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Assessing the second-hand effects of a new no-smoking policy in an acute mental health trustAims and method To examine whether a new no-smoking policy in an in-patient mental health setting had any effects outside of smoking cessation. Our hypothesis stated that a forced smoking ban for in-patients may result in an increased susceptibility for clinical incidents, aggression and lower admission rates. All patients admitted to adult in-patient mental health services in Coventry and Warwickshire Partnership NHS Trust were included in the analysis. Data 6 months post-implementation of the smoking policy (1 July 2015 to 1 January 2016) were compared with the same period 1 year prior (1 July 2014 to 1 January 2015). Patient demographics, admission rates, ward occupancy, average lengths of stay, numbers of reported incidents and use of the Mental Health Act 1983 (MHA) were compared. Results We analysed 4223 admissions. We found a significantly increased number of admissions under the MHA (P = 0.007), a significantly greater number of reported smoking-related incidents (P < 0.001) and aggression-related incidents in the psychiatric intensive care unit (P < 0.001). However, we found no significant difference in capacity of in-patient wards (P = 0.39), admission length (P = 0.34) or total aggression-related incidents (P = 0.86). Clinical implications Although further comparisons over longer time periods are necessary, our results suggest that enforced smoking cessation on acutely unwell psychiatric patients admitted to the most restricted environments may have some negative effects. Nicotine replacement therapy should be offered to all patients to minimise the risk of clinical incident.
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QI 73 Reducing Restrictive Practice - November 2018 to April 2020Aim: To reduce the overall use of restrictive practice by 30% by April 2020. This project was run by RCPSYCH and included 40 wards across the country, focussing on Improving Mental Health Safety. Rowans was identified as a target ward to be included and was supported by a QI Coach from the RCPSYCH. We created a Driver Diagram to help focus change ideas into themes Leadership and Learning Culture, Co-Production, Environment, Prevention and Predication and Person Centred Care. We identified how we would collect data and display progress, using a safety cross and incident reporting data, and we used a collaborative approach, including patient involvement, to generate ideas to implement and test using the PDSA cycle. Tools Used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. PDSA Cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Statistical Process Control (SPC) chart - www.england.nhs.uk/statistical-process-control-tool. Project Impact: Staff and patients identified communication and trust was improved. The staff team felt more motivated. The team feel less stressed and able to focus on being creative with the client group and developing interpersonal relationships. The patients felt that the interventions have been empowering. Overall data showed a 55% reduction. Physical restraint saw a 57% reduction and rapid tranquilisation became in line with normal variation.
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QI 140 To reduce the length of stay within the Crisis Home Treatment Team (CRHT) for Older AdultsAim: To reduce the length of stay within the Crisis Home Treatment Team (CRHT) to 42 days for 60% of Older Adults by September 2021. The age integrated CRHT caters for people aged 18 years and over. Clinical reviews within the team indicated inadequate risk assessments leading to ineffective management plans when dealing with older adult referrals. Informal discussion with staff revealed lack of experience and confidence leading to poor service delivery and impact on length of stay with the team. Key areas of focus 1.Recruit skilled professionals within Triage and Assessment. Team with older adult experience. 2. Develop older adult champions. 3. Develop link workers within IPUs who can work alongside the champions for seamless transfer of patients. Tools Used: Plan, Do, Study, Act (PDSA) Cycle which is a framework that helps you to test small changes. This is part of the Model for Improvement framework, which helps you to test out small changes and build on the learning from each cycle - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram which is a tool designed to show 'cause and effect' and can help you plan your improvement project - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf. Project Impact: Training : Feedback before and after related to confidence in dealing with older adult referrals. Overall, very positive feedback and request for more online resources related to social care and voluntary sector –which were sent to attendees. Referrals: There was a very marked reduction in the number of referrals received between the 2020 period and the 2021 period. Reduction occurred in referrals which then resulted in relatively short lengths of stay. 30.8% of the overall reduction of 318 referrals was in referrals that were discharged on the same day, and 84.3% of the reduction comes from referrals discharged within four days. The number of referrals discharged on the same day fell from 110 in 2020 to just 12 in 2021.
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QI 180 Implementing Behavioural Family Therapy (BFT) in the Perinatal Mental Health Team (PMHT)Perinatal Psychological therapies is part of the NHS England Long Term Plan (LTP). The national ambition is to expand access to evidence-based therapies within PMHT so that they also include parent > infant, couple and family interventions. A secondment post was introduced in the Trust’s PMHT to help achieve this aspect of the LTP to introduce and implement a ‘whole family’ approach utilising the BFT MERIDEN Programme which is already utilised in psychosis specific teams within CWPT (Early Intervention and Recovery). Tools used: Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Stakeholder Analysis - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf. Project Impact: The project has helped offer more support and resources for client’s carers and families and upskilled staff and increased their confidence of this patient cohort. The project benefitted the Trust by securing a cost saving of £1,150 by negotiating training costs with the training provider. Not only has the project given carers of patients more of a voice and support system, it has united the PMHT and supported integrated working. Next steps are; 1. Secure Develop leaflets and handouts to support programme delivery 2. Continue BFT supervision for the contracted year with MERIDEN 3. Continue to complete data template 4. Adapt process for other mental health services in the Trust
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Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot studyObjective: This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE). Method: Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion. Results: The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up. Discussion: Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE. Public significance: This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.
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Sertraline for anxiety in adults with a diagnosis of autism (STRATA): study protocol for a pragmatic, multicentre, double-blind, placebo-controlled randomised controlled trialBackground: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. Methods: STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1-2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. Discussion: Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population.
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Sleep and Postpartum Psychosis: A Narrative Review of the Existing LiteratureSleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP.
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Rapid review of facilitating reflective practice groups with staff in adult inpatient mental health settingsReflective practice is poorly defined and often lacks distinction from other practices, such as clinical supervision. In the UK, the National Health Service (NHS) faces unparalleled challenges within the context of chronic underfunding, high staff attrition, and the recent global pandemic. Frontline staff are desperately trying to meet the demands of their roles and services are struggling to prioritise their professional development and wellbeing, further exacerbating these problems. This rapid review of the evidence sought to identify barriers and facilitators of Reflective Practice Groups (RPGs) within adult inpatient mental health services, using three databases. Two-hundred and one unique references were retrieved, yielding eight papers meeting the inclusion criteria. Barriers to facilitating RPGs included: practicalities; individual and team expectations; needs and competencies of facilitators; and organisational issues. Studies suggested solutions including facilitating RPGs off-ward to reduce disruptions and protect the space; increasing psychological safety by incorporating clear guidelines and expectations for attendees; and organisational support. The review highlighted universal challenges faced by healthcare professionals and organisations in facilitating and accessing RPGs. The review illustrates the paucity of research in this area, which may be due to nebulous definition and inconsistencies between different organisations. Implications for practice are discussed.
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Realist assessment of fidelity during the implementation of the PARTNERS collaborative care intervention for people with diagnoses of severe mental illness within a cluster randomised controlled trialMany with severe mental illnesses are underserved by disjointed service provision. PARTNERS aims to address this via collaborative care with recovery-based coaching. PARTNERS was evaluated in a randomised controlled trial. Understanding how intervention delivery compared to the model, why this was, and under what circumstances, aids interpretation of trial results and optimisation of future implementation. This paper reports the results of a Realist assessment of fidelity, exploring delivery compared to model and refining programme theory. Practitioners, service users, supervisors, primary care representatives, and researchers (n = 39) were interviewed. Additional data included session recordings, follow up interviews, practitioner reflective logs, supervision logs, contact data, service user surveys, and meeting minutes. A framework analysis with evaluative coding was used to assess the extent to which delivery matched the Realist initial programme theory, and how, why and under what circumstances this was the case. Retroductive analysis was used to refine the programme theory. Delivery was good, but varied by practitioner and over time. Delivery improved over time, as practitioner understanding of the intervention increased. Refinements to the programme theory include training leading to practitioners forming collaborative relationships with service users most of the time, but unidentified contextual factors causing variation in consistency. Whether training led to practitioners liaising across different bodies was dependant on the contextual factors of existing relationship skills and previous connections. System-level difficulties in providing consistent supervision made it difficult to assess the impact of this mechanism on delivery. Variation in delivering means caution should be applied when interpreting trial results. Implementation of practitioner-level change without implementing system-level change limits the ability to fully implement the model and to draw conclusions as to effectiveness. Current changes to NHS community mental health care may make this more achievable. Further research is needed to understand the role of supervision and optimal training. Trial registration: This is the realist process evaluation of the cluster randomised controlled trial ISRCTN95702682. REC approval: West Midlands–Edgbaston Research Committee 29/06/2017, ref: 14/WM/0052 (trial registration number ISRCTN95702682).
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Mental health services for black and minority ethnic elders in the United Kingdom: a systematic review of innovative practice with service provision and policy implicationsBackground: Long-standing ethnic inequalities in access and mental healthcare were worsened by the COVID-19 pandemic. Objectives: Stakeholders coproduced local and national implementation plans to improve mental healthcare for people from minority ethnic groups. Methods: Experience-based codesign conducted in four areas covered by National Health Service (NHS) mental health trusts: Coventry and Warwickshire, Greater Manchester, East London and Sheffield. Data were analysed using an interpretivist-constructivist approach, seeking validation from participants on their priority actions and implementation plans. Service users (n=29), carers (n=9) and health professionals (n=33) took part in interviews; focus groups (service users, n=15; carers, n=8; health professionals, n=24); and codesign workshops (service users, n=15; carers, n=5; health professionals, n=21) from July 2021 to July 2022. Findings: Each study site identified 2-3 local priority actions. Three were consistent across areas: (1) reaching out to communities and collaborating with third sector organisations; (2) diversifying the mental healthcare offer to provide culturally appropriate therapeutic approaches and (3) enabling open discussions about ethnicity, culture and racism. National priority actions included: (1) co-ordination of a national hub to bring about system level change and (2) recognition of the centrality of service users and communities in the design and provision of services. Conclusions: Stakeholder-led implementation plans highlight that substantial change is needed to increase equity in mental healthcare in England. Clinical implications: Working with people with lived experience in leadership roles, and collaborations between NHS and community organisations will be essential. Future research avenues include comparison of the benefits of culturally specific versus generic therapeutic interventions.
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Self-Harm in Eating Disorders (SHINE): a mixed-methods exploratory studyIntroduction: Self-harm is highly prevalent among young people with eating disorders. However, why a young person may develop and continue to experience both an eating disorder and self-harm is unclear. This study will investigate the frequency, intensity, duration, function, context and processes of self-harm among people aged 16-25 diagnosed with an eating disorder. It will explore participants' perspectives on the genesis and functions of both their self-harm and eating disorder, as well as their support needs. The study was designed with the input of members of a Young Persons' Advisory Group, who will be key to study delivery and dissemination. Methods and analysis: This exploratory study has a sequential mixed-methods explanatory design. Between 70 and 100 young people aged 16-25 with both an eating disorder diagnosis and self-harm thoughts and/or behaviours will be recruited from three NHS Eating Disorder outpatient services in England. Phase 1: a 14-day (six prompts per day) ecological momentary assessment (EMA) of participants' feelings, thoughts, motivations, behaviours and experiences of self-harm. Phase 2: 20-30 participants from phase 1 will be reapproached to take part in an in-depth qualitative interview on the psychological, emotional and social factors that underlie their self-harm and eating disorder as well as their support needs. EMA data from phase 1 will be analysed using descriptive and multilevel statistics. Qualitative interview data from phase 2 will be analysed using inductive and deductive thematic analysis. Results from both phases will be integrated using a mixed-methods matrix, with each participant's data from both phases compared alongside comparative analysis of the datasets as a whole. Ethics and dissemination: The study gained ethical approval from the NHS HRA West Midlands-Black Country Research Ethics Committee (number: 296032). We anticipate disseminating findings to clinical, academic and lived experience audiences, at academic conferences, through peer-reviewed articles, and through various public engagement activities (eg, infographics, podcasts).
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Borderline personality disorder: course and outcomes across the lifespanThis article presents an overview of the current literature on the course and outcomes of BPD. It begins with an overview of our changing understanding of BPD in terms of age of onset and prognosis over time. Recent research on clinical, functional and social recovery from BPD in youth and adult populations is then summarised. This is followed by an overview of contemporary prospective studies of adolescent BPD in community populations which seek to unravel complex pathways and the co-development of BPD symptoms and psychosocial problems. Studies of older populations are then described to shed light on how BPD manifests in middle to old age. The review concludes by bringing together these research strands to develop a picture of BPD across the lifespan and highlight areas for future research.
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The prevalence of personality disorders in the community: a global systematic review and meta-analysisBackground: Personality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders. Aims: To calculate the worldwide prevalence of personality disorders and examine whether rates vary between high-income countries and low- and middle-income countries (LMICs). Method: We systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from January 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094). Results: A total of 46 studies (from 21 different countries spanning 6 continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8% (95% CI 6.1-9.5). Rates were greater in high-income countries (9.6%, 95% CI 7.9-11.3%) compared with LMICs (4.3%, 95% CI 2.6-6.1%). In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage v. one-stage assessment), county income (high-income countries v. LMICs) and interview administration (clinician v. trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of cluster A, B and C personality disorders were 3.8% (95% CI 3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%). Conclusions: Personality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations.
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Clinical effectiveness and cost-effectiveness of Structured Psychological Support for people with probable personality disorder in mental health services in England: study protocol for a randomised controlled trialIntroduction Evidence-based psychological treatments for people with personality disorder usually involve attending group-based sessions over many months. Low-intensity psychological interventions of less than 6 months duration have been developed, but their clinical effectiveness and cost-effectiveness are unclear. Methods and analysis This is a multicentre, randomised, parallel-group, researcher-masked, superiority trial. Study participants will be aged 18 and over, have probable personality disorder and be treated by mental health staff in seven centres in England. We will exclude people who are: unwilling or unable to provide written informed consent, have a coexisting organic or psychotic mental disorder, or are already receiving psychological treatment for personality disorder or on a waiting list for such treatment. In the intervention group, participants will be offered up to 10 individual sessions of Structured Psychological Support. In the control group, participants will be offered treatment as usual plus a single session of personalised crisis planning. The primary outcome is social functioning measured over 12 months using total score on the Work and Social Adjustment Scale (WSAS). Secondary outcomes include mental health, suicidal behaviour, health-related quality of life, patient-rated global improvement and satisfaction, and resource use and costs. The primary analysis will compare WSAS scores across the 12-month period using a general linear mixed model adjusting for baseline scores, allocation group and study centre on an intention-to-treat basis. In a parallel process evaluation, we will analyse qualitative data from interviews with study participants, clinical staff and researchers to examine mechanisms of impact and contextual factors. Ethics and dissemination The study complies with the Helsinki Declaration II and is approved by the London—Bromley Research Ethics Committee (IRAS ID 315951). Study findings will be published in an open access peer-reviewed journal; and disseminated at national and international conferences.
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Management of transitions to adult services for young people with eating disorders: survey of current practice in EnglandAims and method: The Royal College of Psychiatrists has published recommendations for managing transitions between child and adolescent mental health services (CAMHS) and adult services for eating disorders. A self-report questionnaire was designed to establish how many CAMHS teams meet these recommendations and was distributed to 70 teams providing eating disorders treatment in England. Results: Of the 38 services that participated, 31 (81.6%) reported a flexible upper age limit for treatment. Only 6 services (15.8%) always transferred young people to a specialist adult eating disorders service and the majority transferred patients to either a specialist service or a community mental health team. Most services complied with recommended provision such as a written transition protocol (52.6%), individualised transition plans (78.9%), joint care with adult services (89.5%) and transition support for the family (73.7%). Clinical implications: Services are largely compliant with the recommendations. It is a concern that only a small proportion of services are always able to refer to a specialist adult service and this is likely to be due to a relative lack of investment in adult services.
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The Experiences and Views of Service Providers on the Mental Health and Well-Being Services for Syrian Refugees in Coventry and WarwickshireObjectives: Previous literature demonstrated that, even when mental health and psychological support services are available for refugees, there may still be obstacles in accessing services. This is the first known study to explore the experiences of mental-health and well-being services for Syrian refugees in Coventry and Warwickshire, United Kingdom. The research investigates the views and perceptions of service providers on the current mental-health and well-being services provided for this population. Methods: Eight service providers participated in semistructured interviews and focus groups, and the data were analyzed using thematic analysis. Results: Three main themes emerged from an analysis of the data: “positive aspects of service delivery,” “service challenges,” and “recommendations for service improvements and quality.” Conclusion: The findings bring to the fore specific gaps in current provision and interpreting services. Recommendations for proposed improvements in service provision and policy as well as clinical implications are included in this article.
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The Mental Capacity Act 2005 and autoerotic asphyxiation: pleasure versus the risk of harmThere has been a series of judgments in recent years emanating from the Court of Protection in England and Wales involving sexual relations. One such judgment is unique in that it is the first time the court has assessed capacity in the sexual practice of autoerotic asphyxiation in a person with a diagnosis of autism spectrum disorder. This article reviews the judgment and specifically the key section of the Mental Capacity Act 2005, section 27, which applies to capacity decisions in the context of family relationships, including sexual relationships. The practice of autoerotic asphyxia can be a complex and emotive subject and dangerous to individuals undertaking it. The judgment provides guidance and a framework for applying the Act to assess the capacity of someone practising autoerotic asphyxia that can be used in clinical practice for people with any mental disorder.
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Demographic, clinical, and service-use characteristics related to the clinician's recommendation to transition from child to adult mental health services.Purpose: The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. Methods: Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. Results: Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion: Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.
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Are Psychiatrists Trained to Address the Mental Health Needs of Young People Transitioning From Child to Adult Services? Insights From a European Survey.Background: In mental health, transition refers to the pathway of young people from child and adolescent to adult services. Training of mental health psychiatrists on transition-related topics offers the opportunity to improve clinical practice and experiences of young people reaching the upper age limit of child and adolescent care. Methods: National psychiatrist's organizations or experts from 21 European countries were surveyed 1/ to describe the status of transition in adult psychiatry (AP) and child and adolescent psychiatry (CAP) postgraduate training in Europe; 2/ to explore the amount of cross-training between both specialties. This survey was a part of the MILESTONE project aiming to study and improve the transition process of young people at the service boundary. Results: Transition was a mandatory topic in the AP curriculum of 1/19 countries (5%) and in the CAP curriculum of 4/17 countries (24%). Most topics relevant for transition planning were addressed during AP training in 7/17 countries (41%) to 10/17 countries (59%), and during CAP training in 9/11 countries (82%) to 13/13 countries (100%). Depending on the training models, theoretical education in CAP was mandatory during AP training in 94% (15/16) to 100% of the countries (3/3); and in AP during CAP training in 81% (13/16) to 100% of the countries (3/3). Placements were mandatory in CAP during AP training in 67% (2/3) to 71% of the countries (12/17); and in AP during CAP training in 87% (13/15) to 100% of the countries (3/3). Discussion and conclusion: Specific training about transition is limited during CAP and AP postgraduate training in Europe. Cross-training between both specialties offers a basis for improved communication between child and adult services but efforts should be sustained in practical training. Recommendations are provided to foster further development and meet the specific needs of young people transitioning to adult services.
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QI 1264 Improving the Referral Pathway to AMHAT at George Eliot Hospital (GEH)To reduce the time of the Arden Mental Health Acute Team (AMHAT) referral process for patients on GEH wards by 15 minutes and for patients in A&E by 10 minutes by 30th April 2024. AMHAT at CWPT provides liaison work to UHCW, SWFT and GEH and receives referrals from each of these areas. This project focussed on referrals from GEH wards and A&E. The AMHAT team receives an average of 45 referrals from wards at GEH and 75 referrals from GEH A&E each month. Staff on wards were required to write out referrals by hand and to then ask ward clerks to scan and email them to the AMHAT team; this whole process, if done smoothly took an average of 30 minutes. However, several issues were noted within the process which often led to increased referral times. Referrals from A&E were made over the phone to AMHAT clinical support staff, who then wrote on the referral form and informed clinical staff to respond. This process took an average of 21 minutes. The staff involved wanted to simplify the referral process and make it more robust to improve the referral experience for both patients and staff. Tools Used PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-conventional-process-mapping.pdf Project Impact Patients can be seen and treated faster. The time for each referral from the ward reduced by an average of 17 minutes and the time for referrals from A&E reduced by 11 minutes. There was a reduction in the total time spent on making referrals each month from 24 hours to 11 hours. Legibility problems have been eliminated and there is no longer any missing information as the required fields are mandatory. The new system also provides a transparent process and audit trail. Ward clerk time as been freed up as this is no longer needed for AMHAT referrals. There is a reduction in paper waste as paper forms are no longer in use.
