Aims: To improve induction to medical seclusion reviews (MSRs) for Resident Doctors (RDs) rotating into psychiatry in Derbyshire Healthcare NHS Foundation Trust (DHCFT). Concerns were previously raised by rotating RDs in DHCFT regarding induction to seclusion and feeling unprepared for leading MSRs. Seclusion, as restrictive practice with potential large impacts on our patients, is closely audited both nationally and locally as per the Mental Health Act Code of Practice. Many RDs are not psychiatry trainees and are therefore unfamiliar with the process. Nursing staff within the trust had also reported concerns regarding safety awareness of RDs during MSRs particularly soon after newly rotating into the trust. Methods: We developed a video of a mock scenario encompassing all aspects of a MSR including timing and structure of reviews based on both local guidelines and the Mental Health Act Code of Practice. This video was recorded within a seclusion suite to demonstrate the layout. This was shown to current RDs 3 months into their rotation. A survey wascompleted on previous experience of seclusion, confidence of completing seclusion reviews, whether had been previously inducted on seclusion and preparedness to complete MSRs prior to viewing the video. Results were compared with a follow-up survey after viewing the video assessing its impact. Results: Of the 29 respondents to the initial survey; 79% (n=23) reported having no previous induction to seclusion. Respondents were a mixture of Foundation Doctors, GP trainees, Psychiatric Core trainees and Psychiatric Higher Specialty trainees. Mean confidence completing seclusion reviews was 2.66/5. 93% (n=27) of respondents stated they were not prepared enough to complete a MSR after induction. 22 reponses were received to the follow-up survey. Mean confidence completing seclusion reviews increased to 4.23/5. 100% of respondents stated a video on seclusion in induction would be helpful. Conclusion: This video has demonstrated a novel, relevant and sustainable approach to delivering induction for RDs surrounding a unique aspect of psychiatry which had previously been insufficient in preparing newly rotating RDs for completing seclusion reviews. This video is being further shared with East Midlands School of Psychiatry so that it can contribute to shared learning across other trusts within the region.

Aims The Psychiatric Trainees Committee (PTC) is a national community of psychiatric trainees comprised of representatives from all College areas. Over our recent term, Dr Deepa Krishnan, Dr Kris Roberts and Dr Emma McPhail covered the Trent region. In addition to national roles, we were keen to encourage trainees to engage with the PTC to improve trainee advocacy in line with National PTC strategy. Engaged and supported trainees are vital for ensuring good standards of patient care, and for safeguarding the future of the workforce in terms of recruitment and retention, which further intersects with ongoing quality and provision of patient care. The agreed aims, which were agreed with the RCPsych Trent Executive Committee, were formulated in-line with the national PTC priorities for 2021–2022: 1,to enhance communication, visibility and reach of the RCPsych within trainees in the Trent region; and 2, being mindful of challenges around recruitment and retention in psychiatry training posts, to improve education and support for trainees. Methods Using quality improvement methodology, we hypothesised there to be two aspects to trainee engagement. These were conceptualised in two ways: emotional engagement (meaning feeling supported, valued, and promotion of well-being); and intellectual engagement (meaning cognitive stimulation, recognition, and access to opportunities to develop knowledge). A free, online trainee-specific conference, the first of its kind in the Trent Division, was agreed as an intervention to address trainee engagement across both domains. Because it was run “for trainees by trainees”, we were able to tailor the content to be specifically helpful and relevant to trainees. We were keen to offer a varied program within the broad domains affecting engagement and we were delighted to be able to secure an exciting line-up of speakers both from within the Trent region and from further afield. Results The conference proved so popular to sign up to that it had to be closed early. The conference gathered excellent feedback from participants, with 100% of trainees rating the conference overall as “good” or “excellent.” Conclusion The Trent PTC hopes to run the conference again in the coming year, we hope it will become a regular fixture in the RCPsych Trent calendar, to ensure that trainees are kept at the heart of division planning. This project spearheaded by trainees for trainees to improve trainee engagement and support exemplifies collaborative leadership.

Aims Compared with the general population, people with mental health disorders are at increased risk of negative physical and mental health outcomes following SARS-CoV-2 infection. In the UK, all adult mental health in-patients were offered COVID-19 vaccination as a priority group. Patients admitted to medium secure care have greatly increased mortality compared with the general population. Understanding COVID-19 vaccine uptake, and reasons for refusal, in patients in medium secure hospitals is important given the high prevalence of chronic physical health comorbidities such as obesity and diabetes, as these conditions are also associated with poor clinical outcomes in COVID-19 disease. Aims: To assess the proportions of patients who accepted or declined the COVID-19 vaccine, and explore their reasoning. To examine vaccine uptake between White and Black Asian minority ethnic (BAME) patients, and between younger/older patients. Methods The study took place at a medium secure hospital with male and female inpatients. All patients were offered a COVID-19 vaccine, and had a capacity and physical health evaluation completed by their Consultant Forensic Psychiatrist. Results Data regarding capacity to consent to the vaccine, acceptance/refusal, and demographics were retrospectively collected from the clinical records. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented. Those from a BAME background were more likely to decline than White British patients. The reasons for capacitous refusal appeared similar to the general population. Conclusion COVID immunisation was broadly acceptable for patients in medium secure hospitals. The prevalence and reasoning of capacitous refusal appears similar to the general English population. The indication that BAME patients were more likely than White patients to decline the vaccination echoes the findings of research conducted in the Leicester general hospital. Further consideration needs to be given to how the uptake of COVID-19 vaccination can be improved in people with BAME ethnicity, especially as this group is also overrepresented in secure hospital settings. The study demonstrates that similar services should be able to approach the vaccination process with confidence. As many people with severe mental disorder also have high physical comorbidity that would increase the risk of a poor clinical outcome if they contracted COVID-19, protecting this vulnerable population through vaccination must be a priority for mental health services.

Summary Patients in medium secure hospitals may be at particularly increased risk of coronavirus disease 2019 (COVID-19) infection and complications. We undertook a service evaluation involving all current in-patients within a single, English medium secure hospital to describe the uptake of the COVID-19 vaccine among this population. Data regarding capacity to consent to the vaccine, acceptance/refusal of this (and reasons for refusal) and demographics was retrospectively collected from the patients’ clinical records and analysed. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented to have the vaccine. Those from a Black Asian minority ethnic background were more likely to decline the vaccine than White British patients. The reasons for capacitous refusal appeared similar to those seen in the general population.

Aims Improve and standardise the quality of medical seclusion reviews (MSRs). Acknowledge existing good practise. Highlight areas for improvement. Improve the awareness of doctors performing MSRs of the requirements in the Mental Health Act Code of Practice (MHA CoP) Background MSRs are an essential clinical tool to ensure safe and consistent patient care. Patients detained in seclusion can be at heightened risk of poor mental and physical health, in addition to being a risk to themselves and others. There is clear guidance in the MHA CoP regarding what areas require to be covered in a MSR. Method A retrospective audit of all MSRs in September 2019 across all patients within all directorates within Rampton Hospital was undertaken. 281 inpatients were identified within Rampton Hospital, and 61 of these patients were found to have had seclusion in September 2019. A total of 439 MSRs were identified for these patients. The standard applied was the MHA CoP guidance for MSRs: 1) MSRs should be conducted in person, and should include: 2) Review of physical health 3) Review of psychiatric health 4) Assessment of the adverse effects of medication 5) Review of observations required 6) Reassessment of medication prescribed 7) Assessment of the patient's risk to others 8) Assessment of the patient's risk of self-harm 9) Assessment of the need for continuing seclusion 100% compliance with targets or a reason why it was not possible was expected to be documented. Result The results show there is a large variation in compliance with the MHA CoP. The area with the highest compliance was the completion of reviews in person-(99.3%). The criterion with the average worst compliance was whether the need for physical observations was reviewed-(4.3%). Physical health was reviewed in 86.1% of cases, in contrast to psychiatric health at 38.3%. The adverse effects of medication and reassessment of medication prescribed were recorded in only 8.9%. The risk from the patient to others was recorded in 25.3%, whereas risk to self was recorded in 10.7%. The need for continuing seclusion was recorded in 72.7%. Conclusion The quality of MSRs at Rampton Hospital is currently inadequate. Improvement in practice is required to meet accepted standards and ensure safe, consistent patient care. Ways to improve this are being considered, including improving the knowledge of the MHA CoP and providing a MSR template.