SURVEY ON THE KNOWLEDGE AND EXPECTATIONS OF PSYCHIATRY OF INTELLECTUAL DISABILITY (ID) IN JUNIOR DOCTORS JOINING A NHS MENTAL HEALTH TRUST

Background: Nationally, there is a drive to rotate more Foundation and GP Trainee Doctors through Psychiatry posts. In East London Foundation Trust (ELFT) in Bedfordshire, doctors from Core Psychiatry, Foundation and GP training programmes come to train in Psychiatry. Many will not have worked in Psychiatry before and have little experience of patients with ID. The prevalence of people with ID is increasing with improved life expectancy. They are a complex and vulnerable group with considerable wider legal, ethical and social issues. Recent national reports including the Confidential Inquiry in to Premature Deaths in People with Learning Disability3 and Transforming Care4 have recommended increased training and awareness of the roles and responsibilities for all health staff who provide care to people with ID. Aim: To survey the knowledge level and expectations of junior doctors on Psychiatry placements in Bedfordshire in relation to ID and local logistical arrangements of services and on call duties. Methodology: The local ID governance committee together with the Postgraduate Medical Education Department created a questionnaire which was circulated to new trainee Doctors on placements with ELFT. The questionnaire was distributed to new trainees after 3 different inductions throughout the year. This combined self-rating questions using Likert scales, multiple choice answers and others allowing for expanded free text answers. Discussion: The results show the self-rated knowledge levels of ID psychiatry in general and with regard to local services and on call arrangements amongst new trainees was low. The majority of trainees indicated they would have liked to have received information on the suggested areas at the start of the placement. When given the option of themes of information the psychiatric and medical presentation was most sought, although general and on call specific information was also indicated to be useful. The most popular delivery of information was found to be oral presentation and hand out at induction, followed by an electronic document. 8 trainees were interested in attending clinical sessions in ID and most felt it would be feasible in their posts to get to these. Conclusions: This survey shows that Junior Doctors from different training programmes rate their knowledge of ID psychiatry to be low. This has implications during their rotation in a mental health trust as they are expected to cover an ID ward whilst on call, but also going forward in their careers as all specialties will encounter patients with ID. It is known that awareness of patients with ID is lacking in many healthcare professionals and we know that people with ID are living longer, however continue to have worse health than the general population. The results show trainees would like more education on ID and would be interested in attending clinical sessions in ID psychiatry. The results will enable clinicians in ID services how best to improve the local induction experience for trainees. It also will guide how to educate colleagues outside of the specialty to improve their practice with people with ID, which will improve standards in the quality of care people with ID receive from doctors who treat them

MENTAL HEALTH SUPPORT SERVICE FOR UNIVERSITY STUDENTS

Service: The Mental Health Support Service provides substantial one to one practical support for students to enable them to manage their mental health and study to provide coordinated support and ensure compliance with the Equality Act 2010. Resources: The service consists of a full time Mental Health Advisor and a part time Support Worker and is available all year round. Supervision is received from a Consultant Psychiatrist. Roles: To liaise with students and professionals when a student is admitted to hospital/Crisis Teams. Close communication with other services such as Student Engagement, the International Office, the Chaplain and academics. National Trends: Data from the Office of National Statistics between 2007 and 2011 have shown an increase in the number of student suicides since the start of the recession. Survey Feedback: Feedback highlights that students benefit from the support and value the professional and welcoming attitude of the team. Conclusion: The service continues to provide good quality support to those who access it. Student feedback shows that they believe the support has helped them to stay at university and complete their degree

STUDY ON THE USE OF ANTIPSYCHOTIC MEDICATION IN AN INTELLECTUAL DISABILITY (ID) COMMUNITY CASELOAD

Background: People with intellectual disabilities (ID) are prescribed antipsychotic medications for different reasons; sometimes this is for a mental illness such as psychotic or affective symptoms, however antipsychotics are also used to improve behaviours that challenge, which are common in people with intellectual disabilities (ID) or autism or both. Antipsychotic medications can have many unwanted side effects and these should be monitored for. Guidelines also indicate that reductions in medication should be considered at psychiatry reviews and alternative interventions should be trialled. Methodology: Using national recommendations on antipsychotic prescribing and monitoring and also on reducing antipsychotics in people with intellectual disabilities (ID), audit standards were determined. Results: The Bedford caseload included 192 service users; of these 2 were new referrals and had yet to be seen so were not included. 70 of the remaining 190 were not on an antipsychotic medication. 120 patients were on an antipsychotic medication. Medical records of 60 of these were audited against the identified standards. The records over the previous year were observed to see either how an antipsychotic was started or an existing antipsychotic was monitored compared to the standards

RECOGNISING AND TREATING DEPRESSION IN THE ELDERLY

Introduction: Depression is a major contributor to healthcare costs and is projected to be the leading cause of disease burden in middle and higher income countries by the year 2030. Depression in later life is associated with disability, increased mortality, and poorer outcomes from physical illness. Its prevalence remains high throughout lifetime, with almost 14% of older adults living in the community estimated to have clinically relevant symptoms of depression worldwide. Diagnosis: Recognizing depression in the elderly is not always easy. Medical illnesses are a common trigger for depression. Treatment: Most depressed people welcome care, concern and support, but they may be frightened and may resist help. The treatment of depression demands patience and perseverance for the patient and physician. Sometimes several different treatments must be tried before full recovery. Each person has individual biological and psychological characteristics that require individualized care. Prognosis: The prognosis for recovery is equal in young and old patients, although remission may take longer to achieve in older patients. Further Care: Depression is a highly treatable medical condition and is not a normal part of growing older. Therefore, it is crucial to understand and recognize the symptoms of the illness in the primary care

STUDY ON LITHIUM MONITORING AMONGST PATIENTS IN A COMMUNITY MENTAL HEALTH AND PRIMARY CARE SETTING IN RURAL ENGLAND

Background: Lithium is widely used as a mood stabilizer in managing Bipolar Disorder. It is also licensed as an augmenting agent for recurrent depression and treatment resistant depression. However, it has a narrow therapeutic index with potentially significant side effects and adverse drug interactions. Toxicity is one of the main concerns for prescribers and serum levels should be checked regularly. Also, due to the adverse effects on Kidneys and Thyroid, there are strict guidelines to monitor the kidney as well as thyroid functions periodically. Whilst the need to monitor blood biochemistry is well established, less well recognized is the need to monitor patients’ physical health by means of annual checks of Body Mass Index (BMI) and waist circumference. Aim: The purpose of this study was to investigate compliance against the NICE CG185 guidelines. Hereford is a rural town in England with a population of about 180000. Currently, the Herefordshire part of 2gether Mental Health NHS Foundation Trust does not have clearly agreed shared care protocols for Lithium monitoring. Lithium monitoring is done by GPs as part of QOF targets. As Psychiatrists recommend treatment with lithium, they have the responsibility to have an updated results and act on these appropriately. Therefore, an important aspect of this audit was to identify monitoring gaps that may result from the dual ownership of patient care. Results: We found that 80% of cases complied with NICE guidance as regards blood monitoring however, only 40% of cases were compliant as regards checks on the physical health parameters of BMI and weight. Conclusion: The blood biochemistry of patients on lithium is generally well monitored however, physical health assessment is rarely completed with the required annual frequency and, waist circumference is almost never measured; either on initiation of lithium therapy or, on an on-going basis. More needs to be done to promote awareness of the need to monitor the physical health of patients on lithium and, in particular, to ensure that these checks include measurement of waist circumference. We believe that to improve monitoring of patients on lithium, shared care protocols should be developed between mental health services and GP services

SETTING UP A MENTAL HEALTH CLINIC IN THE HEART OF RURAL AFRICA

Introduction: The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO 1948). In Africa, mental health issues often come last on the list of priorities for policy-makers& people’s attitudes towards mental illness are strongly influenced by traditional beliefs in supernatural causes/remedies. The massive burden attributed to mental illness in these communities, poses a huge moral, cultural/economic challenge and requires a concerted and integrated approach involving policy makers, mental health Practitioners, the general public, service users and their families and other stake holders to reverse the trend. Project Objectives: • Improving community awareness of mental illness. • Change the negative perception of mental illness by the community. • Providing a screening/referral pathway for mental illnesses. • Providing supervision of patient care. Potential Results: Promote community participation on issues regarding mental health with a view to challenge existing traditional attitudes and beliefs, reduce stigma and promote health seeking behaviour

NEED FOR A COMPREHENSIVE SEX AND RELATIONSHIP EDUCATION PROGRAMME FOR ADULTS WITH LEARNING DISABILITY

Introduction: Most people with learning disabilities (PWLD) have little understanding of the concept of sex and relationship. PWLD are vulnerable and more likely to be victims of sexual offending. Currently, the only formal access to sex and relationship education that PWLD have is in special need schools. Background: The right to express their sexuality is frequently restricted or denied by restricted policies, negative attitudes and lack of awareness of their needs. Aims: To provide a Comprehensive Sex and Relationship Education programme for PWLD. Methodology: These group/individual sessions will led by a sexuality support worker with experience in working with PWLD. They will be supported by members of the multidisciplinary team including, psychiatrist, psychologist, occupational therapists etc. Conclusion: Providing sex and relationship education PWLD would help them achieve a fulfilling and rewarding sexual experience and make them less vulnerable to sexual abuse. There should be greater emphasis to be placed on sex and relationship education in PWLD; preferably by qualified professionals

WHAT’S IN A NAME? – THE PSYCHIATRIC IDENTITY CONUNDRUM

Background: The proper label to describe people receiving care has evoked considerable debate and controversy among providers and bio-ethicists. Fashionable terms in current use include "patient, client, consumer, customer and service user." There is little evidence to show that changes in nomenclature actually take patients preferences as to how they would like to be addressed into account Aims: This aim of this study is to survey the views of the people with learning disability in inpatient settings to establish the term they prefer. This is the first study of its kind looking at the views of people with learning disability about how they would like to be addressed and to identify factors associated with various preferences. Method: Approval was obtained from the local clinical governance board. The target population covered a tertiary level inpatient service including acute assessment and respite services, forensic (male/female and low/medium secure services) and CAMHS LD covering the Coventry, Warwickshire and Birmingham areas (rural and inner city population). Participants were provided with an information sheet on the research project. The questionnaire was administered by means of a joint interview carried out by the authors of the study. Dictionary definitions were analyzed as to the derivation and connotations of various terminologies. A questionnaire was developed which was tailored for use in PWLD after consultation with Speech & Language Therapists and local peer review. Responses were than analyzed to identify factors associated with various preferences Results: Evidence indicates lack of universality in preferences for terms and suggests the need for dialogue about preferred terms between service providers and recipients. This study shows a preference for the term “patient” in all categories that were measured within an LD inpatient setting and very interesting demographic preferences were identified. A more differentiated approach may be suggested by taking professional background and some demographic characteristics into consideration. A positive therapeutic relationship is a fundamental component of psychiatry and should take into account patients’ preferences regarding how they are addressed by professionals

WHAT’S IN A NAME? – THE PSYCHIATRIC IDENTITY CONUNDRUM

Background: The proper label to describe people receiving care has evoked considerable debate and controversy among providers and bio-ethicists. Fashionable terms in current use include "patient, client, consumer, customer and service user." There is little evidence to show that changes in nomenclature actually take patients preferences as to how they would like to be addressed into account Aims: This aim of this study is to survey the views of the people with learning disability in inpatient settings to establish the term they prefer. This is the first study of its kind looking at the views of people with learning disability about how they would like to be addressed and to identify factors associated with various preferences. Method: Approval was obtained from the local clinical governance board. The target population covered a tertiary level inpatient service including acute assessment and respite services, forensic (male/female and low/medium secure services) and CAMHS LD covering the Coventry, Warwickshire and Birmingham areas (rural and inner city population). Participants were provided with an information sheet on the research project. The questionnaire was administered by means of a joint interview carried out by the authors of the study. Dictionary definitions were analyzed as to the derivation and connotations of various terminologies. A questionnaire was developed which was tailored for use in PWLD after consultation with Speech & Language Therapists and local peer review. Responses were than analyzed to identify factors associated with various preferences Results: Evidence indicates lack of universality in preferences for terms and suggests the need for dialogue about preferred terms between service providers and recipients. This study shows a preference for the term “patient” in all categories that were measured within an LD inpatient setting and very interesting demographic preferences were identified. A more differentiated approach may be suggested by taking professional background and some demographic characteristics into consideration. A positive therapeutic relationship is a fundamental component of psychiatry and should take into account patients’ preferences regarding how they are addressed by professionals