• A conceptual framework outlining the use of compassionate mind training following incidents of moral injury within forensic mental health services

  Williams, Catrin; Cook, Aimee (Emerald Group Publishing, 2025)

  Purpose: Forensic mental health professionals often face challenging situations that can lead to moral injury. This occurs when individuals' experiences or actions conflict with their values and moral beliefs, leading to psychological distress or discomfort. Moral injury has been shown to be linked with a plethora of adverse psychological health outcomes, and can impair both occupational and personal functioning, including the quality of care delivered to service users. Design/methodology/approach: This paper details how forensic mental health professionals can respond to threat-based thinking, emotions and self-criticism using compassion following incidents of moral injury with compassionate mind training (CMT). Finding(s): CMT has been found to alleviate psychological distress and support development of soothing capabilities (Gilbert and Procter, 2006). Practical implications: This paper describes the central tenets of CMT and how it supports the balancing of three motivational systems: threat, drive and soothing systems. Originality/value: It further highlights the three flows of compassion: compassion from others, compassion towards others and compassion for self and how this can influence staff well-being in relation to moral injury. Copyright © 2025, Emerald Publishing Limited.
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  Mechanical restraint in inpatient psychiatric settings : a systematic review of international prevalence, associations, outcomes, and reduction strategies

  Whiting, Daniel; Tully, John (Cambridge University Press, 2025)

  BACKGROUND: There is increasing emphasis on reducing the use and improving the safety of mechanical restraint (MR) in psychiatric settings, and on improving the quality of evidence for outcomes. To date, however, a systematic appraisal of evidence has been lacking. METHODS: We included studies of adults (aged 18-65) admitted to inpatient psychiatric settings. We included primary randomised or observational studies from 1990 onwards that reported patterns of MR and/or outcomes associated with MR, and qualitative studies referring to an index admission or MR episode. We presented prevalence data only for studies from 2010 onwards. The risk of bias was assessed using an adapted checklist for randomised/observational studies and the Newcastle-Ottawa scale for interventional studies. RESULTS: We included 83 articles on 73 studies from 1990-2022, from 22 countries. Twenty-six studies, from 11 countries, 2010 onwards, presented data from on proportions of patients/admissions affected by MR. There was wide variation in prevalence (<1-51%). This appeared to be mostly due to variations in standard protocols between countries and regions, which dictated use compared to other restrictive practices such as seclusion. Indications for MR were typically broad (violence/aggression, danger to self or property). The most consistently associated factors were the early phase of admission, male sex, and younger age. Ward and staff factors were inconsistently examined. There was limited reporting of patient experience or positive effects. CONCLUSIONS: MR remains widely practiced in psychiatric settings internationally, with considerable variation in rates, but few high-quality studies of outcomes. There was a notable lack of studies investigating different types of restraint, indications, clinical factors associated with use, the impact of ethnicity and language, and evidence for outcomes. Studies examining these factors are crucial areas for future research. In limiting the use of MR, some ward-level interventions show promise, however, wider contextual factors are often overlooked.
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  Barriers and facilitators to using standardised diagnostic assessments in child and adolescent mental health services : a qualitative process evaluation of the STADIA trial

  Thomson, Louise; Newman, Kristina L.; Ewart, Colleen; Sayal, Kapil (Springer Nature, 2025)

  The STADIA trial aimed to assess the effectiveness of a standardised diagnostic assessment tool (Development and Wellbeing Assessment, DAWBA) in aiding clinician-made diagnosis decisions in Child and Adolescent Mental Health Services (CAMHS). This study reports the qualitative process evaluation of the STADIA trial, which aimed to identify barriers and facilitators to using the online-completed DAWBA in CAMHS. Qualitative data were collected through 109 semi-structured interviews with young people, parents/carers, healthcare professionals and service commissioners/funders in 8 CAMHS sites across England. Deductive thematic analysis was guided by the domains of the Consolidated Framework for Implementation Research. Young people and parents/carers showed high levels of engagement with the DAWBA. They perceived a validation of symptoms from the generated DAWBA report, which they actively used as 'evidence' when seeking help from other services. Clinicians involved in determining referral acceptance/rejection decisions were positive about its use and saw benefits in aiding decision-making. In contrast, however, barriers to clinicians engaging with the DAWBA report during the assessment stage arose from limited awareness and accessibility to the report, a context of high workload and pressure, and general concerns about the value of a diagnosis. The DAWBA was not widely used by clinicians in the expected way to aid diagnostic decision-making. However, it may offer children and young people much-needed engagement during long waiting times for initial assessment in CAMHS. The DAWBA may be more acceptable to clinical teams in triaging referrals to help with timely decisions about the most suitable services.Trial registration ISRCTN15748675 (29/05/2019).
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  Black psychiatrists' experience of discrimination and related behaviours in the workplace : UK survey

  Orrell, Martin (Cambridge University Press, 2025)

  AIMS AND METHOD: In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being. RESULTS: Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance. CLINICAL IMPLICATIONS: These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.
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  What works well for people with dementia and their supporters from South Asian, African and Caribbean communities in the UK: A narrative synthesis systematic review and expert consultations

  Orrell, Martin (Wiley, 2025)

  OBJECTIVES: This review aims to synthesise the evidence regarding the use and provision of dementia services and support for people with dementia and/or supporters from South Asian, African or Caribbean backgrounds living in the UK. METHODS: A narrative synthesis systematic review of the original research articles published up to April 2024 was conducted. A lay summary of the initial review findings was evaluated by experts-by-experience (n = 15) for scrutiny and to enable further discussions, to produce key recommendations for further developing dementia services. RESULTS: A total of 18 studies (16 qualitative and 2 mixed methods studies) met the full inclusion criteria and were included in the review. The review findings and experts-by-experience consultations highlighted that: (1) dementia is not openly discussed or disclosed within many diverse ethnic communities. This can lead to family carers and people with dementia feeling isolated and unsupported. (2) Mainstream dementia support services and hospitals often do not meet diverse communities' cultural and religious needs, and (3) home-based care supported by external care agencies can be helpful but ensuring consistency of care staff in their culturally appropriate care can be extremely difficult to ensure. CONCLUSIONS: Encouraging South Asian, African and Caribbean communities to increase their dementia knowledge is important. However, mainstream dementia support services also need to incorporate their cultural and religious essentials into care packages to encourage their help seeking behaviours and tackle dementia stigma. Collaborative service developments between the diverse communities, Health and Social Care providers and policy makers are essential to ensure equitable and culturally appropriate dementia care for diverse community members in the future.
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  Cost-effectiveness of a group psychological intervention for postnatal depression in British south Asian women : an economic evaluation from the ROSHNI-2 trial

  Morriss, Richard K. (Elsevier, 2025)

  BACKGROUND: Minority ethnic groups often face ethnocultural barriers in accessing mental health treatments. The ROSHNI-2 trial compared culturally adapted cognitive behavioural therapy (Positive Health Programme [PHP]) with treatment as usual for postnatal depression in British south Asian women. We aimed to assess the cost-effectiveness of the PHP intervention. METHODS: The ROSHNI-2 trial was a multicentre, two-arm, assessor-blinded, randomised controlled trial; we conducted an economic evaluation over a 12-month period to assess the cost-effectiveness of PHP plus treatment as usual versus treatment as usual alone from the perspective of the English National Health Service and personal social services. In the trial, British south Asian women aged 16 years or older with a child aged up to 12 months, and meeting DSM-5 criteria for depression, were recruited from northwest England, Yorkshire, the East Midlands, and London. The PHP intervention involved 12 group sessions delivered by two trained bilingual facilitators, held once per week for 2 months and once per fortnight thereafter, each lasting 60-90 min. Questionnaires on depression symptoms, quality of life, and resource use were completed at baseline, 4 months (end of intervention), and 12 months after random assignment. Quality-adjusted life-years (QALYs) were used for the cost-utility analysis, and recovery from depression at 4 months (the primary clinical outcome), assessed using the Hamilton Rating Scale for Depression, informed the cost-effectiveness analysis. After the onset of the COVID-19 pandemic, the intervention was adapted for online delivery for the remaining participants. A stratified analysis compared the cost-effectiveness of online versus in-person delivery. The trial involved researchers with lived experience, and all methods, including health economic measures, were developed in consultation with service users, community members, and faith leaders. This is a preplanned analysis of the ROSHNI-2 trial, registered with ISRCTN (ISRCTN10697380). FINDINGS: From Feb 8, 2017, to March 29, 2020, 732 eligible women were enrolled: 368 participants were randomly assigned to the PHP arm and 364 to the treatment as usual arm. The base-case intention-to-treat analysis showed that PHP significantly increased costs (£712, 95% CI 311 to 1113) and QALYs (0·036, 95% CI 0·006 to 0·067), with an incremental cost-effectiveness ratio of £19 601 (7622 to 83 772). Based on the UK National Institute for Health and Care Excellence (NICE) maximum willingness-to-pay threshold of £30 000 per QALY, the likelihood of PHP being cost-effective was 77% from a health and social care perspective. Cost per remission from depression at the 4-month follow-up was £5509 (2916 to 17 860). In a stratified analysis of 34 participants attending online sessions during the pandemic, incremental QALY effects were 0·125 (0·048 to 0·203), resulting in costs of £202 (-3906 to 10 918) per additional QALY gained. INTERPRETATION: The average cost of PHP for postpartum women was below the lower end of the NICE threshold of £20 000-30 000 per QALY, excluding benefits to the child or potential gains such as reduced lost productivity from early remission. PHP, a culturally adapted group cognitive behavioural therapy-based intervention, might be a cost-effective intervention for postnatal depression in British south Asian women. Online PHP delivery showed promising clinical and cost-effective results for this group but requires a large-scale study. FUNDING: UK National Institute for Health and Care Research.
• Promoting the resilience of Iranian women through a narrative arts approach

  Masud, Saima (SAGE Publications, 2025)

  No abstract available
• Accelerated intermittent theta burst transcranial magnetic stimulation of the dorsolateral prefrontal cortex for chronic knee osteoarthritis pain

  Lankappa, Sudheer; Morriss, Richard K. (Elsevier, 2025)

  OBJECTIVE: This study assessed feasibility, safety, and tolerability of accelerated intermittent theta burst stimulation (aiTBS) with effective connectivity-guidance targeting the left dorsolateral prefrontal cortex (lDLPFC) from the right anterior insular (rAI) in chronic knee osteoarthritis pain. METHODS: The BoostCPM clinical trial (ISRCTN15404076) was a randomized, sham-controlled, single-blind, parallel-group pilot study in patients with mild-moderate chronic pain. Participants were assigned 2:1 (active: sham) aiTBS for 4 consecutive days (totaling 36,000 pulses) at a daily dose of 9000 pulses (5 sessions of 1800 pulses). Primary outcomes included safety, tolerability, pain-related and affective outcomes, and quantitative sensory testing. RESULTS: 45 participants received active (n = 33) or sham (n = 12) aiTBS. No serious adverse events were recorded, and protocol adherence (tolerability) was 80.6 % and 100 % for active and sham. Follow-up response rate was 78.1 % and overall acceptance/satisfaction was 89 %. Pain relief was observed immediately after treatment and lasted 16 weeks with clinically meaningful reduction of pain burden, but no differences between groups. CONCLUSIONS: aiTBS with rAI-connected lDLPFC targeting is a safe, well tolerated, feasible, and acceptable intervention in chronic pain patients. However, we found no additional improvements compared to sham. SIGNIFICANCE: Further studies of aiTBS and lDLPFC targeting for pain relief are warranted.
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  A 10-week remote monitoring study of sleep features and their variability in individuals with and without ADHD

  Groom, Madeleine J.; Hollis, Chris P. (BioMed Central, 2025)

  BACKGROUND: People with attention deficit hyperactivity disorder (ADHD) often report disturbed sleep, as well as co-occurring symptoms of anxiety and depression. Yet studies employing objective assessments often do not show as many sleep disturbances compared to subjective measures. These discrepancies may relate to subjective reports capturing problematic nights, which may not be captured in a single night's sleep or by averaging objective measurements over several nights. Given that variability in behaviours is in general strongly linked to ADHD, individuals with ADHD could have greater sleep variability than individuals without ADHD. Using active and passive remote monitoring, we investigate differences in the level and variability of daily sleep behaviours between individuals with and without ADHD and explore if sleep is associated with changes in anxiety and depressive symptoms across a 10-week remote monitoring period. METHODS: Forty individuals (20 with ADHD, 20 without) took part in a 10-week remote monitoring study. Active monitoring involved participants completing questionnaires on ADHD and co-occurring psychiatric symptoms at weeks 2, 6 and 10. Passive monitoring involved participants wearing a wearable device (Fitbit) that measured sleep each night. RESULTS: Individuals with and without ADHD were similar in the levels of sleep recorded each night. However, compared to those without ADHD, participants with ADHD had more variable sleep duration, sleep onset and offset, and sleep efficiency over 10 weeks. Within-individual associations of co-occurring anxiety and depressive symptoms with the sleep features were non-significant. CONCLUSIONS: In a 10-week remote monitoring study of sleep using a wearable device, we show that what distinguishes individuals with ADHD from those without is their greater variability in sleep features: participants with ADHD had a more variable sleep duration, sleep onset and offset, and sleep efficiency. Inconsistency and high variability are hallmarks of ADHD, and we show that this characteristic extends also to sleep among adolescents and adults with ADHD. TRIAL REGISTRATION: Clinical trial number: not applicable.
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  Artificial intelligence in forensic mental health : a review of applications and implications

  Ebo, Titus O. (Elsevier, 2025)

  This narrative review explores the transformative role of artificial intelligence (AI) in forensic mental health, focusing on its applications, benefits, limitations, and ethical considerations. AI's capabilities, particularly in areas such as risk assessment, mental health screening, behavioral analysis, and treatment recommendations, present promising advancements for accuracy, efficiency, and objectivity in forensic evaluations. Predictive models and natural language processing enhance the precision of high-stakes assessments, enabling early intervention and optimized resource allocation. However, AI's integration in forensic mental health also brings significant challenges, particularly regarding data quality, algorithmic bias, transparency, and legal accountability. Limited access to high-quality, representative data can hinder reliability, while biases within AI models risk perpetuating existing disparities. Ethical concerns surrounding data privacy and the "black box" nature of many AI algorithms underscore the need for transparency and accountability. The review highlights future directions for responsible AI use, including improving data standards, fostering interdisciplinary collaboration, and establishing robust regulatory frameworks to safeguard ethical and fair AI applications in forensic settings. Balancing technological innovation with ethical considerations and legal obligations is essential to ensure AI supports justice and upholds public trust. This review calls for ongoing research, policy development, and cautious implementation to harness AI's potential while protecting individuals' rights within the justice system.
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  Comparison of the diagnostic performance of the central vein sign and CSF oligoclonal bands supporting the diagnosis of multiple sclerosis

  Das Nair, Roshan (American Academy of Neurology, 2025)

  Background and Objectives The central vein sign (CVS) describes the presence of venules within multiple sclerosis (MS) brain lesions, visible on T2*-weighted MRI. In the upcoming revision of the MS diagnostic criteria, the simplified “rule of 6” (i.e., finding 6 lesions with a central venule) can support the diagnosis of MS as an alternative to lumbar puncture (LP). We evaluated whether a T2*-weighted MRI scan is more sensitive than oligoclonal bands (OCBs) for diagnosing MS at presentation with a typical clinically isolated syndrome (CIS). We also compared the tolerability of LP and the additional MRI. Methods Participants requiring an LP to meet the 2017 McDonald diagnostic criteria for MS were enrolled in this multicenter, prospective, diagnostic superiority study from 3 UK neuroscience centers. A six-minute T2*-weighted sequence was used to assess the CVS using 2 definitions: a 40% threshold of all eligible lesions and the rule of 6. These were compared with OCBs, using the clinical diagnosis at 18 months as the reference standard. Results Of 113 participants, 99 (mean age: 38, female: 73%) have completed all study activities: 80 were diagnosed with MS, 10 remained CIS, 8 had alternative diagnoses, and 1 remained without a diagnosis. No significant difference in diagnostic sensitivity was detected between 40% CVS threshold (90% [CI 81%–96%]) and OCB testing (84% [CI 74%–91%]) (p = 0.332). The rule of 6 had a sensitivity of 91% (CI 83%–96%). Side effects were reported by 75% following LP compared with 9% following MRI. All participants preferred their MRI scan over their LP. Discussion CVS and OCB testing is equally sensitive in supporting the diagnosis of MS in cases of typical CIS. CVS assessed using the 40% threshold, and the simpler rule of 6 produces equivalent diagnostic performance. Compared with OCB testing, CVS testing seems safer and better tolerated by patients. Further studies are needed to evaluate CVS specificity, particularly outside of typical CIS cases, as studied here. Classification of Evidence This study provides Class IV evidence that CSF OCBs and the CVS are equally sensitive in supporting a diagnosis of MS in patients presenting with CIS.
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  Vocational rehabilitation for people with multiple sclerosis in the national health service of the United Kingdom: A realist evaluation

  das Nair, Roshan (Public Library of Science, 2025)

  BACKGROUND: There is limited evidence about how vocational rehabilitation (VR) for people with multiple sclerosis (MS) can be delivered through the United Kingdom's (UK) National Health Service (NHS) and how it works. AIM: To understand the mechanisms and context for implementing a VR intervention for people with MS in the NHS and develop an explanatory programme theory. METHODS: A realist evaluation, including a review of evidence followed by semi-structured interviews. A realist review about VR for people with MS in the NHS was conducted on six electronic databases (PubMed, MEDLINE, PsychINFO, Web of Science, CINAHL, and EMBASE) with secondary purposive searches. Included studies were assessed for relevance and rigour. Semi-structured interviews with people with MS, employers, and healthcare professionals, were conducted remotely. Data were extracted, analysed, and synthesised to refine the programme theory and produce a logic model. RESULTS: Data from 13 studies, and 19 interviews (10 people with MS, five employers, and four healthcare professionals) contributed to producing the programme theory. The resulting programme theory explains the implementation of VR in the NHS for MS populations, uncovering the complex interplay between the healthcare and employment sectors to influence health and employment outcomes. VR programmes that offer timely support, tailored to the needs of the person with MS, and that support and empower the employee beyond the healthcare context are most likely associated with improved employment outcomes, for example, job retention. CONCLUSION: Embedding VR support within the NHS requires substantial cultural and organisational change (e.g., increased staff numbers, training, and awareness about the benefits of work). This study emphasises the need to routinely identify people with MS at risk of job loss and follow a collaborative approach to address employment issues. This realist evaluation provides insight on how to improve the quality of care available to people with MS.
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  Close to the comfort zone : stakeholders' perspectives on implementing leisure activities in dementia and eldercare

  Craven, Michael P. (MDPI AG, 2025)

  BACKGROUND: This study aimed to explore stakeholders' perspectives on implementing non-digital leisure activities to promote social interaction in dementia and eldercare settings. METHODS: A secondary analysis of online semi-structured interviews was conducted, focusing on nine stakeholders with expertise in dementia and eldercare. The data collected were analyzed using inductive qualitative thematic analysis to identify key themes and insights. RESULTS: Three key themes emerged, emphasizing inclusivity, usability, and context. Stakeholders highlighted the importance of tailored activities, ease of use, and privacy. Challenges included resource allocation and availability. The findings underscore the significance of supporting innovations in both digital and non-digital leisure activities within dementia and eldercare settings. Clinicians and policymakers should consider integrating inclusive activities into care plans to enhance social interaction for older adults. Future research should focus on identifying optimal levels of engagement and evaluating the effectiveness of leisure activities in promoting well-being among older adults in diverse settings. CONCLUSION: Despite current limitations, stakeholders affirmed the value of non-digital leisure activities, such as board games, for enhancing social interaction and well-being in dementia and eldercare settings. Integrating non-digital and digital activities was seen as promising for meeting diverse needs.
• Real world effectiveness of rTMS in depression and anxiety

  Thanki, Milind; Briley, Paul M.; Ottahal, Sarah; Lankappa, Sudheer; Katshu, Mohammad Z. (Royal College of Psychiatrists, 2024)

  Aims. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation recommended by NICE for treatment of depression with minimal side-effects and a high patient acceptability. Our aim was to assess the effectiveness of rTMS in real world clinical service in alleviating symptoms of depression and anxiety. Methods. All patients receiving rTMS in our Centre for Neuromodulation Services (CNS) received 5 daily treatment sessions a week for a period of 5 weeks (25 sessions in total). All patients routinely completed PHQ-9, BDI-II and GAD-7 measures before and after the course of treatment. The scores on these measures were retrospectively analysed using paired-Sample t-test. Results. All 15 patients completed the PHQ-9 and GAD-7 scales while 10 patients completed BDI-II. Eleven patients (73%) had improved PHQ-9 scores post-treatment with average improvement of 5.5 points which was statistically significant [pairedsample t-test: t(14) = 3.019, p = 0.009]. Nine patients (90%) had improved BDI-II scores post-treatment with average reduction of 36% from baseline which was statistically significant [t (9) = 3.681, p = 0.005]. Eleven patients (73%) had improved GAD-7 scores post-treatment, with average reduction of 4 points. This reduction was also statistically significant [t(14) = 3.038, p = 0.009]. Improvement in all measures was also of a level that would be considered clinically significant for these measures. All patients tolerated the treatment well with no patients dropping out due to side effects. Conclusion. With the limitation of relatively small sample size, our initial analysis indicates that rTMS treatment offered in real world clinical service is effective in treating symptoms of depression. Although our protocol was not intended to treat anxiety, our patients had remarkable improvement in anxiety symptoms as well.
• Quality improvement project on standardising GP discharge summaries in liaison psychiatry services for older people in Nottinghamshire Healthcare NHS Trust

  Tan, Sue Fen; Wilson, Sarah; Lander, Robin (Royal College of Psychiatrists, 2024)

  Aims. Discharge letters to general practitioners (GPs) are pertinent in summarising patients' care in secondary healthcare settings and communicating follow-up management plans for continuity of care. 26 GPs from 13 GP surgeries in the West Midlands thought that discharge letters lacked important information and standardisation. We developed a quality improvement (QI) project to standardise GP discharge summaries within the liaison psychiatry services for older people in Nottinghamshire Healthcare NHS Trust. We aimed to ensure that 100% of GP discharge letters are written in a standardised format and meet the mandatory subheadings within six months. Methods. A comprehensive literature search was performed, and we invited six GPs across Nottinghamshire to comment on the quality of anonymised discharge summaries written by our colleagues. After discussing the findings with our stakeholders, we developed a new discharge summary template with the subheadings of 'Reason for Liaison Psychiatry Involvement', 'Summary', 'Diagnosis (if applicable)', 'Risk Formulation', and 'Treatment or Plan of Action'. We held a team meeting and distributed a guidance document with scoring criteria for each subheading for our clinical colleagues to practise for two weeks. Subsequently, 75 discharge summaries were randomly selected and independently scored across seven weeks by an internal team member and an external QI data analyst to improve inter-rater reliability. 98 discharge summaries written six weeks before the new letter template was introduced were retrospectively scored for baseline measurement. Results. At baseline, the discharge summary scores ranged between 6 and 20 (out of a maximum of 20), depending on the individual completing them. The mean score was 12.3. The implementation of the new discharge summary template improved the mean score to 19.0, irrespective of the author. The mean score was consistent across seven weeks. Most of our colleagues did not face significant challenges in learning a new style of writing and for some, a standardised template reduced administrative time. The same GPs reviewed the new set of anonymised discharge summaries and were satisfied with the new summary format. Conclusion. Formulating a standardised discharge summary template which adhered to professional guidelines was pivotal in improving the quality of GP discharge summaries. GP involvement throughout the project convinced stakeholders and colleagues to commit to a new writing template and tremendously helped achieve our project aim.
• Narrowing the gap in differential attainment for psychiatry core trainees in East Midlands through mentorship scheme

  Seun-Fadipe, Champion T.; Oluwaranti, Oluwaseun; Yanson, Yanson (RCPsych International Congress 2024, 2024)

  Aims. The use of mentorship schemes may be a pragmatic approach to bridging the differential attainment gap for psychiatry trainees. There is robust evidence that mentorship improves outcomes for core trainees across several domains including exam pass rates, ARCP outcomes and clinical practice. A survey was developed to elicit core psychiatry trainees' perspective about the need for mentoring as well as their expectations. This was an initial survey done as part of a Quality Improvement project focused on mentoring scheme for psychiatry core trainees in the East Midlands region. Methods. A 16-item self-rated questionnaire was designed to elicit information relating to respondents' demographics, professional qualifications, UK experience prior to commencement of training, perception of mentorship as an unmet need as well as expected focus of potential mentoring relationship. These were administered to psychiatry core trainees in the East Midlands region. The data was collected in February 2023. Results. About a quarter of the core trainees (n = 21) participated in the survey. Majority (47.6%) of the respondents had Black or Black British ethnic origin and 11 (52.4%) were in their second year of training. Although 13 (61.9%) had a non-UK primary medical qualification, majority had some months of UK experience before commencement of training (median = 1.4 years). Twenty (95%) of the respondents identified mentoring as an unmet need and they highlighted the areas of need. Conclusion. This survey showed a high level of acceptance of the mentoring scheme among the trainees. Their expectations and suggestions helped further the design of the mentoring scheme which is currently ongoing.
• Medication required : p*RN - promoting healthy attitudes and improved access to pornography in wathwood hospital

  Parry, Joanne (Royal College of Psychiatrists, 2024)

  Aims. The key aim of this project was to update and modernise the hospital procedure on how patients access pornographic material whilst detained at Wathwood Hospital. Within the update, we aimed to promote inclusivity and acceptance of all patients' sexual identities as well as utilising the opportunity to emphasise healthy consenting sexual relationships. Patients in Forensic Mental Health settings are often inpatients for a significant amount of time, with multiple restrictions imposed on their private and family life. Current policy allows patients to purchase pornography for private use in their own room. It must be material of the same nature available in a main street outlet. In practice, material is usually purchased in DVD format from the Amazon website and subsequently screened for suitability by Security staff and finally approval by the Responsible Clinician. There have been numerous incident reports involving the trading of pornographic material. Methods. Qualitative semi-Structured group interviews (up to 5 people at a time) were conducted with patients in the mediumsecure forensic services of Wathwood Hospital. They were recruited from the fortnightly Patient Forum. Anonymised questionnaires involving Likert scales and free text response spaces were also distributed at the Patient Forum. Data gathered investigated the percentage of patients who were aware of the current procedure, if they felt it worked well and what they thought the impact of accessing pornographic material might be. Staff were invited to complete a similar anonymised questionnaire, again considering their opinions on the positive or negative impacts of pornography for patients. In addition, we gathered data on whether there was a difference on the degree of comfort/discomfort about pornography, depending on whether the material involved opposite sex or same sex couples. In total, there were 40 survey participants. Results. Some key areas for concern were found, for example, only 17% of staff and 16% of patients thought the current policy works well despite 69% of staff and 84% of patients feeling it is a patient's right to access pornography. Free text and focus group feedback established many benefits to it. It was clear that there were some areas of difficulty in the hospital policy, which would benefit from being refreshed. Conclusion. Staff and patients overall feel that access to pornography is important for many of the patients. We identified areas for improvement in how this is accessed and a need to continually be considering the need to consider meeting the holistic needs for the patients.
• Improving health literacy for individuals with intellectual and developmental disability and their carers

  Omokanye, Mariam (Royal College of Psychiatrists, 2024)

  Aims. The aim of our project is to support health literacy in patients and carers under the Nottinghamshire Intellectual and Developmental Disabilities (IDD) service. To achieve this aim, we will produce a 20 page newsletter, containing updated and accessible research on mental health disorders that are common in the IDD population. We will also utilise a Trust webpage to publish the newsletter and produce a video/ podcast for the webpage, showcasing individuals with intellectual disabilities discussing and interacting with the articles. Methods. Research into the relevant articles included a search on Google Scholar and PubMed, and a list was written up. Final research articles to be included in the newsletter were selected after consultation with the consultant peer group within the Intellectual and Developmental Disability team within Nottinghamshire Healthcare NHS Foundation Trust. Easy read forms of all the articles were drafted by researchers, which will be sent to relevant authors to verify that this is an accurate representation of their research. An accessible 20-page newsletter will be produced, and an IDD focus group will review the content of the newsletter, discuss the articles and relevant videos/ podcasts will be made of these interactions. A webpage on the trust website will be created to publish the newsletter and allow users to interact with the articles electronically (using the standard electronic accessibility tools) and this will also contain the videos/podcasts produced. Feedback will be obtained electronically via a QR code and via traditional means e.g. an easy read reply slip. Results. The key outcomes of our project are producing 10 easy read articles within our newsletter. These articles need to be useful and accessible to the IDD population, which will be verified by small focus groups consisting of patients with IDD, carers and staff to review literature before publication as well as the feedback after publication. Another key outcome is the use of coproduction to involve people with IDD in production of the newsletter and webpage, in order to recognise the value of their lived experience, improve the quality of the project and drive success. Conclusion. Successful publication and feedback will pave a way for exploring a second edition the following year for printing via Trust communications. If successful, this project could be used as a template for an effective way to share research findings that contribute to the understanding of assessment and treatment pathways for people with an Intellectual and Developmental Disability.
• Effective induction programme for higher specialist trainees : a quality improvement project

  Nisa, Zaib; Krishnan, Deepa B.; Junaid, Kehinde; Edwards Suarez, Lori; Lankappa, Sudheer (Royal College of Psychiatrists, 2024)

  Aims. To create a safe and effective induction programme for Higher Specialist Trainees (HST) at Nottinghamshire Healthcare NHS Foundation Trust. An effective induction improves trainees' satisfaction, they feel welcomed and valued. It improves patient safety, retention, and recruitment (GMC Report 2020). Methods. Based on GMC report, published in 2020, a survey was developed locally and data for 2021 HST induction was collected using digital platform. Initial stakeholder analysis completed, and relevant parties were invited to share the results. Two key deliverables were identified after consultation, one was a dedicated induction programme for HST which was co-produced along with trainees and stakeholders. The other deliverable was updating the induction booklet. The proposed induction plan was implemented in August 2023, the survey was repeated to the new HST cohort following induction via digital platform. Results of the survey were analysed via mixed methods (qualitative & quantitative). Results. The surveys conducted in 2021 and 2023 were compared and there was an increase in response rate from 50% to 64%. The domains were devised from GMC standards and assessed by if staff had received everything in the domain within a week of starting their placement and results evaluated using a t-test. Domain A is gaining access to places and system (keys, fobs, security passes, computers, ID badges, mobile phones, IT system). This significantly improved from 27% to 88% with a p-value of < 0.001. Domain B is physical orientation of the setting (staff facilities such as lockers, parking, library, and site layout). This significantly improved from 45% to 88% with a p-value of < 0.018. Domain C is gaining day to day knowledge (HR, rota, annual leave, study leave, pay-roll, mandatory training, e-expenses, and guardian of safe working). There was no significant change between 9% and 19% with a p-value of < 0.48. Domain D is an understanding of expectations (duties and responsibility during working hours, on-call, team introduction). This significantly improved from 9% to 69% with a p-value of < 0.002. HSTs were given the chance to add comments and the responses in 2023 were more positive "excellent induction compared to previous years" compared with 2021 when HSTs felt isolated and devalued "worst ever induction in whole career in NHS". Conclusion. Overall, the results of the 2023 survey showed considerable improvement in all the key areas of induction within one week of starting the placement. Domain C demonstrates a challenge still and needs further work.
• Thematic analysis of coroners' prevention of future deaths (PFDs) reports in mental health related suicide

  Manning, Dean; Mittal, Shweta (Royal College of Psychiatrists, 2024)

  Aims. To identify professional and organisational-related themes in Coroners' PFDs reports which contributed to mental health related suicide. Methods. We reviewed Coroners' PFDs reports via the UK Judiciary website. We filtered reports by those which were mental health related deaths and included the keyword 'suicide'. 100 reports were reviewed starting with the most recent which was August 2023. We reviewed which Coroner's area the reports originated from and the age and gender of the deceased. Then, we examined the contents of the PFDs reports including the inquest conclusion, circumstances of death and concerns raised by the coroner. Themes were identified and grouped into patient-related, professional-related, and organisational-related factors that may have contributed to the death by suicide. Results. Reports were reviewed from across the UK. The highest number of reports were from the coroner area of Manchester South (12%). From those reports whereby the deceased's age was mentioned, the mean age was 36 with an age range of 14-81 years (35% of reports did not include the deceased's age). 61% of reports were of males and 39% females. The main professional-related factors identified from thematic analysis of the PFDs reports were issues around risk assessment and management (45%), lack of interprofessional communication and collaboration (33%), inadequate clinical queries/assessment (25%), lack of consultation of family/carers (17%) and lack of treatment/follow up plan following discharge (11%). The main organisational-related factors were inadequate service provision for the population covered (20%), inadequate training/ knowledge (18%), inadequate staffing or reliance on agency staff (15%), poor systems in place including information technology (13%) and lack of audit or evidence of learning from prior investigations & events (11%). Patient-related factors were less commonly identified but included lack of engagement with services, denying suicidality and autistic spectrum disorder. Conclusion. The commonest theme was issues around risk assessment and management which was identified in 45% of suicides. It is hoped by highlighting common themes arising from PFDs reports across the UK this analysis could inform targeted improvements in practice that will lead to reductions in mental health related suicide which is the need of the hour.

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