OBJECTIVES:To evaluate the impact of a pharmacist-led primary care review clinic on reducing opioid prescribing. METHODS:Retrospective analysis of routinely collected opioid prescription data for patients using strong opioids for pain at a practice with high social deprivation and staffed mainly by locum GPs. KEY FINDINGS:Forty-seven patients were reviewed. The median opioid dose before review was 80 mg oral morphine equivalent. After intervention, the median dose was 30 mg. Thirty-seven (78.7%) patients had reduced doses or discontinued opioids. No adverse events were reported. CONCLUSIONS:A pharmacist-led clinic aimed at reducing opioid medication appears feasible and effective.

OBJECTIVES:Clinical registries are critical components of digital health infrastructure, supporting quality improvement, research, and system performance monitoring. The economic value and cost-effectiveness of registries across clinical areas remain poorly understood. This systematic scoping review aimed to synthesize evidence on the costs, cost-effectiveness, and methods in economic evaluation of clinical registries. METHODS:Medline, Embase, CINAHL, and the Cochrane Library were searched from inception to February 2025, for economic evaluations or costing analyses of clinical registries. Eligible studies included full economic evaluations, cost-only studies, and gray literature reporting registry costs. Data were extracted and summarized descriptively. Methodological quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards, the Joanna Briggs Institute checklist for economic evaluations, and the cost-of-illness checklist for cost analyses. RESULTS:Twenty-two primary studies and 11 gray literature sources were included. Six full economic evaluations demonstrated registries were cost-effective or cost-saving, with reported returns on investment, derived from costs and estimated cost savings, ranging from 1.5 to over 2250 per £1 invested. Sixteen cost-only studies and 11 gray literature reports provided costs across diverse registry types. Cost patterns showed economies of scale, with higher per-patient costs in smaller registries and greater efficiencies in larger or national programs. Equity-focused analyses were rare, only 1 study examined subgroup impacts. CONCLUSIONS:Clinical registries represent strategic, cost-effective investments in digital health systems. Their economic benefits and efficiencies support ongoing national and international investment. Future evaluations should adopt standardized costing methods, integrating equity and distributional analyses to enhance comparability.

INTRODUCTION:A clinical registry is a systematically collected database of health-specific information about a patient population. Clinical registries can be used for a variety of purposes including surveillance, monitoring of outcomes and patient care. The establishment and maintenance of clinical registries come with a significant cost. This scoping review aims to identify the methods used to economically evaluate clinical registries including their costs and benefits. METHODS:This systematic scoping review protocol has been developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The final review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The electronic databases Medline, Embase, Cochrane Library and The Cumulative Index to Allied Health Literature(CINAHL) database will be searched. Relevant national organisation websites will be searched to identify empirical studies within grey literature. The inclusion criteria include studies that economically evaluate clinical registries and are published in the English language from inception to February 2025. Two reviewers will independently screen 100% of titles and abstracts and full texts of studies for inclusion. Data will be extracted from eligible studies prior to being assessed for quality using a multi-tool approach. ETHICS AND DISSEMINATION:The findings of this review will be published in an international peer-reviewed journal. They are likely to be of interest to custodians of existing clinical registries and to those wishing to establish or evaluate clinical registries.KeywordsClinical registries, economic evaluation, costs, cost-effectiveness, health economics, registry based studies.

BACKGROUND:With a rising prison population, a substantial portion of whom are identified as substance misusers, it is important to understand the availability of treatment pathways, their successes and areas for improvement. Given the likely importance of national factors in criminal justice and substance use service provision, we chose to focus on one country. AIM:To review substance misuse treatment and outcomes for such treatments as implemented in British prisons for men. METHODS:We conducted a mixed-methods systematic review, searching Ovid MEDLINE, Ovid Embase, APA PsycINFO, CINAHL Plus, Sociology Collection, Web of Science Core Collection and Social Science Premium Collection between 1 January 2000 and 5 June 2024. Included were empirical, peer-reviewed studies of processes and outcomes of UK male prison-based substance misuse programmes. Primary outcomes included changes in substance use, withdrawal symptoms and experiences of interventions, whereas secondary outcomes encompassed quality of life, locus of control and mental health. Because of study design heterogeneity, meta-analysis was not possible. Analysis followed JBI methodology with a convergent synthesis. RESULTS:Fourteen studies were included: 8 qualitative, 5 quantitative studies of which 3 were randomised control trials (RCTs) and 1 mixed-methods study, with a combined sample of 4037 participants engaged in opioid substitute treatment (OST) and/or psychosocial interventions. Four key themes emerged: the power of purposeful activity, strengthening support systems, bridging patient needs with treatment plans and, for those in opiate programmes, experiences and engagement with opioid substitution treatments. CONCLUSIONS:Participants articulated diverse treatment needs, highlighting the necessity of individualised and tailored reduction or maintenance plans. Treatment requires a comprehensive approach with the aim of facilitating effective social integration.

Lysenko was a powerful Soviet pseudoscientist, whose theories cost millions of lives. He died 50 years ago, but his legacy is highly salient. Anti-science and ideology come together slowly, and UK pseudoscience has had unforeseen consequences. Pseudoscience must be challenged even when this has repercussions for those who speak up.

Aims: The Social Determinants of Health (SDOH) are generally taught as epidemiological facts rather than clinically relevant context. Psychiatry placements at HMP Berwyn (INSIGHT) provide medical students with exposure to SDOH at an individual level, allowing them to learn about the unique challenges faced by both the inmates and clinicians. Aims were to explore healthcare professionals’ (HCPs) attitudes on psychiatry prison placements as a medical education measure to teach about social determinants in physical and mental health. Methods: HCPs working at HMP Berwyn were surveyed. Questions were structured to answer whether these placements benefit students, improve their understanding of SDOH, and whether having students present is disruptive. Results: We collected 25 out of 42 (60%) responses in Mar 2024. Key results include: 75% of respondents strongly agreed that psychiatry placements in prison are beneficial for medical students; 71% believed the prison placements should be continued as part of the medical education; 54% indicated that students had a poor understanding of SDOH at the start of the placement; 42% agreed that students’ understanding of SDOH improved by the end of their placements; and 42% strongly disagreed that having students in prison was disruptive. Discussion: The majority of the participants viewed psychiatry placements in prison positively, emphasising their role in enhancing students’ understanding of SDOH. Additionally, most of the staff did not find the placements disruptive, supporting the continuation or extension of the programme. Potential limitations include response bias from participants with strong opinions and the absence of time-dependent data. Our ongoing research will explore student experiences and track staff opinions over time. Conclusion: In our previous publications during the past three years, we have highlighted students’ positive responses to prison placements. This study further demonstrates that the HCPs at HMP Berwyn support these placements, recognising their value in improving students’ understanding of SDOH in challenging environments. This awareness exposes the importance of in-depth patient history-taking and equips future doctors to approach patient care holistically, ultimately fostering more equitable healthcare delivery and improving patient outcomes.

Services around the world are increasingly fragmented and specialized, with the result of excluding more people in need. The use of coercive practices has increased, and clinical and social outcomes are not producing the expected results. Services are fundamentally not person-friendly, difficult to access and navigate. This article summarizes the values and principles that should underpin mental health services, as suggested by a group of patients and carers. Continuity of care, use of compulsory admissions, open door, involvement of carers and risk management are explored and discussed, with particular emphasis on the current scientific evidence or each theme. More person-friendly services are not only possible but should be the main drive when planning and designing healthcare systems.

This paper reviews the last 30 years of developments in UK psychiatry and looks forward at what possibilities exists for the specialty in the years to come. At the beginning of the era there was a short interlude when progressive innovations became easier, as the unintended consequence of NHS 'reforms'. The subsequent period has been dominated by efforts to control professional conduct, with the effect that there has been an increasing emphasis on services' use of compulsion and duress. The focus of services has moved away from care of the chronically ill and towards time-limited intervention. I see little possibility that this emphasis on 'safety' will diminish, nor that the commodification of publicly funded services is likely to diminish. I anticipate that there will be an increasingly two-tier service, with the neglect of people who are chronically ill. However, new interest in social psychiatry, a less insular clinical psychology, a renewed emphasis on relational psychiatry, the service user movement and the global psychiatry movement are all reasons for optimism. Although the community psychiatry ideal seems dead in the public sector, these ideas may flourish outside of it.

Introduction Intentional injuries can be broadly classified into those that are self-inflicted (eg, suicide, self-harm), and those that are inflicted by others (eg, homicide, assault). Many risk factors are the same for all intentional injuries. It is widely accepted that there needs to be a public health approach to self-harm and interpersonal violence prevention, including surveillance of presentations to emergency departments. Self-harm and interpersonal violence are important causes of morbidity and mortality in Wales. Interpersonal violence surveillance is already operationalised in Wales, but variables are limited and case ascertainment may not be complete. There is no self-harm register. The aim of this study is to understand the utility of existing systems in North Wales that collect data about self-harm and interpersonal violence, and how a registry could be implemented to address any unmet needs.Methods and analysis The project consists of five work packages. First, process mapping will be used to understand the pathways by which patients access emergency care, and how data are collected about patients. Second, routinely collected data will be explored to understand the burden of disease, and the strengths and limitations of existing data collection systems. Third, semi-structured interviews will be completed with stakeholders to understand their needs and experiences. Fourth, semi-structured interviews with third sector organisations which work with people with lived experience of self-harm or interpersonal violence will explore the acceptability of data collection. Fifth, a method will be developed that would enable economic evaluation of a self-harm and interpersonal violence register.Ethics and dissemination Results will be used to understand whether a self-harm and interpersonal violence registry is required in Wales. The results have the potential to influence local and national strategy on intentional injury prevention. Results will be disseminated to local services, regional and national programme teams, and published as a peer-reviewed journal article.

Patients find the term ‘borderline personality disorder’ offensive and, from a list of alternative labels, prefer ‘emotional intensity disorder’. It is suggested that any term will take on a pejorative connotation if professional attitudes do not change as well; and that this requires an alteration in the environment in which professionals operate. This should not look so strongly to compulsion to prevent suicide, but should allow therapeutic relationships to flourish. Blaming clinicians for incidents when they have few choices is counterproductive. The problem reflects a systemic impatience with patients who get better slowly or not at all.

Introduction: Burn registers provide important data that can track injury trends and evaluate services. Burn registers are concentrated in high-income countries, but most burn injuries occur in low- and middle-income countries where surveillance data are limited. Injury surveillance guidance recommends utilisation of existing routinely collected data where data quality is adequate, but there is a lack of guidance on how to achieve this. Our aim was to develop a rigorous and reproducible method to establish an electronic burn register from existing routinely collected data that can be implemented in low resource settings. Methods: Data quality of handwritten routinely collected records (register books) from a tertiary government hospital burn unit in Mysore, India was assessed prior to digitisation. Process mapping was conducted for burn patient presentations. Register and casualty records were compared to assess the case ascertainment rate. Register books from February 2016 to February 2022 were scanned and anonymised. Scans were quality checked and stored securely. An online data entry form was developed. All data underwent double verification. Results: Process mapping suggested data were reliable, and case ascertainment was 95%. 1930 presentations were recorded in the registers, representing 0.84% of hospital all -cause admissions. 388 pages were scanned with 4.4% requiring rescanning due to quality problems. Two-step verification estimated there to be errors remaining in 0.06% of fields following data entry. Conclusion: We have described, using the example of a newly established electronic register in India, methods to assess the suitability and reliability of existing routinely collected data for surveillance purposes, to digitise handwritten data, and to quantify error during the digitisation process. The methods are likely to be of particular interest to burn units in countries with no active national burns register. We strongly recommend mobilisation of resources for digitisation of existing high quality routinely collected data as an important step towards developing burn surveillance systems in low resource settings. (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this.

This paper reflects on a special edition of the journal History of Psychiatry and a related symposium held at Somerville College, Oxford, exploring the innovations in mental healthcare in Oxfordshire led by Dr Bertram Mandelbrote between 1959 and 1988. I draw on clinical culture, biography, mental health policy and my lived experience to understand Mandelbrote's life and work, and his legacy and lessons for contemporary psychiatrists. I explore the ecological niche that Mandelbrote created and conclude with the probable importance of his relationship with Professor Michael Gelder, who led the University of Oxford Department of Psychiatry at the time.

ObjectiveSocioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka.MethodsData on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected.ResultsThe sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors.ConclusionThe results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.

AIMS AND METHOD:Calls for the integration of spirituality into psychiatric practice have raised concerns about boundary violations. We sought to develop a method to capture psychiatrists' attitudes to professional boundaries and spirituality, explore consensus and understand what factors are considered. Case vignettes were developed, tested and refined. Three vignettes were presented to 80 mental health professionals (53% said they were psychiatrists; 39% did not identify their professional status). Participants recorded their reactions to the vignettes. Four researchers categorised these as identifying boundary violations or not and analysed the factors considered. RESULTS:In 90% of cases, at least three of the four researchers agreed on classification (boundary violation; possible boundary violation; no boundary violation). Participants' opinion about boundary violations was heterogeneous. There was consensus that psychiatrists should not proselytise in clinical settings. Reasoning emphasised pragmatic concerns. Few participants mentioned their religious beliefs. Equivocation was common. CLINICAL IMPLICATIONS:Mental health professionals seem unsure about professional boundaries concerning religion and spirituality in psychiatric practice.