Delayed discharge from hospital is a global healthcare problem with negative impacts on patient outcomes and the wider health system. Delays to discharge can arise when a patient remains in hospital even when they are medically fit due to nonmedical reasons such as a lack of appropriate housing or social care. However, whilst several nonmedical interventions have been developed to facilitate timely hospital discharge, there remains a lack of evidence on their impact. This study reports on findings from a mixed-methods process evaluation of a newly integrated housing and health service in two United Kingdom- (UK-) based hospitals (one mental health hospital and one general hospital). The service involved housing support coordinators (HSCs) being based within hospitals and supporting inpatients with their housing-related needs. We employed qualitative interviews with service users and hospital/housing staff (N = 16) and routine data analysis (n = 488) to understand the impact of the service and any challenges to service delivery. Service users faced different housing barriers, for example: 28.3% experienced homelessness (n = 136) whilst 80 (16.4%) faced challenges with their accommodation no longer meeting their physical needs. Service users received support for a variety of issues such as assistance with medical priority applications, support to apply for social housing, and referral to other support services. Healthcare professionals at all levels credit the service for improving hospital discharge processes and reducing stress on clinical staff, enabling them to concentrate more effectively on clinical tasks. Key to success is experienced housing staff providing patient-centred support, being integrated within a multidisciplinary team with management and oversight from the health service, and the availability of appropriate housing stock and wider services to support people after discharge. Our findings indicate that other hospitals may benefit from implementing similar housing and health integrated services.

AimsThe current audit aims to assess the compliance with Prescribing Observatory for Mental Health (POMH-UK) guidance on monitoring of metabolic side effects of patients prescribed antipsychotics. Compliance was monitored to ensure that all patients prescribed continuing antipsychotics have their body mass index (BMI), blood pressure, blood glucose and lipids checked within the expected time limits of minimum once per year.BackgroundPatients diagnosed with Schizophrenia rank amongst the worst of chronic medical illnesses in terms of quality of life. This may in part be due to the use of long term antipsychotic medications, in particular the use of atypical antipsychotics which have been increasingly associated with metabolic side effects including hypertension, weight gain, glucose intolerance and dyslipidaemia. These side effects are related to the development of both diabetes mellitus and cardiovascular disease and can lead to increased mortality and morbidity, affecting compliance and engagement to healthcare services. Despite the availability of clinical guidelines, monitoring and screening of metabolic side effects in patients prescribed antipsychotics continues to be suboptimal.MethodThe audit involved a review of electronic records relating to physical health monitoring of patients at two acute inpatient units from January-March 2019. Demographic and clinical variables were collected which included ethnicity, diagnostic grouping as well as current medications. Data were collected on evidence of screening for hypertension, BMI, blood glucose and lipids. Descriptive statistics were applied to study the clinical features of the sample and examine whether performance met clinical practice standard.ResultThe audit overall demonstrated partial compliance with POMH-UK guidelines with a total of 31 patients admitted on long term antipsychotics. Of these patients, 86% were prescribed atypical antipsychotics with 14% prescribed typical antipsychotics. Screening only occurred in 68% of patients for lipid profile with only 71% for BMI and 74% for blood glucose. Blood pressure had the highest compliance rate of 87% of patients being screened.ConclusionEarly identification and monitoring of complications from metabolic syndrome may decrease the risk of more serious health outcomes and improve patients’ quality of life. However in clinical practice, standards are not always met in accordance with best practice recommendations. Requirement of a tailored guideline for physical health monitoring with weekly planned interventions as well as adequate training and awareness of healthcare staff is imperative to drive improvement and increase adherence rates.

COVID-19 or Coronavirus pandemic has generated a very serious and grave global concern regarding the health of every person in the whole world. Besides, due to the rapid diffusion of the viral infection, there are already alarms on how to deal with the psychiatric aspects of COVID-19 pandemic in persons with an established diagnosis of psychiatric disorders, staff, and those in self-isolation. What is the influence of COVID-19 on mental health? The current study will review the psychiatric implications of COVID-19 pandemic on the general population, the bearing of social isolation, the prevention behaviours, and clinical cases of people who required psychiatric admission to hospital due to the emotional impact of COVID-19 social circumstances.

There is a considerable paucity of empirical data on the use of clozapine in people with intellectual disability, and to the authors’ knowledge these are the first published data on its use in a patient with trisomy 5p and with a diagnosis of schizophrenia. In this case we describe a patient with learning difficulties and a diagnosis of trisomy 5p and schizophrenia that has responded remarkably to clozapine treatment despite numerous additional clinical risk factors.

There is limited evidence relating to the treatment of psychotic symptoms in Huntington's disease (HP); therefore, treatment decisions are based on clinical consensus and expert opinion. In this article, Dr Majothi et al. describe the use of clozapine in an unlicensed manner in HP, which proved to be safe and effective.

CoViD-19 pandemic has created a global concern in the whole population. The psychiatric and social impact of the viral infection is recorded differently by the community. However, more vulnerable individuals with negative psychiatric history are presenting to mental health hospitals for admission, assessment and treatment due to abnormal reactions to CoViD-19 pandemic. The current study reports six clinical cases of first psychiatric presentation that were characterised by sudden onset of symptoms, manic and psychotic symptoms, adverse response to stress, psychomotor agitation and behaviours out of character. The presentation was short-lived and responded to typical antipsychotics and antidepressants. The posed diagnoses were acute and transient psychotic disorder and acute stress reaction.

BackgroundThe Back-Pain Attitudes (Back-PAQ) questionnaire measures back beliefs across 6 domains. Our previous study showed that manual handling advisors (MHAs) have more negative beliefs than physiotherapists (PTs), and those who think straight back lifting is safer than a rounder back have more negative beliefs. However, exactly which domains of the Back-PAQ are most negative is unknown. ObjectivesGain deeper understanding of how MHAs and PTs construct their back beliefs, and relate this safe lifting posture beliefs. DesignData was collected via an electronic survey. MethodParticipants' back beliefs were collected via the Back-PAQ. They were also asked to select the safest lifting posture from four options: two with a straight back; two with a rounder back. Back beliefs were analysed in the 6 domains that construct the Back-PAQ. Relationships were investigated using multiple linear and regression models. Results400 PTs and MHAs completed the survey. MHAs scored higher (more negative beliefs) than PTs across all 6 domains, and those who perceive straight back lifting as safest scored higher across five of the 6 domains. The belief to keep active with back pain was common among all groups, but MHAs and those who prefer straight back lifting believe the back is vulnerable and more in need of protection. ConclusionWhile all believe staying active is beneficial for back pain, residual negative beliefs regarding the vulnerability of the spine persist. Education campaigns may need to emphasise a ‘trust your back’ message rather than a ‘protect your back’ message while encouraging activity.

BackgroundIt is commonly believed lifting is dangerous and the back should be straight during lifting. These beliefs may arise from healthcare professionals, yet no study has evaluated the lifting and back beliefs of manual handling advisors (MHAs) and physiotherapists (PTs). ObjectivesTo evaluate (i) what lifting technique MHAs and PTs perceive as safest, and why, and (ii) the back pain beliefs of MHAs and PTs. DesignData was collected via an electronic survey. MethodParticipants selected the safest lifting posture from four options: two with a straight back and two with a more rounded back, with justification. Back beliefs were collected via the Back-Pain Attitudes Questionnaire (Back-PAQ). Relationships were investigated using multiple linear and logistic regression models. Results400 PTs and MHAs completed the survey. 75% of PTs and 91% of MHAs chose a straight lifting posture as safest, mostly on the basis that it avoided rounding of the back. MHAs scored significantly higher than PTs on the Back-PAQ instrument (mean difference = 33.9), indicating more negative back beliefs. Those who chose the straight back position had significantly more negative back beliefs (mean 81.9, SD 22.7) than those who chose a round back lift (mean 61.7, SD 21.1). ConclusionAvoiding rounding the back while lifting is a common belief in PTs and MHAs, despite the lack of evidence that any specific spinal posture is a risk factor for low back pain. MHAs, and those who perceived a straight back position as safest, had significantly more negative back beliefs.