Mental Health Teams Research Articles

Introducing Compassionate and Relational Enquiry (CARE): A Three-Day Training for Mental Health Clinicians on Relational Ways of Working.

Research shows that, in mental healthcare, empathy and active listening skills play a fundamental role in the therapeutic relationship. Despite this, clinicians receive little training in cultivating these qualities, and there is a dearth of training in therapeutic relationships and relational care in this field more generally. In response to this paucity of training, a new intensive three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). The CARE training programme has recently been delivered to a number of mental health teams in different boroughs of an NHS Trust and has undergone several rounds of redevelopment. This paper outlines the CARE training programme's objectives and mode of delivery, and subsequently presents questionnaire results from recent CARE trainees regarding their experience of the nature and utility of the training. Four main themes emerged from responses to the question of the utility of the training, these were 'A shift towards more person-centred care', 'Strengthens the therapeutic relationship', 'Facilitates more collaborative care with patients and their families' and 'Development of new skills and therapeutic techniques'. The paper concludes by discussing the potential of this training to help forge a substantial shift in the culture of mental health services in a systemic way.

The role of Qatar's first forensic community team in reducing recidivism and re-admission of mentally unwell offenders.

Introduction: Qatar established its Community Forensic Mental Health Team (CFMHT) in 2019 as part of the region's first comprehensive forensic psychiatry service. We present here the data on clinical and offending outcomes since its establishment and compare this with data from before the service was established. Objectives: To compare clinical and offending outcomes in mental health patients with criminal offending histories in Qatar before and after the establishment of CFMHT. Methods: This is a retrospective study comparing the socio-demographical characteristics, clinical outcome and recidivism measures of forensic patients, under the CFMHT for the last 2 years with data from a similar period before the services were in place. Results: Data for 85 patients under the active care of forensic community team were matched with a comparable group before the establishment of the services. The re-admission and reoffending rates after the establishment of the service over 2-year follow-up were 17.6% and 12.9%, respectively, compared with 40% and 32% before the service. Conclusions: Since its inception, the CFMHT has made a significant positive impact on quality of life, mental well-being and safety of patients under its care. Close working relationships with the criminal justice system, families and carers have helped fight stigma and promote safer communities.

Turning 18 in mental health services: a multicountryqualitative study of service user experiences and views.

Worldwide, the division between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) has frequently resulted in fragmented care with an unprepared, non-gradual transition. To improve continuity of care and other service transition experiences, service user input is essential. However, such previous qualitative studies are from a decade ago or focused on one mental disorder or country. The aim of the present study was to learn from service users' transition experiences and suggested improvements. Semi-structured interviews were held with young people aged 18-24 and/or parents/caregivers in the United Kingdom, Ireland, the Netherlands and Croatia. Inclusion was based on the experience of specialist mental health care before and after turning 18. Thematic analysis of transcribed and translated interview transcripts was performed using ATLAS.ti 9. Main themes of service user experiences included abrupt changes in responsibilities, various barriers and a lack of preparation, communication and ongoing care. Young people expressed a great need for continuity of care. Their suggestions to improve transitional care included early and adequate preparation, joint working, improved communication from and between services, overlapping services, staying at CAMHS for longer and designated youth mental health teams. Young people who experienced care before and after turning 18 suggested either altering the age limits of services or ensuring early preparation and communication regarding the transition and finding AHMS. This communication should include general changes when turning 18. Further considerations include increasing collaboration and overlap between CAMHS and AMHS.

Understanding How Contingency Staffing Programs Can Support Mental Health Services in the Veterans Health Administration.

Introduction: Beginning in 2019, the Department of Veterans Affairs (VA) prioritized improving access to care nationally to deliver virtual care and implemented 18 regionally based Clinical Resource Hubs (CRHs) to meet this priority. This observational study describes the quantity and types of care delivered by CRH Mental Health teams, and the professions of those hired to deliver it. Methods: A retrospective cohort study, based on national VA CRH mental health care utilization data and CRH staffing data for CRH's first 3 years, was conducted. Results: CRH Mental Health teams primarily used Telemental Health (TMH) to provide care (98.1% of all CRH MH encounters). The most common disorders treated included depression, post-traumatic stress disorder, and anxiety disorders. The amount of care delivered overtime steadily increased as did the racial and ethnic diversity of Veterans served. Psychologists accounted for the largest share of CRH staffing, followed by psychiatrists. Conclusions: CRH TMH delivered from a regional hub appears to be a feasible and acceptable visit modality, based on the continuously increasing CRH TMH visit rates. Our results showed that CRH TMH was predominantly used to address common mental health diagnoses, rather than serious mental illnesses. Traditionally marginalized patient populations increased over the 3-year window, suggesting that CRH TMH resources were accessible to many of these patients. Future research should assess barriers and facilitators for accessing CRH TMH, especially for difficult-to-service patient populations, and should consider whether similar results to ours occur when regional TMH is delivered to non-VA patient populations.

Evaluation of adherence to treatment in patients with anxious-depressive syndrome.

IntroductionTreatment-resistant depression can pose a major challenge to mental health professionals, both in identifying cases and in devising consequent therapeutic strategies (1). However, it is not uncommon that the lack of response to antidepressant treatment is actually due to non-adherence to it in many cases (2).ObjectivesIn this context, it would be interesting to know the rate of abandonment of antidepressant treatment in patients with anxious-depressive symptomatology, since the patient’s evolution may depend entirely on this.MethodsTo this end, the psychiatry service of the Hospital Clínico Universitario de Valladolid has collected data on adult patients who come for a first consultation in the mental health team, referred for presenting symptoms of anxiety and depression.These data have been recorded over the last 2 years, including different socio-demographic and clinical variables. Subsequently, a descriptive analysis was carried out, the preliminary results of which are presented below.Results We started from a sample of 222 patients at the present time: 69 men and 153 women, which is in accordance with previous data on the prevalence of anxiety disorders and depression by gender (3).Antidepressant treatment was prescribed (from psychiatry or primary care) in 80% of them. A review 6 months later showed that up to 1/3 of these patients (34%) had abandoned treatment on their own before completing this period, as can be seen in the first graph (image 1), which is contemplated in several guidelines and recommendations in the scientific literature (4). No major differences were observed between genders for treatment indication or treatment abandonment. On the other hand, 61% of the patients in the sample had been treated with benzodiazepines. Among them, up to 74% were still taking these drugs 6 months later (image 2). This result is striking, since in reality, the duration of treatment with benzodiazepines should be much shorter, according to the latest reviews (5).Finally, cross-checking these data, it was observed that for 116 patients (52% of the total) the initial treatment included antidepressants and benzodiazepines. At 6 months, 18 of these patients (16%) had voluntarily discontinued the antidepressant, but continued with benzodiazepines.Image:Image 2:ConclusionsIt is very important to review adherence to treatment in all patients, especially in those cases in which the persistence of symptoms makes us think of a possible resistant depression. For this reason, it would be advisable to try to establish an adequate doctor-patient relationship that allows trust in the therapist and communication between both and leads to a favorable evolution.Disclosure of InterestNone Declared

Working with social isolation and loneliness in older people’s mental health services

Isolation and loneliness are common problems in both older people and individuals with mental health problems. However, little research has focused on how these issues might be addressed in clinical practice with older adults with complex mental health problems. Here we set out to understand how social isolation and loneliness present and how they could be better addressed from the perspective of older adults with complex mental health problems and the clinicians working with them. Semi-structured interviews were conducted with nine healthcare professionals and 11 service-users from an older people’s mental health team and analysed using reflexive-thematic analysis. Results showed that professionals found social isolation easier to understand and work with than loneliness and tended to address both issues by targeting behaviours (i.e. what service-users could do differently). The psychological dimensions of loneliness (i.e. service users’ thoughts and feelings) received less attention, although service-users emphasised these aspects. Other themes included the challenges faced by professionals in fostering social connections because of limited resources. We conclude that a greater awareness of the psychological dimensions of loneliness in older people with complex mental health problems is needed, as well as the resource challenges faced in creating social connections beyond mental health services.

Liquor for breakfast, fighting against alcohol consumption

IntroductionThe harmful consumption of alcohol is known for how tortuous its management can be in mental health, encouraging introspection of it as a serious problem is perhaps the main key to starting to battle against its damaging influence on the development of a functional and full life.ObjectivesTo describe a clinical case showing an unpredictible complication in an alcohol detoxification process.Methods54-year-old man, native of Cádiz, widowed for half a decade, without children. He resides with his parents in the family home. Currently unemployed for approximately a year. He has previously worked in the IT sector. As a notable somatic history, we found long-established arterial hypertension and a total hip replacement. He has been under irregular follow-up with a mental health team for anxiety-depressive symptoms in the context of grief. He goes to the emergency service brought by his family to begin the detoxification process in the hospital setting. He acknowledges ethanol consumption since he was widowed, which began when he awakes; quantities that ranged between one or up to three bottles of distilled liquor per day, generally consumption is in the home environment. A little less than a year ago, he began to isolate himself in his room and abandon his self-care, eating increasingly insufficient food intake, refusing to receive professional care to quit the habit, mainly because he did not recognize it as disruptive.The patient was admitted to hospital with symptoms suggestive of withdrawal, making it extremely difficult to control blood pressure levels. On the third day of admission to the acute care unit, fever peaks, blood pressure levels well below normal parameters, and compromised level of consciousness began to be evident.ResultsBlood tests were performed that, together with the clinical picture, suggested imminent septic shock, so critical care was contacted for transfer and stabilization. A germ of probable urinary etiology sensitive to a broad spectrum of antibiotics was isolated in blood cultures, and the medication of the detoxification process was progressively optimized. Once clinical stability was achieved at all levels, an inpatient cessation resource was managed, which the patient accepted and considered suitable for his complete recovery.ConclusionsA holistic approach to the alcoholic patient is important, since serious problems of an organic nature often arise. This is why a multidisciplinary intervention is necessary, as well as a holistic approach to care, involving both classic pharmacology and assiduous long-term psychotherapeutic intervention.Disclosure of InterestNone Declared

Non-suicidal self-injury at a Canadian paediatric emergency department.

Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury. This is a health records review of patients aged 12-18years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017-May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen's Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests. We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen's Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3-75.4) and negative predictive value of 71.2% (95% CI 68.2-74.0). Cutting was the most common method of non-suicidal self-injury (80.3%). Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients' coping strategies.

Opportunities and challenges of community mental health centers in Türkiye

AbstractIn 2011, Türkiye restructured the mental health care system in community-based settings following the announcement of the National Mental Health Action Plan. Community mental health centers (CMHCs) are the major element of this approach. As of now, the total number of CMHC have reached 186, and the service users have almost reached 100.000. Mental health care system gained significant advantages through CMHCs, such as 1) improvement in the conditions of mental health services, 2) better follow-up of patients with chronic severe mental disorders, 3) capability of in-home services, 4) decrease in the number of hospitalizations, 5) increased social involvement of patients with severe mental disorder. CMHCs also played a significant role in promoting social rehabilitation, including employment status, development of social relationships, and redress of stigmatization. All these advantages were put into practice by community mental health teams comprising a psychiatrist, psychologists, nurses, social workers and ergotherapists, if available.Community mental health centers come with severe challenges and shortcomings despite their ameliorations. First, CMHCs need trained mental health professionals. However, only 52% of the CMHC teams completed the CMHC trainings currently. Second, standardized work flow algorithms should be developed for CMHCs. Third, there should be a strong relationship between CMHCs, primary health care system and inpatient units as a complementary part of essential mental health care. In addition, hospital administration should be trained in terms of CMHC policy since every CMHC is affiliated with a state hospital. For instance, the ongoing issue of defining quality standards for CMHCs contributes to a misconception, portraying these centers as profit-making units rather than dedicated rehabilitation facilities.In conclusion, community-based settings and CMHCs significantly advance mental health services despite the challenges confronted in practice. To optimize the effectiveness of community mental health care facilitated by CMHCs, it is imperative to review the implementation process with the active involvement and support of non-governmental organizations, including patient-driven organizations and national psychiatric associations.Disclosure of InterestNone Declared

Improving the Sexual Wellbeing of Patients with Psychotic Illness

Introduction Sexual dysfunction (SD) is common in psychotic illness including schizophrenia, occurring in 30-82% of patients. It negatively impacts wellbeing and antipsychotic compliance, resulting in higher risk of relapse and hospitalisation. Due to over-reliance on spontaneous reports from patients, SD is typically under-identified which prevents investigation and treatment.ObjectivesTo establish whether SD is under-identified in patients with psychosis in a general adult community mental health team; to elicit whether the Arizona Sexual Experience Scale (ASEX) improves identification; to investigate and manage identified cases of SD; to make recommendations about identification and monitoring of SD in this patient population.MethodsA 12-month retrospective audit of patients with psychosis prescribed a long-acting injectable (LAI) antipsychotic (n=36) to identify sexual symptoms was completed. The ASEX was subsequently issued to screen for SD.ResultsAudit: 3/36 (8%) patients had documented sexual symptoms. Of the 18/36 patients that completed the ASEX: 10 (56%) exhibited SD. 4 consented to further investigation. 5 patients experienced significant difficulties with the language used in the ASEX. At the end of the project we revised the ASEX with simpler, colloquial language.ConclusionsImplementation of the ASEX results in clear improvements in identification and monitoring of SD. Maudsley Practice Guidelines can inform investigation and management of SD. We suggest a review of NICE guidance to incorporate the above into clinical practice. Further work is needed to establish whether the revised ASEX can be developed and validated.Disclosure of InterestNone Declared

IJCM_331A: Helping beyond the Helpline – Experience from a Unique Model for Mental Health Care among Frontline workers during COVID – 19 Pandemic in Andhra Pradesh

Background: Psychological issues among Health Care Workers (HCWs) in COVID-19 stem from the fact that normal people are being exposed to extraordinary situations. Facing this critical situation, it is essential to ensure that these personnel are identified early and offered appropriate intervention. Hence, AIIMS Mangalagiri partnering with UNICEF started a project to reach out to all frontline workers in the state of Andhra Pradesh. Objectives: To set up a Psycho-Social Counselling (PSC) system for healthcare & other front-line workers in the state of Andhra Pradesh to handle stress due to COVID–19 To conduct capacity-building programs for health care & other front-line workers to prevent psycho-social conditions arising due to COVID–19 Methodology: A simple Mental Health Screening Questionnaire (MHSQ) was developed and validated in the local language. After getting prior approvals, a Google form link of the MHSQ was sent via email, SMS, and WhatsApp to every frontline worker in the state. Consenting participants with scores above 6 were contacted personally by the psychologists for further detailed evaluation. A helpline number for counseling was publicized and psychologists conducted sessions on mental health awareness and coping strategies in various institutes across the state. Results: About 8,217 respondents attempted the MHSQ out of which detailed mental health evaluation (GAD-7, PHQ-9, CAGE, AUDIT, and PSQI) was done for 392 respondents. The most common issues identified were Anxiety (45%), Insomnia (42%), Depression (12%), and Substance Abuse (2%). Also, as a part of the mental health capacity-building campaign around 4,500 healthcare workers like nurses, Anganwadi teachers, and ANMs were trained offline across the state, along with the District Mental Health team. Conclusion: Mental health can have a significant impact on the competence of frontline workers. In addition to existing interventions available, confidential mental health intervention and service provision are the need of the hour.

Emergency Department Presentations to the Mental Health Services at Sligo University Hospital during the COVID pandemic

IntroductionIn March 2020, the WHO declared the outbreak of SARS-CoV-2 a pandemic and Ireland went into its first lockdown. The Mental Health Liaison team at Sligo University Hospital operate 8 am to 8 pm, 7 days a week, with out of hours covered by the on-call Psychiatry junior doctors. The service has seen an increase in referrals, many of whom are known to community mental health teams.ObjectivesWe reviewed the numbers and trends of mental health presentations to the Emergency Department at Sligo University Hospital throughout the pandemic, including the patterns of presentations around the implementation of lockdowns.MethodsThe Liaison Mental Health Service at Sligo University Hospital gathers data relating to numbers and types of presentation to the service. Data was taken from a pre-existing database of psychiatric presentations to the emergency department at Sligo University Hospital including patient demographics, nature of presenting complaint, time period in which they presented and whether they were previously linked in with a community mental health team in the preceding six months. We also looked at the pattern of ED mental health presentations from March 2019 to August 2021. In order to compare psychiatric presentations pre and during covid, data was broken down into two groups: the twelve months preceding March 2020 and the twelve months from March 2020. Categorical data were analysed using the Chi squared test for homogeneity in SPSS.ResultsOverall, there was a 14% increase in mental health presentations during the pandemic. There was a significantly greater proportion of presentations of psychosis during the pandemic period (p<.014) and for medication review (p=.03) and significantly less presenting with addiction (p <0.001). Of those patients seen in the Emergency Department in 2021, 54.3% were known to the CMHT in the previous 6 months. in 2019, mental health presentations made up 1.36% of total ED attendances. This increased to 1.47% in 2020. From January to August 2021, 2.62% of ED attendances were mental health presentations.Image:ConclusionsThe Covid-19 pandemic led to increased mental health presentations to Sligo University Hospital emergency department, with a significantly greater proportion presenting with psychosis and for medication review. These findings have implications around patient care and service provision. These results show that the prevalence of mental health has increased during the pandemic, particularly severe and enduring mental illnesses. New strategies must be implemented to accommodate to this increase in presentations.Disclosure of InterestNone Declared

Comparing Psychiatric Admission Following Suicidal Presentations to the Emergency Department pre-COVID and During the COVID era

IntroductionSuicide is one of the leading causes of death worldwide, (Centiti et al. 2020). Presentations to the emergency department (ED) with suicidal ideation (SI) or deliberate self-harm (DSH), and admissions following same, are a major part of unscheduled adult mental health service activity.ObjectivesTo evaluate how suicidal presentations to the emergency department (ED), and admission following same have been affected by the COVID era thus far. To evaluate how key patient characteristics affect admission during the COVID era and pre-COVID, namely whether presentations were with suicidal ideation (SI) or deliberate self-harm (DSH), whether the patient was previously known to a community mental health team (CMHT), and whether the patient was intoxicated at the time of presentation. Methods Data is routinely collected on all adults presenting with SI/DSH to the ED. We looked at presentations, admissions and key patient characteristics over the 12 months of the COVID era thus far (March 2020-February 2021) and compared them to the preceding 12 months.ResultsPresentations over the two 12 month periods were similar (pre-COVID n=819, COVID era n=823). However, admission increased by 27% (139 to 177) over the COVID era as a whole. For nine months of the COVID era monthly numbers of admissions were higher than their pre COVID comparison. Admission rates during the COVID era were found to be increased across all patient groups examined, but were particularly increased in those presenting sober or with SI. Admission rates rose equivalently for those known or unknown to a CMHT.Image:Image 2:ConclusionsThe number of admissions following suicidal presentations to the ED has risen significantly in the COVID era. This may be due to more severe presentations in terms of risk of suicide without admission or increased psychiatric morbidity requiring admission. Limitations of service provision in the community due to COVID era restrictions may also partially explain these findings.Disclosure of InterestNone Declared

“Thoroughly out of my depth - A quality improvement project to improve junior clinician’s confidence in undertaking adult ADHD clinic appointments

IntroductionThere has been a 1000% increase in referrals for assessment of adult ADHD within Scotland over the past three years (The Scottish Government. 2023. NAIT adult Neurodevelopmental Pathways Report). These referrals are sent by general practitioners to the local community mental health team. The most junior clinicians (doctors who are pre-membership with the Royal College of Psychiatrists) in the team are often responsible for undertaking the initial assessment of these patients. Patients have on average waited almost a year to be seen and expectations are high.ObjectivesThe diagnosis of ADHD can be challenging, and adult ADHD is still a relatively new and evolving diagnostic entity. We set out to explore how junior clinicians were coping with this in their daily practice.MethodsWe developed a questionnaire that was sent to all junior clinicians working within Argyll & Bute (n=8) via an anonymised email link. The link was open for 1 week and then results were analysed.ResultsThe response rate to our survey was 87.5%. Prior to starting their current roles none of the respondents had ever undertaken an ADHD assessment before. All respondents answered “No” when asked if they felt they had adequate knowledge on ADHD in order to perform assessments. Only 14% (n=1) felt they had access to adequate resources about how to make an ADHD diagnosis. Participants were asked on a scale of 1-10 (1= not at all,10= very) to rate their confidence in conducting ADHD assessments. The average confidence score was 2.43. There was a space for free text feedback in which participants reported the following: “felt thoroughly out my depth”, “I felt chucked in the deep end”, “I felt very under qualified”Image:ConclusionsOur results showed that junior clinicians did not feel confident or knowledgeable about undertaking adult ADHD assessments. In response to this we have now produced, in association with the consultant psychiatrists within our health board, an informative and engaging quick reference poster which explains how to undertake an ADHD assessment (see QR code attached as Image 1). It contains useful pointers about diagnosis, and more importantly guidance on language/phrases to use when explaining to patients whether or not you feel a diagnosis of ADHD is appropriate. It then also explains next steps that can be offered i.e. psychological support/medication options and how to prescribe these. We plan to send out a repeat questionnaire to the next cohort of junior clinicians to assess if they have improved confidence in managing and diagnosing ADHD following this intervention.Disclosure of InterestNone Declared

The difficulties of Adult ADHD management within a Community Mental Health Team

IntroductionADHD is a neurodevelopmental disorder characterised by: inattention, hyperactivity and impulsivity.Diagnosis of ADHD in adults is complex, owing to the need for retrospective evidence that symptoms began in childhood as well as the high rates of comorbid mental health conditions. There are no public specialized clinics for adults with ADHD in Ireland. In their absence, referrals are sent to general adult psychiatry.ObjectivesAn audit of standards of care received by patients with ADHD against those set by the NICE guidelines.MethodsCare received pre and 8 weeks post MDT (multi-disciplinary team) educational session. Inclusion criteria: existing adult community mental health team (CMHT) patients with a diagnosis of ADHD. Recommendations as per NICE guideline used for assessment: Specialist MDT team input, OT/ Psychology input, MDT review of reports, Specialist consultant with training in diagnosis and treatment, Diagnosis based on structured assessment e.g. DIVA, Detailed psychiatric assessment, Physical health monitoring before commencing treatment (e.g. ECG), Ongoing physical health monitoring (BP, HR, weight), Patient regularly attending follow upResultsThere were 7 patients with diagnosed ADHD attending the CMHT, 4 male, 3 female aged 19-42yo. 4 patients were diagnosed privately (average age at diagnosis 31yrs). 2 were diagnosed by CAMHS. And 1 was diagnosed by primary care psychology (age 27). 8 weeks following MDT meeting; 2 patients had been commenced on ADHD medication. Those on the wait list for OT/psychology remained on the wait list.ConclusionsADHD is a specialised area which requires a specialist MDT led by a consultant with expertise in diagnosis and treatment. As evidenced by this audit, despite the best efforts of adult psychiatric services, teams are not sufficiently resourced to meet the needs of adults with ADHD and fall short of the expected standards of care.Disclosure of InterestNone Declared

Psychopharmacological management in patients with Di George syndrome

IntroductionIt is widely described in the scientific literature that patients who suffer from some type of congenital syndrome such as Di George Syndrome are more likely to present some type of psychopathological alteration during their development that may require intervention and treatment by infant and juvenile mental health teams in coordination with neuropediatrics (1). On this occasion, we will present the clinical case of a patient who regularly attends psychiatry consultations for management of anxious symptoms with impulse control deficits associated with intellectual disability, diagnosed since childhood with tetralogy of Fallot and later with Di George syndrome. In this type of case, treatment is usually considered taking into account possible comorbidities at the organic level (since there may be cardiological involvement, which can be an added difficulty when taking into account the adverse effects of some psychotropic drugs) (2).ObjectivesThis is followed by the presentation of the clinical case, which can serve to exemplify this type of case and clarify any doubts that may arise regarding treatment.MethodsPresentation of the clinical case and review of updated scientific literature on the subject.ResultsPatient who first came to the infantile-junior consultations at the age of 8 years due to delay in the acquisition of verbal language and impulsivity. The patient had a history of pediatric follow-up since birth for different physical symptoms that finally led to the diagnosis of Di George syndrome.Given the difficulties he presented both at home and at school, different psychometric tests were performed and it was determined that it could be beneficial to initiate treatment with extended-release methylphenidate. Prior to treatment, psychomotor restlessness (without aggressiveness) and difficulty in concentration prevailed, which improved significantly after upward adjustment of the dose to a guideline corresponding to his age and weight. It was not necessary in this case to administer other treatments (the possibility of starting Aripiprazole in case of episodes of agitation was considered, but it was not necessary). The patient has continued to be monitored by cardiology to assess the possible side effects of the treatment (since it can increase heart rate and blood pressure (3), but so far no complications have been detected).Thanks to psychotherapeutic and educational intervention, language acquisition was achieved, although to date he still requires support due to the difficulties he still presents.ConclusionsIt is important to take into account the possible side effects of psychopharmacological treatment in patients with an associated congenital syndrome. Intensive and comprehensive follow-up by psychiatry and pediatrics (and later by their primary care physician) should be performed.Disclosure of InterestNone Declared

Integrating Mental Health In Perinatal Care: Perspectives Of Interprofessional Clinicians.

Despite the prevalence of perinatal mental health issues in the United States, gaps in care persist. To address this, perinatal health care settings are asked to focus on patients' mental health by administering standardized screening and, increasingly, by integrating mental health teams in their clinics. Using in-depth interviews and ethnographic observations, I investigated these emerging practices, exploring the experiences of certified nurse-midwives, obstetricians, and mental health clinicians. I found that certified nurse-midwives and obstetricians lack time, resources, and expertise, restricting their ability to address patients' mental health. Integrated mental health clinicians are constrained by the stratified organization of health care and structural deprioritization of mental health. Redesigning perinatal health care and de-siloing mental health training are necessary to increase clinicians' effectiveness and to improve perinatal health outcomes.

Student mental health support: A qualitative evaluation of new well-being services at a UK university

ABSTRACT Increasing numbers of UK students now seek mental health support while at university. Clear evidence for the best configuration of student support services is lacking. Most service evaluations have focused on counselling – with little evaluation of low-intensity support services such as non-clinical mental health and well-being teams or student accommodation welfare support. This qualitative study addresses that gap, examining student and staff experiences of new well-being advisers in academic departments and halls of residence at one UK university in 2018, marking a step-change in welfare support delivery. Using reflexive thematic analysis with data collected in 40 focus groups and interviews approximately 18 months after service launch, five themes were identified: Trusted Friend; Joined Up Approach; Proactive versus Reactive; Belonging; and My University Cares. The well-being advisers offered timely, low-intensity support as an accessible, approachable addition to academic, clinical and online provision. However, evidence showed operational challenges such as data-sharing between academic, professional and support service staff. The volume of students seeking support also appeared to compromise resource intended for preventative and community-building work, particularly in student accommodation. Concerns remained for students who do not seek help, with findings underlining the importance of issues of belonging, connection and representation in relation to well-being support. Notably, this highly visible well-being investment appeared to shift a negative cultural narrative which was undermining student and staff confidence to one of greater reassurance of support. Our conclusions have implications for student support service configuration and emphasise the importance of a whole university well-being approach.

A referrals audit and qualitative analysis of staff experience of referrals in a specialist community learning disability service

PHOTO CREDIT: Aaron BurdenSpecialist community teams are set up to support people living with Learning Disability (LD) who are unable to access mainstream mental health (MH) teams with reasonable adjustments. National guidance is available to guide best practice in making reasonable adjustments, to support increased access to mainstream services. This audit of referrals into a specialist Community LD team, aimed to establish referral acceptance rates and reasons for referral rejection. Total referrals and referrals made specifically from mainstream MH teams were investigated. A focus group explored LD clinicians’ experiences of the referral process and criteria in the context of working alongside mainstream MH teams. A lower acceptance rate of referrals from mainstream MH teams than overall acceptance rate was found, and differences in the reasons for rejection were highlighted. No LD diagnosis in the referral was the most common rejection reason for mainstream MH team referrals. Thematic analysis highlighted four themes of clinician’s experiences which focused on: referral point struggles; service limitations; lack of diagnostic clarity; and attempts to bridge a gap between services. Recommendations include review of the referral process, joint working protocols, clarification of remit and dissemination of shared learning.

Improving interprofessional teamwork in a community mental health team: a team building circle program based on the restorative justice paradigm

ABSTRACT Improving teamwork among mental health practitioners is crucial. However, there have been few intervention studies on teamwork enhancement among community mental health practitioners in South Korea. We aimed to determine the effectiveness of the Team Building Circle program (TBC) based on the restorative justice paradigm, which sought to promote integration and cohesion. The TBC was developed to improve conflict interpretation mind-set, interpersonal skills, and teamwork among practitioners in community mental health centers. We conducted a quasi-experimental study using a pre and posttest design with a non-equivalent control group. The participants were 44 practitioners from four community mental health centers. Data were collected before the implementation TBC (pretest), just after (posttest), and 3 months after TBC (follow-up test). A generalized estimating equation model was used for analysis. Our findings indicate that the intervention group had improved scores in the ability to cope with interpersonal stress in a constructive way, interpersonal relationship skills, and teamwork compared to the control group. To improve teamwork among community mental health practitioners, managers are encouraged to consider providing TBC intervention.