy of the SharePoint handover system. Awareness improved through sessions in the Resident doctors' induction, emails and medical education newsletter. Working in collaboration with the IT team, the SharePoint system was securely moved to a safe server with changes made to the template and dropdown options to improve safety and accuracy. Automatic email reminders were set up to improve handover job completion and recording. A PowerBI dashboard was created to assess system use and the quality of the handover recording to ensure ongoing quality assurance and improvements. Result(s): Six-week baseline data showed that the compliance rate of handovers was 80%, with 20% of handovers indicating neither faceto- face nor verbal communication. Only 20% (42 out of 209) of the jobs were marked complete, against standards of 100%. After implementing change ideas, four-week data showed 100% compliance, indicating that all handovers were completed and recorded. Only 23.03% of the jobs were marked complete on the handover system, indicating an area for further improvement. Conclusion(s): A Trustwide Standard Operating Procedure for Resident Doctor Handover is being developed, and further IT changes are planned to continuously monitor and improve the handover system. In this case, collaborative leadership, perseverance when encountering roadblocks, and a systematic data-driven improvement approach with iterative changes helped establish a safer, more usable, and accessible handover system.
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Mentorship Scheme - a Novel Approach for Plugging the Gap in Differential Attainment for Psychiatry Core Trainees in East MidlandsAims: The MRCPsych results report and GMC annual report on trainee performance highlighted that UK PMQ candidates perform better than OS PMQ candidates and that White candidates perform better compared with candidates with other ethnic backgrounds. A mentoring scheme was designed as a proposed solution to bridge the gap of differential attainment in Core trainees in Psychiatry with a focus on improving ARCP outcome and Exam Pass rate in Psychiatry. Method(s): The Mentorship Scheme was piloted between August 2023 to August 2024 among Core trainees and Higher Trainees working in Psychiatry in Mental Health Trusts in East Midlands. Higher trainees took part in the project as mentors and were required to complete mentorship course from e-lfh hub prior to start of mentorship. The evaluation was of a longitudinal, prospective design. It spanned 12 months, with two waves of data collection. Using a mixed methods approach core trainees were required to complete survey with numerically rated items and open-ended questions pre- and post-intervention. Recruitment of core trainees and higher trainees was achieved through purposive sampling. A 18-item survey was designed to enable quantitative analysis of training needs in Psychiatry and qualitative analysis of conceptions of mentorship. There were a total of 9 Likert questions and 1 openended question that enabled free text entry for qualitative analysis. A 23-item questionnaire was designed to evaluate Mentees response post-mentorship scheme. Result(s): Pre-intervention: 75% identified career goals as an area that they would mostly likely value support with, closely followed by 68.3% reporting exam preparation, 31.3% reported support with e-Portfolio training and 25% with ARCP preparation as areas that they were hoping to get support with through mentorship. Post-intervention: 66.7% reported improvement in competence in areas of difficulty which included: 55.6% improvement in clinical skills. 44.4% improvement in exam preparation. 66.7% improvement in diary management. 33.3% improvement in ARCP preparation. 44.4% improvement in e-portfolio training. 88.9% valued the presence of having to speak to someone as a useful aspect of the mentoring scheme and 44.4% reported recommending mentoring scheme to other trainees. Conclusion(s): There is a breadth of evidence substantiating use of mentorship as a helpful tool in improving competence in doctors across different levels of their training. This finding was supported through a 12-month evaluation of the Mentorship scheme which appears to afford core trainees a cost-effective opportunity in improving training needs.
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Evaluating PRN medication prescribing practices in mental health services : a comparative audit following a serious incidentAims: PRN (pro re nata) medications are widely used in mental health settings but are prone to misuse and prescribing errors. A serious incident involving a patient's death linked to excessive PRN medication supply prompted an initial audit to evaluate compliance with prescribing standards. A re-audit was conducted to assess progress and identify ongoing challenges. Method(s): Two prospective audits were conducted across an inpatient acute ward and a rehabilitation centre. The initial audit (29/07/2024-06/08/2024) and re-audit (29/01/2025-06/02/2025) reviewed medication cards, Rio (electronic patient notes) and EPMA (Electronic Prescribing and Medicines Administration) for 31 patients prescribed PRN medications. Compliance was assessed against 13 predefined standards, including generic naming, dose intervals, BNF compliance, and regular reviews. Result(s): Sustained Full Compliance: Both audits demonstrated 100% compliance in key areas: generic naming, specified administration routes, separate prescriptions for multiple routes, adherence to BNF limits, clear indications for use, and rewriting altered prescriptions. Key Improvements: Minimum dose interval specification improved from 64.5% to 93.5%. Maximum dose documentation increased from 96.7% to 100%. Regular ward round reviews rose dramatically from 3.2% to 64.5%. Discontinuation of unused PRN medications (>1 month) improved from 0% to 22.2%. Review of PRN medications used regularly (>72 hours) increased from 0% to 28.5%. Documentation of regular vs. PRN use improved from 33.3% to 44.4%. Ongoing challenges: Review of PRN medications used regularly (>72 hours) remained low at 28.5%. Discontinuation of unused PRN medications (>1 month) was only 22.2%. Documentation of regular vs. PRN use remained below 50%. Conclusion(s): The re-audit demonstrates significant progress in dose interval specification, maximum dose documentation, and ward round reviews. However, challenges persist in the regular review and discontinuation of PRN medications, as well as in documenting regular vs. PRN use. Continued focus on these areas is essential to ensure patient safety and adherence to best prescribing practices. Recommendations: Key recommendations include integrating PRN standards into doctor inductions, involving pharmacists in ward rounds, and conducting regular re-audits to monitor progress and sustain improvements. Disseminating guidelines and providing feedback to medical teams are essential steps toward achieving full compliance and enhancing patient safety.
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Barriers to lead psychiatric clinical supervision - a cross-sectional surveyAims: The Royal College of Psychiatrists (RCPsych) recommends that psychiatric trainees receive one hour of 1:1 supervision per week, with clinical supervisors allocated 0.25 PA (programmed activity) protected time per trainee weekly. The GMC National Training Survey 2023 found that 86% of trainees reported positive feedback on clinical supervision, though the survey was not psychiatry specific. Locally, the Resident Doctors Forum raised concerns about some trainees not receiving the recommended supervision time, prompting the introduction of a new supervision form. Aims were to identify and assess barriers to providing regular supervision to support the professional development of psychiatrists in training within Nottinghamshire Healthcare NHS Foundation Trust. Method(s):Aquestionnaire was developed based on the "Enablers and Barriers to Effective Clinical Supervision in the Workplace: A Rapid Evidence Review" to identify barriers to effective clinical supervision. It was emailed to all lead clinical supervisors in Adult Mental Health, with a two-week response deadline. The feedback was analysed using a mixed methods approach, combining quantitative and qualitative analysis. Result(s): The survey received a 30% response rate (21 out of 70 eligible trainers), with a distribution reflecting the grades of resident doctors in the trust: 34% supervising HST, 34% supervising CT, 19% supervising FY, and 13% supervising GPVTS. Key findings include: 67% of trainers felt their clinical workload allowed sufficient time for supervision, but 81% sometimes had to cancel due to clinical commitments. Trainers with sufficient time for supervision typically had protected time formally agreed in their job plans (85%). 80% of trainers faced cancellations due to trainee unavailability (e.g., shift work, staff shortages), and 10% felt supervision was hindered by inadequate resources, such as lack of private spaces. Awareness of the RCPsych supervision guidance was low (33%), and 50% were not familiar with or did not use the local supervision form. Opinions on the form were divided: half found it helpful, while the other half saw it as additional workload. Major barriers to effective supervision included intense clinical workload, time pressure, staff shortages, managing multiple trainees, and trainee unavailability due to on-call or leave commitments. Conclusion(s): Suggested actions to address these barriers include: Distributing the RCPsych guidance and Supervision Form to all trainers. Encouraging supervisors to schedule supervision mid-week to avoid conflicts with on-call shifts. Supervisors should discuss protected time in their job plans with clinical directors and work with medical education to find private workspaces for supervision.
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How can citizen science enhance mental health research quality : theory of change developmentObjective Public involvement in mental health research enhances research quality. The use of citizen science methods in mental health research has been described as a conclusion of a movement towards increased public involvement; however, this field is in its early stages of development. Our objective was to create a theory of change (ToC) for how citizen science can be used to enhance mental health research quality. Design Iterative consultation with the stakeholders of an existing citizen mental health science study, that is, change for citizen science to achieve co-production at scale (C-STACS: https://www.researchintorecovery.com/research/c-stacs/) Methods We co-developed a ToC through an iterative consultation with C-STACS stakeholders who were (a) representatives of mental health community organisations (n=10), individuals with public involvement experience (n=2) and researchers (n=5). In keeping with established ToC practice, entities were identified, including long-term impacts, outcomes needed to create an impact, stakeholder assumptions and indicators for tracking progress. Results A desired primary long-term impact of greater co-production of research was identified between researchers and members of the public, which would create a secondary impact of enhancing public capacity to engage in citizen mental health science. We proposed long-term outcomes needed to enable this impact: (1) greater co-production of research objectives and pathways between researcher and the public, (2) greater embedment of citizen mental health science into funder processes (eg, the creation of specific funding calls for citizen mental health science proposals, (3) greater clarity on the boundaries between citizen science and other participatory approaches (eg, so that there is not loss of impact due to conceptual confusion between these, (4) increased knowledge around effective frameworks to enable mass public participation and (5) greater availability of technology platforms, enabling safe and accessible engagement with citizen mental health science projects. Conclusion The proposed ToC is grounded in the C-STACS project, but intended to be broadly applicable. It allows the continued formation of a community of practice around citizen mental health science and should be reviewed, as greater knowledge is developed on how citizen mental health science creates change. Copyright © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
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Inpatient compliance with levothyroxine timing : a clinical audit of administration practices and patient knowledgeIntroduction: Levothyroxine, which is absorbed in the small intestine and, hence, is affected by the presence of food, is best taken up (60-80%) after a period of fasting. Hence, guidelines recommend that it is taken on an empty stomach, at least 30 min before food, caffeine-containing drinks and some medication.1-3 On busy wards with medication and meal rounds possibly functioning independently, sticking to this standard is challenging, and made more so by the knowledge gap. This audit aimed to evaluate inpatient compliance with timing recommendations, assess patient knowledge and identify concurrently prescribed medications that affect levothyroxine absorption. Material(s) and Method(s): This prospective audit was carried out at the Sherwood Forest Trust from August 26 to September 19, 2024. Inpatients who were taking levothyroxine were identified, and data were collected by reviewing EPMA and structured questionnaires administered to patients, assessing compliance, concurrent interacting medications and patient knowledge. The audit was performed against National Institute of Health and Care Excellence (NICE) guidelines, which state that levothyroxine should be administered at least 30 min before meals or other medication.3-5 Results and Discussion: Out of 51 patients audited, only 21.6% reported being compliant pre-admission. This dropped to 13.7% during inpatient stay (Fig 1). Only 3.9% of patients recalled being advised by a healthcare provider (pharmacist or GP) on correct timing, and the same proportion recalled having received leaflets/written education materials. Patients using dosette boxes took levothyroxine with other medication, and many were unaware that taking it with coffee or tea affected absorption,6 often taking levothyroxine before meals, but with a cup of coffee or tea. Concurrent prescriptions of proton pump inhibitors (PPIs) and calcium were common, with nearly 81.5% of patients on PPIs taking them at the same time as levothyroxine (Fig 2). Curiously, concurrent iron administration was not noted, in contrast to an audit at North Cumbria Integrated Care NHS Trust,7 which showed that 84% were taking it at the same time. Hospital morning routines, which consist of nursing shift handovers and mealtimes between 08;00 and 09;00, mean that levothyroxine is often taken with breakfast or during bundled morning rounds, limiting adherence to guidelines. Patient understanding of what constitutes an 'empty stomach' was inconsistent, with tea/coffee often substituted for water, and pharmacy labels were often brief, stating only 'take in the morning'. EPMA was also open-ended and did not provide alerts for concurrently administered interacting medications; neither did it provide a default closed window for administration. These systemic and educational gaps suggest the need for multi-level interventions to improve adherence. Conclusion(s): This audit elucidates unsatisfactory compliance with levothyroxine administration guidelines in hospitalised patients. Knowledge gaps, hospital routines and lack of enabling scaffolding via EPMA have been observed to be barriers to meeting the standards. Implemented interventions include default early-morning (06:00-07:00 h) EPMA scheduling paired with interacting medication alerts, updated pharmacy labels specifying 30 min before food, including coffee/tea, nursing team briefings and patient education material. Further planned interventions include flagging thyroxine for annual medication review and monitoring adherence to guidelines.
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Supporting qualitative practitioner research in child and adolescent mental healthThis editorial piece addresses the relationship between clinical practice and qualitative research in child and adolescent mental health. We outline some guiding assumptions informing the development of a practice orientated research 'lab' which focusses on child and adolescent mental health and child welfare research with ethnographic and psychosocial methodologies. We consider cascading effects of practitioner-initiated research, where skills and ambitions for a 'bottom up' research culture can help professionals embed research-minded practice in services. We also address the role of researcher and methodological reflexivity in research that is close to the social and emotional complexity of practice. We suggest 'labs' for such practice-near research generate opportunities for clinical ideas to be examined more effectively as they are resituated outside of the clinic for the purposes of research; furthermore such research can support critical awareness of the socially and historically contingent quality of methods and practices.
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Principles of Industry-Academic Partnerships Informed by Digital Mental Health Collaboration : Mixed Methods StudyBACKGROUND: Cross-sector collaboration is increasingly recognized as essential for addressing complex health challenges, including those in mental health. Industry-academic partnerships play a vital role in advancing research and developing health solutions, yet differing priorities and perspectives can make collaboration complex. OBJECTIVE: This study aimed to identify key principles to support effective industry-academic partnerships, from the perspective of industry partners, and develop this into actionable guidance, which can be applied across sectors. Mental health served as a motivating example due to its urgent public health relevance and the growing role of digital innovation. METHODS: Using a 3-stage, mixed-methods approach, we conducted a web-based survey of UK-based digital mental health companies (N=22) to identify key barriers and facilitators to industry-academic partnerships. This was followed by 2 focus groups (n=5) that explored emerging themes from the survey using thematic analysis. Finally, we conducted a workshop with industry representatives, researchers, clinicians, and PPI members to co-develop the Principles of Industry-Academic Partnerships (PIP) guidance. RESULTS: Survey findings highlighted that industry partners valued academic collaboration for enhancing credibility, facilitating knowledge transfer, and gaining access to PPI networks. However, key barriers included high costs, slow academic timelines, and complex contracting processes. The 4 major themes that emerged from the focus groups were: advantages of collaboration, cultural differences between organizations, collaboration models, and structural barriers within universities. Through informed discussions in the workshop, these themes were explored, leading to the development of 14 actionable strategies. These strategies reflect industry perspectives and formed the PIP guidance, categorized under project initiation, defining the scope and agreements, project execution, and promoting sustainability. CONCLUSIONS: The PIP guidance provides a practical framework to support more effective and mutually beneficial collaborations between industry and academia. Developed through the lens of mental health research, the strategies identified are broadly applicable across disciplines where cross-sector partnerships are essential. Industry partners valued academic collaborations for their credibility and scientific rigor, but highlighted persistent structural and cultural barriers within universities. Addressing these challenges by aligning expectations and timelines, adopting flexible collaboration models, and streamlining operational processes can help foster impactful and sustainable partnerships in mental health and beyond.
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An Exploration of Online Positive Feedback in Relation to Mental Health Nursing PracticeWeb-based databases of service user feedback have become an important resource for the task of understanding the quality of healthcare provision, both in the UK and internationally. This research explores positive feedback submitted to the Care Opinion website (https://www.careopinion.org.uk/), some of which can provide insights into effective mental health nurse practices. An iterative search was undertaken using the Care Opinion website on 7 March 2025. A set of tags which frequently identified effective mental health nursing practices was identified, and then 51 items of feedback were taken forward for full analysis. The data was then analysed in relation to the deductively selected domains of tone, form, and intent. These were identified in a typology produced by a previous study of 200 positive feedback items across multiple sources. In relation to tone, most pieces of feedback were entirely positive with a small number being mixed. The intent of the feedback was often to express gratitude but also functioned to emphasise change and contrast the helpfulness of certain staff or organisations against others which were experienced as less helpful. A typology of form was established, comprised of (1) Narratives of being there; (2) Narratives of listening and being heard; Narratives of therapeutic relationships; and Narratives of recovery. Positive feedback can provide a valuable insight into the experiences of service users. This research provides proof of concept evidence that knowledge can be gained about the impact of mental health nursing through the analysis of online feedback gathered through websites such as Care Opinion.
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Co-prescribing of antidepressants and opioids for non-cancer pain in England, 2010-2019 : a descriptive study using CPRD primary care electronic health recordsBACKGROUND: There is a complex relationship between pain and mood disorders, and interactions between opioids and antidepressants can affect the effectiveness and adverse effects of these medicines when taken together. However, little is known about the scale of co-prescription for these medicines. METHODS: We used routinely collected primary care data from the Clinical Practice Research Datalink to describe the extent of opioid and antidepressant co-prescribing in over 4.3 million adults in England. Linked data included deprivation information and hospital episode statistics admitted patient care data to improve completeness of ethnicity information. We identified all primary care prescriptions of opioids and antidepressants between 2010 and 2019 and counted if an opioid and antidepressant prescription overlapped, and if so, for how long. People were censored at the first date of a record of cancer, terminal illness, heart failure or opioid misuse. RESULTS: There were 4,355,694 people included in the study population. Of these, 304,029 (7.0%) had an opioid and antidepressant co-prescribed at least once during the study period. The prevalence of co-prescribing increased from 35.8 per 1000 person-years in 2010 to 44.1 in 2015 and then decreased to 39.2 in 2019. Co-prescribing rates were higher in females, older age groups, people living in more deprived areas and the White ethnic group. The overall median length of the opioid and antidepressant co-prescriptions was 29 days (interquartile range: 17 to 51 days). The most commonly co-prescribed medicines were codeine and amitriptyline, co-prescribed 235,017 times to 87,274 people. The second most commonly co-prescribed combination was codeine and citalopram, co-prescribed 55,792 times to 158,812 people. Combinations of opioids and antidepressants both metabolised by CYP2D6 were also common. CONCLUSIONS: There is a substantial group of people co-prescribed opioids and antidepressants in England, including combinations that may be less effective. This information will be useful to help GPs, dispensing professionals, policymakers and others understand how many people in the UK may be at risk of harm from using both types of medicines at the same time, and which groups are particularly affected. Future research should determine whether there are higher risks of adverse events in these co-prescribed groups.
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The Nottingham Guide: How to do a literature reviewTrainee Psychiatrists in the Child and Adolescent Mental Health Services (CAMHS) are expected to undertake a systematic review as part of their Specialty Trainee (ST) 4-6 Higher Training. In my role as Senior Knowledge Specialist, I support these trainees by attending a quarterly research workshop, where trainees and mentoring consultants share knowledge and experience and support each other through the process of undertaking a systematic review. The aim is to understand the process, select an appropriate question (preferably CAMHS-based), and go through all the steps of a systematic review. Some go on to publish, but that’s not a requirement. My role is to advise on scoping the topic (has it already been published?), establish the search strategy, either run the search or provide training to the trainees on searching the databases, provide support on referencing, comply with PRISMA, peer-reviewmanuscripts, and find target journals to publish in. In 2016, the consultants decided to write a formal guide to support the trainees undertaking the review process, as well as the trainers to refer to when advising how to undertake a review. The aim was to circulate it amongst anyone who was interested in undertaking a review as part of their training. When the library was asked to join the workshop in 2017, they asked me to review the content of the guide, and between the four of us (three consultants and myself), we created “How to do a literature review: A guide for Specialty Trainees”.It goes through choosing a subject, arranging a meeting with the library, performing a scoping search, registering with PROSPERO, performing a search, title/abstract screening, grouping articles into topics, data extraction, writing the paper, and peer-reviewing and feedback. In July 2025, the Chair of the Child and Adolescent Psychiatry Specialist Advisory Committee from the Royal College of Psychiatrists emailed to say the guide was discussed at the faculty meeting and asked for our permission to upload the guide to the faculty website. It was renamed “The Nottingham Guide” and is now available to read under the section “How to do a literature review”: Guide to research for child and adolescent psychiatry
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Academic psychiatry is everyone’s business : commentary, MorrissNo abstract available
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Mindfulness-Based cognitive therapy for Life (MBCT-L) versus stress reduction psychoeducation (SRP) for the improvement of mental well-being in health care and other public sector staff : protocol for the well at work randomized controlled trialBACKGROUND: Mindfulness-based and stress reduction interventions have been recommended by the National Institute for Health and Care Excellence guidelines in England and Wales as effective preventive mental well-being interventions for health care and other public sector staff at risk of poor mental health. OBJECTIVE: This trial aims to assess the effectiveness of the increasingly implemented Mindfulness-Based Cognitive Therapy for Life (MBCT-L) intervention versus a routinely available Stress Reduction Psychoeducation (SRP) intervention in reducing perceived stress and improving other mental health and work-related outcomes in national health care and other public sector service employees. METHODS: The trial is a multisite, single-blind, parallel-group, 2-arm superiority randomized controlled trial. Recruitment, interventions, and assessments will be conducted remotely via online platforms. We will recruit 260 health care and other public sector staff into 26 intervention groups across the United Kingdom, with the intervention delivered through human resource staff well-being provision channels affiliated with participating National Health Service trusts. Participants will be randomly allocated in a 1:1 ratio to either MBCT-L or SRP. Primary and secondary outcomes will be collected at 6, 12, and 20 weeks after randomization. The primary outcome will be the change in scores on the Perceived Stress Scale-14 from baseline to 20 weeks after randomization. Demographic, intervention-related, and health economic data will also be collected. Secondary outcomes will involve assessments of well-being, mental health state, and work-related engagement and performance. Adverse events will be recorded. Data analysis will involve multilevel modeling, and it will be conducted on an intention-to-treat basis. A substudy will involve online semistructured interviews after 20 weeks of randomization with a subsample of participants (n=30, 12%). Transcribed data will be subjected to thematic analysis to elicit qualitative outcomes on perceived well-being and work-related changes after intervention as well as drivers and barriers to intervention uptake and acceptability. RESULTS: Recruitment of participants commenced on August 29, 2023. The target recruitment of 260 participants was reached on April 30, 2024. Follow-up outcome data collection was completed on September 30, 2024, and data analysis is underway. A total of 30 qualitative interviews have been conducted. CONCLUSIONS: Findings will inform future recommendations on intervention suitability and implementation for public care staff well-being. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN18049845; https://www.isrctn.com/ISRCTN18049845. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/67695.
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Infant Parent Support (IPS) : a multidisciplinary intervention to improve the mental health of children with a social worker - a study protocol for a feasibility randomised controlled trial with embedded process evaluationBACKGROUND: In many families where children have a social worker, parents have experienced challenges in their own childhoods or have neurodevelopmental conditions. These families often endure significant stress, which is frequently worsened by financial or housing challenges. This added pressure can strain relationships and increase the risk of child maltreatment, as well as contribute to mental health issues in children. Relationship-focused interventions show promise in preventing child maltreatment, although there are currently no interventions that simultaneously address neurodevelopmental conditions and the impact of poverty. We have co-produced, alongside parent experts-by-experience, local stakeholders, and infant mental health practitioners, a new service called Infant Parent Support (IPS). IPS will i) adopt a relationship-focused approach to comprehensive understanding of family functioning, ii) incorporate child and parent mental health and neurodevelopmental awareness, and iii) ensure a poverty aware approach throughout. The aim of this phase is to investigate the feasibility of a definitive Randomised Controlled Trial (RCT) of IPS compared with services-as-usual (SAU). METHODS: The study settings are social care services in two local authorities: Glasgow City Council (Scotland) and the London Borough of Bromley (England). Our target population is children on a 'child in need' plan (or the Scottish equivalent) and eligible participants are families where i) the infant(s) are aged 0-5 years and ii) the family has an allocated social worker plus a multi-agency support plan. Thirty participants will be identified by social workers and randomised to receive either IPS or SAU. Families randomised to IPS will receive an intensive multidisciplinary attachment-focused assessment that provides a foundation for relationship-focused interventions. IPS will incorporate child and parent mental health and neurodevelopmental awareness and ensure a poverty aware approach throughout. Families randomised to SAU will receive the assessment and support that social care services normally implement. We will utilise a pre-post and 3/6-month follow-up design with embedded mixed-method process evaluation and exploratory economic analysis. The primary objective is to assess if enough families can be recruited, randomised, and retained in the trial such that a full-scale RCT is likely to be feasible. The secondary objectives are to assess the acceptability and feasibility of the planned outcome measures and the IPS intervention to families and professionals. CONCLUSIONS: A service like IPS, that uses a relationship-focused approach to child and parent mental health, neurodevelopmental and money/housing problems, has never previously been tested. Therefore, there are several areas of uncertainty that need to be addressed before moving onto a definitive RCT. TRIAL REGISTRATION {2A AND 2B}: Registered in ClinicalTrials.gov Identifier: NCT06003582. Co-production and Feasibility RCT of Intervention to Improve the Mental Health of Children with a Social Worker. Registered 22/08/2023. https://classic. CLINICALTRIALS: gov/ct2/show/NCT06003582 .
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Examining the effects of mental health literacy on stigma : study of Zimbabwe Prisons and Correctional Service (ZPCS)Background Mental illness affects an estimated 500 million people globally, with 85% living in low- and medium-income countries (LMICs). Research has shown that people with mental illness are over-represented in the criminal justice system compared with the general population. There is limited information available on institutional attitudes towards mental illness in LMICs. Aims This study aimed to examine mental health literacy (MHL) and mental health stigma (MHS) among Zimbabwe Prisons and Correctional Service (ZPCS) officers. Method A cross-sectional study using an online survey was conducted among ZPCS officers (N = 163) between August and December 2022. Data were collected using the Mental Health Literacy Scale (MHLS) and Attitudes Towards Mentally Ill Offenders (ATMIO). The primary hypothesis was that increased MHL is inversely related to MHS in this group. Results A significant inverse correlation was found between MHL and MHS (r = 0.36, P < 0.001). A regression analysis controlling for age and sex showed that MHLS is a statistically significant component in this model, indicating that MHL is associated with reduced MHS (P < 0.001). Conclusions In this group, increased MHL is associated with decreased MHS. This suggests that interventions to increase MHL should be further evaluated in these settings. Copyright © 2025 The Author(s).
