Aims and method Services for people who are high users of emergency departments (EDs) have developed in a piecemeal fashion, including those embedded within liaison mental health services, over the past decade. We conducted a national survey of all 171 National Health Service hospitals in England with an ED to identify high user services, alongside 20 interviews from exemplar services to characterise the interventions offered. Results We had a 100% response rate. Of the 171 hospitals, 76 (44%) had a high user service in the ED without designated staff and 71 (42%) offered services with some designated staff time; 10 (6%) had community services, either separate or with hospital outreach; and 14 (8%) had no service. Interviews revealed great variability among services on most parameters, including staffing levels, entry criteria, case-load and types of intervention. Clinical implications There is a need for clarity on entry criteria, case-load and types of intervention, to improve consistency and effectiveness of these services to guide decision-making.

Background Paediatric Mental Health Liaison (PMHL) in England is poorly understood with limited data on services previously collected. Aim To describe the characteristics of PMHL services in England and create a service model typology. Method Data were collected using a cross-sectional online survey adapted from the questionnaire used by the existing adult-care-focussed Liaison Psychiatry Surveys of England (LPSE).The survey was distributed via email through professional networks and social media. Survey data were supplemented with direct correspondence with survey respondents. Responses were coded numerically and analysed descriptively using SPSS. Free-text responses were analysed using NVivo. Results Results were obtained from 28 services serving 47 hospitals. Three service models were identified; Type 1 services providing psychological care for children and young people (CYP) with long-term conditions (LTCs);Type 2 services providing care for CYP in crisis, and Type 3 services providing care for both groups. Few services provided 24/7 crisis care for all under-18s; many respondents reported this was provided by community child and adolescent mental health (CAMH) teams. Type 1 services were often constrained by condition-specific funding. Type 1 and Type 2 services lacked multidisciplinary staffing compared to Type 3 services. Conclusions This is the first survey of English PMHL service provision. Findings are exploratory, as they are based on a partial and non-representative sample of services. However, they suggest significant variation by hospital including a lack of dedicated 24/7 crisis care for all under-18s, and inequitable access to psychological support. Further research is required to replicate findings with a larger dataset, and to explore differences in service models. However, this preliminary data suggests that adequate PMHL provision would benefit from clearer national standards. Commissioning should ensure adequate funding and equity with adult provision.Terminology disagreements represent a research barrier.

Background:Frequent users (FUs) of emergency departments (EDs) attend repeatedly, placing a disproportionate burden on healthcare systems. Although known to be heterogeneous, there is limited international evidence characterising FU subpopulations or examining how healthcare costs and outcomes differ across groups. Advancing this understanding is important for developing tailored interventions to meet diverse care needs. Methods:FUs were defined as individuals with ≥5 ED attendances/year. We used two large UK datasets: Hospital Episode Statistics (HES, 2016-2019) and the Centre for Urgent and Emergency Care database (CUREd, 2017-2020). Together, these included over 148 000 FUs from 5 million ED users. Latent class analysis (LCA) was used to identify FU subgroups based on attendance patterns, healthcare use and diagnostic characteristics. Results:We identified three consistent subgroups (HES and CUREd): (1) low-severity FUs (n=23 034, 43.2%; n=7081, 32.7%); (2) high-intensity FUs with mental health and neurological needs (n=6288, 11.8%; n=3456, 15.9%); (3) older FUs with chronic illness and high inpatient use (n=24 028, 45.0%; n=11 139, 51.4%). Subgroups differed substantially in healthcare utilisation, costs and mortality. A fourth class varied across datasets: in HES, it showed moderate morbidity and complex needs; in CUREd, high morbidity and high-intensity ED use. Discussion:This is the first FU study to apply LCA across large-scale, multiyear ED datasets, identifying a potentially universal subgroup structure. Current services focus on a narrow subset of high-intensity users. Additional tailored strategies are needed to address the full spectrum of FU needs.

BACKGROUND:This paper introduces the UK Biobank (UKB) second mental health questionnaire (MHQ2), describes its design, the respondents and some notable findings. UKB is a large cohort study with over 500,000 volunteer participants aged 40-69 years when recruited in 2006-2010. It is an important resource of extensive health, genetic and biomarker data. Enhancements to UKB enrich the data available. MHQ2 is an enhancement designed to enable and facilitate research with psychosocial and mental health aspects. METHODS:UKB sent participants a link to MHQ2 by email in October-November 2022. The MHQ2 was designed by a multi-institutional consortium to build on MHQ1. It characterises lifetime depression further, adds data on panic disorder and eating disorders, repeats 'current' mental health measures and updates information about social circumstances. It includes established measures, such as the PHQ-9 for current depression and CIDI-SF for lifetime panic, as well as bespoke questions. Algorithms and R code were developed to facilitate analysis. RESULTS:At the time of analysis, MHQ2 results were available for 169,253 UKB participants, of whom 111,275 had also completed the earlier MHQ1. Characteristics of respondents and the whole UKB cohort are compared. The major phenotypes are lifetime: depression (18%); panic disorder (4.0%); a specific eating disorder (2.8%); and bipolar affective disorder I (0.4%). All mental disorders are found less with older age and also seem to be related to selected social factors. In those participants who answered both MHQ1 (2016) and MHQ2 (2022), current mental health measure showed that fewer respondents have harmful alcohol use than in 2016 (relative risk 0.84), but current depression (RR 1.07) and anxiety (RR 0.98) have not fallen, as might have been expected given the relationship with age. We also compare lifetime concepts for test-retest reliability. CONCLUSIONS:There are some drawbacks to UKB due to its lack of population representativeness, but where the research question does not depend on this, it offers exceptional resources that any researcher can apply to access. This paper has just scratched the surface of the results from MHQ2 and how this can be combined with other tranches of UKB data, but we predict it will enable many future discoveries about mental health and health in general.

Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.

OBJECTIVES:Frequent use of emergency departments (EDs) places a considerable burden on healthcare systems. Although frequent attenders are known to have complex physical, mental health and social needs, national-level evidence on their characteristics and patterns of attendance remains limited. This study aimed to provide a comprehensive, population-level description of frequent ED attendance in England, with a focus on age-based subgroups. DESIGN:Retrospective cohort study. SETTING:EDs in England via the Hospital Episode Statistics and the Emergency Care Dataset data linked with primary care prescribing and mortality data, between March 2016 and March 2021. PARTICIPANTS:The dataset received from National Health Service Digital contained approximately 150 million ED attendances by 30 million adult (>18 years) patients over the time period April 2016 to March 2021. A random sample of 5 million people was used for this analysis. OUTCOME MEASURES:The primary outcome was the number of attendances in each financial year by frequent attenders compared with the remaining patients, split by age bands. Patients were classified as frequent attenders if they had ≥5 or ≥10 ED attendances within a rolling 12-month period. Secondary outcomes included demographic, diagnostic and prescribing characteristics, as well as the number of different ED sites visited. RESULTS:A Gaussian mixture model was used to identify age-based subgroups. Descriptive statistics were used to summarise key features; 95% CIs were reported where applicable. Among 3.91 million unique adult ED attenders, there were 8.7 million attendances. Of these, 222 160 individuals (5.7%) had ≥5 attendances in a year, accounting for 12.6% of total attendances. A trimodal age distribution was identified, with three distinct peaks corresponding to ages 18-34, 35-64 and 65+. Frequent attenders were more likely to live in deprived areas and have a history of psychotropic or analgesic prescribing. Mental health diagnoses and polypharmacy were particularly common in the younger and middle-aged groups. Multisite attendance was uncommon, with over 80% of frequent attenders using only one ED site annually. CONCLUSIONS:This national analysis reveals a trimodal age pattern among frequent ED attenders, with differing clinical and socio-demographic profiles across age groups. These findings highlight the need for age-tailored approaches to managing high-intensity ED use and inform targeted service development.

AimsThe association of assault in adulthood with all-cause mortality, and the relevance of intermediate psychological distress, alcohol use and cigarette smoking, is poorly understood. We used data from British birth cohorts (the 1958 National Child Development Study referred to as the 1958 birth cohort and the 1970 British Birth Cohort Study) to investigate association between assault and mortality, employing a formal approach for the identification of psychological distress, alcohol use and cigarette smoking as mediators.MethodsAssociations (HRs), between assault and mortality were estimated with Cox regressions, adjusting for potential confounders. Mediation via intermediate psychological distress, alcohol use and cigarette smoking was explored using the gformula approach. The birth cohorts were analysed separately, and together estimating interaction between exposure and cohort year.ResultsResults were based on 353 deaths in 19 725 individuals. Based on multiply imputed data, the fully adjusted estimate for assault on mortality was 1.72 (95% CI 1.22 to 2.42) in the combined cohorts, 1.53 (95% CI 0.97 to 2.40) in the 1958 birth cohort and 2.05 (95% CI 1.20 to 1.50) in the 1970 birth cohort. The fully adjusted estimate for the association of sexual assault with mortality was 3.17 (95% CI 1.17 to 8.60) in the combined cohorts, 1.36 (95% CI 0.19 to 9.81) in the 1958 birth cohort and 6.02 (95% CI 1.84 to 19.69) in the 1970 birth cohort. The fully adjusted mortality HR for one additional assault was 1.46 (95% CI 1.23 to 1.73) in the combined cohorts, 1.34 (95% CI 0.99 to 1.82) in the 1958 birth cohort and 1.53 (95% CI 1.25 to 1.87) in the 1970 birth cohort. Greater need for medical treatment for assault was associated with a fully adjusted mortality HR of 1.56 (95% CI 1.19 to 2.05) in the combined cohorts, 1.43 (95% CI 1.00 to 2.05) in the 1958 birth cohort and 1.79 (95% CI 1.18 to 2.74) in the 1970 birth cohort.ConclusionsThere was statistical evidence on combining the two birth cohorts, and on analysing the 1970 birth cohort, that assault in adulthood is associated with mortality. Understanding mechanisms underlying this relationship could benefit violence reduction strategies for public health.

Aims and methodThe prevalence of delaying psychiatric care until the patient has received ‘medical clearance’, and the definitions and understanding of ‘medical clearance’ terminology by relevant clinicians, are largely unknown. In a service evaluation of adult liaison psychiatry services across England, we explore the prevalence, definitions and understanding of ‘medical clearance’ terminology in three parallel studies: (a) an analysis of trust policies, (b) a survey of liaison psychiatry services and (c) a survey of referring junior doctors. Content and thematic analyses were performed.Results‘Medical clearance’ terminology was used in the majority of trust policies, reported as a referral criterion by many liaison psychiatry services and had been encountered by most referring doctors. ‘Medical clearance’ was identified as a common barrier to liaison psychiatry referral. Terms were inconsistently used and poorly defined.Clinical implicationsMany liaison psychiatry services seem not to comply with guidance promoting parallel assessment. This may affect parity of physical and mental healthcare provision.

The non-reporting of negative studies results in a scientific record that is incomplete, one-sided and misleading. The consequences of this range from inappropriate initiation of further studies that might put participants at unnecessary risk to treatment guidelines that may be in error, thus compromising day-to-day clinical practice.

Background Liaison psychiatry provision for children and young people in England is poorly evaluated. Aims We sought to evaluate paediatric liaison psychiatry provision and develop recommendations to improve practice. Method The liaison psychiatry surveys of England (LPSE) cross-sectional surveys engage all liaison psychiatry services in England. Services are systematically identified by contacting all acute hospitals with emergency departments in England. Questions are developed in consultation with NHS England and the Royal College of Psychiatrists’ Faculty of Liaison Psychiatry, and updated based on feedback. Responses are submitted by email, post or telephone . Questions on paediatric services were included from 2015 (LPSE-2), and we analysed data from this and the subsequent four surveys. Results The number of acute hospitals with access to paediatric liaison psychiatry services increased from 29 (15.9%) in 2015 to 46 (26.6%) in 2019, compared with 100% provision for adults. For LPSE-4, only one site met the Core-24 criteria of 11 full-time equivalent mental health practitioners and 1.5 full-time equivalent consultants, and for LPSE-5, just two sites exceeded them. Acute hospitals with access to 24/7 paediatric liaison psychiatry services increased from 12 to 19% between LPSE-4 and LPSE-5. The proportion of paediatric liaison psychiatry services based offsite decreased from 30 to 24%. Conclusions There is an unacceptable under-provision of paediatric liaison psychiatry services compared with provision for adults. Number of services, staffing levels and hours of operation have increased, but continued improvement is required, as few services meet the Core-24 criteria.

Objective: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. Methods: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. Results: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVIDpsyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions

Editorial Independence is an essential principle in scientific publishing, protecting the content from undue influence beyond the scientific data. This involves assurances around research integrity, publications ethics, combatting undue influence from journal owners, and improving on research practices including peer review and declarations and management of conflicts of interest. In reality, there are many examples of these principles not being followed, and no formal regulator or mechanism to optimise other than through voluntary efforts of editors and journal owners. We set out some of the fundamental principles and challenges to editorial independence and propose protections and recommendations to improve practice, policy, values, and regulation.

Objective: To explore workload-related stress levels experienced by consultation liaison psychiatry (CLP) staff in England and Ireland, and factors relevant to such a burden, during the COVID-19 pandemic. Methods: Data were obtained for England and Ireland from a European survey among CLP services in general hospitals spread via CLP networks (11th June - 3rd October 2021). The heads of respective CLP services in general hospitals responded on behalf of each service, on 100 CLP hospital staff in total. Dependent variable: workload-related stress levels in CLP services due to COVID-19 (0-10 point scale). Independent variables: hospital size, CLP service size, degree of hospital involvement in COVID-19-related care, and the number of support options available to hospital staff. Spearman's rho correlation analyses were performed. Results: There was a significant association between the hospital's involvement in COVID-19-related care and workload-related stress levels as reported by CLP staff: r(22) = 0.41, p = 0.045, R2 = 0.17. There were no significant associations between workload-related stress levels and other variables including staff support (p = 0.74). Conclusion: Our findings suggest that perceived workload-related stress levels of CLP staff during the COVID-19 pandemic can be an indicator of COVID-19 involvement of the hospitals. Staff support seemed not to alleviate work stress in the context of the pandemic. Healthcare policies should improve working conditions for CLP hospital staff that play an essential role from a population health perspective. Rigorous measures may be needed to ensure mental healthcare provision remains tenable and sustainable in the long term.

There are many structural problems facing the UK at present, from a weakened National Health Service to deeply ingrained inequality. These challenges extend through society to clinical practice and have an impact on current mental health research, which was in a perilous state even before the coronavirus pandemic hit. In this editorial, a group of psychiatric researchers who currently sit on the Academic Faculty of the Royal College of Psychiatrists and represent the breadth of research in mental health from across the UK discuss the challenges faced in academic mental health research. They reflect on the need for additional investment in the specialty and ask whether this is a turning point for the future of mental health research.

Summary Poor research integrity is increasingly recognised as a serious problem in science. We outline some evidence for this claim and introduce the Royal College of Psychiatrists (RCPsych) journals’ Research Integrity Group, which has been created to address this problem.

Objectives To identify aspects of the organisation and delivery of acute inpatient services for people with dementia that are associated with shorter length of hospital stay. Design and setting Retrospective cohort study of patients admitted to 200 general hospitals in England and Wales. Participants 10 106 people with dementia who took part in the third round of National Audit of Dementia. Main outcome measure Length of admission to hospital. Results The median length of stay was 12 days (IQR=6-23 days). People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission (estimated effect -0.24, 95% CI: -0.29 to -0.18, p<0.001). People from ethnic minorities had shorter length of stay (difference -0.066, 95% CI: -0.13 to -0.002, p=0.043). Patients with documented evidence of discussions having taken place between their carers and medical staff spent longer in hospital (difference 0.26, 95% CI: 0.21 to 0.32, p<0.001). These associations held true in a subsample of 669 patients admitted with hip fracture and data from 74 hospitals with above average carer-rated quality of care. Conclusions The way that services for inpatients with dementia are delivered can influence how long they spend in hospital. Initiating discharge planning within the first 24 hours of admission may help reduce the amount of time that people with dementia spend in hospital.

Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels. Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available. Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital. Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

Aims To assess if patients are offered appropriate and adequate NRT (nicotine replacment therapy) upon admission to an acute adult inpatient ward. To evaluate the number of adverse events occurring which are related to mandatory temporary abstinence from cigarette smoking on inpatient wards. Background Not all patients are able or willing to quit smoking when admitted to secondary care. In line with NICE Guidance, psychiatric inpatients should not be permitted to smoke inside the hospital building or outside on hospital grounds. NRT is the most widely used smoking cessation aid. It aims to temporarily replace the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms.. NRT should be offered to patients who need support with nicotine withdrawal during an inpatient stay. Trust guidelines state nursing staff are able to administer NRT to patients on admission without prescription, reducing cravings and withdrawal symptoms such as agitation and anxiety which can lead to adverse events such as aggressive behaviour. Cravings may result in the patients self-discharging or absconding from the ward to smoke. Method A retrospective review of electronic records was conducted of all inpatients admitted to two acute adult units over a three month period (65 patients). Patients were identified as smokers or non-smokers. Search words used included: ‘smoking’, ‘NRT’, ‘nicotine’, ‘cig’ to search for relevant entries. Data collected included whether NRT was offered and given by nursing staff on admission and adverse events related to smoking. Result Data from 65 patient admissions were reviewed (31 males, 34 females, mean age 37 years). 37 (57%) patients were identified as smokers. NRT was offered and accepted by 17% of patients on admission and not recorded in 77% of admissions. NRT was declined when offered by 3% of patients. Adverse events related to smoking occurred in 38% of ‘smoking’ patients. 40% of these adverse events occurred in first 72 hours of admission. Adverse events include verbal conflicts, physical aggression towards nursing staff and smoking in patient areas. Conclusion The majority of patients were not offered NRT on admission or this was not accurately documented in clinical notes. When offered NRT, a large proportion of patients accepted it demonstrating its acceptability amongst this patient group. There is a high rate of adverse events related to smoking on wards. More accurate documentation is required to ensure NRT is being sufficiently offered to patients to reduce possible withdrawal symptoms and adverse events.

Suicidality (ideation, plans, attempts) is elevated among those with chronic pain. However, population-based research is limited and studies primarily focus on mechanisms associated with increasing rather than decreasing risk. This study aimed to identify correlates associated with increased and decreased odds of suicidality among Canadians with usual pain/discomfort in a nationally representative sample.Cross-sectional data from the 2012 Canadian Community Health Survey-Mental Health supplement (CCHS-MH; N = 25,113) identified individuals with usual pain/discomfort (i.e., chronic pain; n = 5891). Multiple logistic regressions examined correlates that may increase (disability, activity limitations) and decrease (social support, positive mental health, spirituality) odds of suicidality among individuals endorsing usual pain/discomfort.Among those endorsing usual pain/discomfort, between 7.1% (suicide attempt) to 21.0% (suicide ideation) endorsed suicidality, notably higher than those without (2.0% vs 9.6% for suicide attempt and ideation, respectively). Both greater social support and positive mental health were associated with decreased odds of suicide ideation and attempts (adjusted odds ratio (AOR) range = 0.94–0.97). Those whose pain prevented most activities had increased odds of suicide plans and attempts (AOR range = 1.72–1.94). Additionally, greater disability was associated with increased odds of suicide ideation (AOR = 1.01, 95% CI[1.01–1.02], p < .001). A multivariable model including all risk and protective correlates found only positive mental health as significantly associated with decreased odds of suicide ideation and attempts.These findings may inform targeted screening, prevention, and intervention strategies to promote resilience and mitigate risk, among those with usual pain/discomfort.