Royal Cornhill Hospital

Aims: Guidance from the Mental Welfare Commission for Scotland (2013) and the Scottish Government’s Best Practice Guideline for Admission to Adult Mental Health Wards for Under 18s (2013) states that young people should be admitted to age-appropriate settings, with admission to adult psychiatric units occurring only in exceptional circumstances. The United Nations Convention on the Rights of the Child (UNCRC) also advocates for age-specific mental health services. This audit examined the frequency, legal compliance, and contributing factors of under-18 admissions to an adult psychiatric unit over six months. It aimed to assess adherence to mental health legislation, including the Mental Health (Care and Treatment) (Scotland) Act 2003, and identify areas for service improvement.Methods: A retrospective review was conducted of all under-18 admissions to the adult psychiatric unit at Royal Cornhill Hospital, Aberdeen, Scotland, between June and December 2024. Data on demographics, referral sources, diagnoses, legal status, duration of stay, and completion of the ADM form (mandatory for notifying Scotland’s Mental Welfare Commission of under-18 admissions) were analysed.Results: Five adolescents (aged 13–17) were admitted during the audit period. Primary diagnoses included substance misuse-induced psychosis (n=2), disordered eating (n=1), acute stress reaction (n=1), and personality disorders (n=1). Legal status at admission varied: 60% (n=3) were voluntary, while 40% (n=2) were detained under a Short-Term Detention Certificate.Critical non-compliance with legal safeguards was identified: only 40% (n=2) had ADM forms completed, breaching statutory requirements under the Mental Health (Care and Treatment) (Scotland) Act 2003. Most referrals originated from regions lacking dedicated CAMHS beds, underscoring geographic inequities in service provision. The average stay was 20.4 days (range: 7–42), reflecting delays in transferring patients to age-appropriate units.Conclusion: These findings highlight systemic failures in delivering developmentally appropriate care, compounded by non-adherence to legal protocols. Extended admissions to adult wards risk therapeutic harm and violate safeguards for vulnerable minors. Urgent measures are required to address service gaps, including investment in dedicated adolescent inpatient units, mandatory staff training on legal compliance, and improved regional coordination to streamline referrals. Policymakers must prioritise equitable access to CAMHS beds and reinforce accountability mechanisms to prevent inappropriate placements. This audit underscores the imperative for Scotland to align its psychiatric care practices with both ethical standards and mental health legislation, ensuring vulnerable young people receive safe, rights-based care.

AimsFollowing discharge from inpatient to community psychiatric services, the first 7 days is the most vulnerable and associated with an increased risk of suicide. According to the NICE Guideline 53, it is recommended that patients discharged from inpatient psychiatric services should be reviewed within 7 days by the relevant community services. Our aim was to determine how well we are adhering to this recommendation, appropriately documenting the appointment in the patients' discharge documents as well as the number of patients that attended the appointment.MethodsWe collected data on an excel spreadsheet of patients discharged from Huntly ward (a General Adult Psychiatry ward) in the Royal Cornhill Hospital from 01/09/2022 and 14/10/2022 (a period of 6 weeks).The data collected included name, CHI, date of admission and discharge, community mental health team, follow-up appointment offered, appropriate documentation on Core discharge document and whether the patient attended the appointment.After the first audit cycle, we had a discussion with the junior doctors on the ward highlighting the importance of 7 day follow up and the need for arranging with the Community mental health team prior to the discharge, documenting a date, time and name of the clinician for the 7 day follow up in the Core discharge document. We also encouraged the use of reminders like using the doctors' diary book on the ward to document anticipated discharges and adequate hand over of patients to the community mental health team at the start of each week's Multidisciplinary Teams meeting.We subsequently did a re-audit on patients discharged from Huntly ward between 04/04/2023 and 12/05/2023 (6 weeks). We compared the results from the first cycle and the second cycle to identify a change.ResultsFirst Audit cycle.Over the 6-week period, 27 patients were admitted into the Huntly ward and 23 patients were discharged.48% (n = 11/23) of discharged patients were offered a follow up appointment.91% (n = 10/11) had this appointment documented in the Core discharge document.100% (n = 7/7) attended the 7 day follow up appointment.Re-Audit.Over the 6 week period, 16 patients were admitted and discharged from Huntly ward.81% (n = 13/16) were offered a 7 day follow up appointment and this was documented in the Core discharge document.100% (n = 13/13) of the patients attended their 7 day follow up appointment.The result showed good improvement from 48% to 81%.ConclusionUsing reminders, properly liaising with the community mental health team, appropriately documenting a named clinician, date and time for the 7 day follow-up ensures that the patient attends.The importance of offering support during the first week after discharge from psychiatric hospital should continue to be emphasized to prevent adverse outcome during this vulnerable period.

BackgroundScotland currently has the highest rates of drug-related deaths in Europe, so drug checking services are being explored due to their potential role in reducing these deaths and related harms. Drug checking services allow individuals to submit presumed psychoactive drug samples for analysis, and then receive individualised feedback and counselling. This paper explores participants’ views on the advantages and challenges of three hypothetical service models, to inform future service delivery in Scotland.MethodsSemi-structured interviews were conducted with 43 people: 27 professional stakeholders, 11 people with experience of drug use, and five family members across three cities. Vignettes were used to provide short descriptions of three hypothetical service models during the interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis.ResultsParticipants identified advantages and challenges for each of the three potential service models. The third sector (not-for-profit) model was favoured overall by participants, and the NHS substance use treatment service was the least popular. Participants also noted that multiple drug checking sites within one city, along with outreach models would be advantageous, to meet the diverse needs of different groups of people who use drugs.ConclusionsDrug checking services need to be tailored to local context and needs, with a range of service models being possible, in order to meet the needs of a heterogeneous group of people who use drugs. Addressing issues around stigma, accessibility, and concerns about the potential impact of accessing drug checking on access to and outcomes of drug treatment, are essential for successful service delivery.

At the start of a new community perinatal mental health service in Scotland we sought the opinions and aspirations of professional and lay stakeholders. A student elective project supported the creation of an anonymous 360-degree online survey of a variety of staff and people with lived experience of suffering from or managing perinatal mental health problems. The survey was designed and piloted with trainees and volunteer patients. A rich variety of opinions was gathered from the 60 responses, which came from a reasonably representative sample. Respondents provided specific answers to key questions and wrote free-text recommendations and concerns to inform service development. There is clear demand for the new expanded service, with strong support for provision of a mother and baby unit in the North of Scotland. The digital survey method could be adapted to generate future surveys to review satisfaction with service development and generate ideas for further change.

AimsDashboards provide a visual summary of relevant data to track performance against key indicators over time. They are used in healthcare to monitor the quality of patient care and to identify potential quality improvement projects. There is little published evidence of them being used in mental health services, especially in forensic psychiatric care.This project aims to design a dashboard for use in a forensic and intensive psychiatric care unit, by specifying measures and ideal features it would include.To develop a model for a quality dashboard for useTo decide which measures would be reported on the dashboardTo find reliable methods of assessing said measuresTo explore staff preferences as to how the dashboard would display data, and how they would like the information to be disseminatedTo use blank data to design a mock dashboard interface for feedbackMethodA literature search was conducted on healthcare dashboards and quality improvement projects taking place on low-secure psychiatric wards similar to the Blair unit. Potential outcome measures and methods of assessing them were researched. Staff thoughts on the dashboard, and which measures they would like to see included, were explored in interviews and using a surveyResultBlank data were fed into excel to create example graphs for a mock dashboard. The results section details: measures to be included, such as staff turnover rate, absences, and patient satisfaction levels; how they can be assessed; and specific features of the dashboard, such as the capability to track trends in selected quality indicators over a period of time. Further development of this project out with the 4 week development timeframe will require cooperation from IT services and unit management staff.ConclusionMany staff suggestions, whilst valuable measures, were more suitable for use in a clinical or nursing dashboard, rather than a quality dashboard. COVID-19 factored into reasons why staff requested certain measures, and also meant that less staff were available to be contacted about the project. This project has limitations based on the four-week timeframe, but could be further developed by staff on the unit if desired.

Background: Fascia Iliaca Compartment Block (FICB) is commonly used in older patients to provide effective analgesia following hip fracture. 
 Objectives: However, only limited Pharmacokinetic (PK) data about levobupivacaine are available to help clinical practice and establish safe volumes and amounts of local anesthetics.Methods: Ten patients aged between 53 and 87 years, who underwent hemiarthroplasty following femoral neck fracture were recruited into this study. A fixed volume (40 mL) of 0.25% levobupivacaine was injected before the induction of anesthesia using ultrasound guidance. Venous blood samples were obtained at 0, 10, 20, 30, 45, 60, 75, 90, and 120 min time points and analyzed using mass spectrometry.
 Results: The median (interquartile range) maximum observed plasma concentration (Cmax) of levobupivacaine was 0.48 (0.45-0.61) µg/mL, with the time to reach Cmax (tmax) of 38 minutes (30–105) after administration, a half-life of 2.8 h (1.65–5.8), and clearance rate of 0.72 L/min (0.36–1.26). The fixed volume (40 mL) of 0.25% levobupivacaine FICB did not exceed the recognized toxic threshold in adults (2.6 µg/mL).
 Conclusion: The data described here indicate a similar levobupivacaine PK profile for older patients undergoing FICB for hip arthroplasty compared with the levobupivacaine PK profile for the general population.

A summary is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.

Introduction: Differences in microbiota composition in children with autism spectrum disorder (ASD) compared to unaffected siblings and healthy controls have been reported in various studies. This study aims to systematically review the existing literature concerning the role of the gut microbiota in ASD. Methods: An extensive literature search was conducted using MEDLINE and EMBASE databases to identify studies (January 1966 through July 2019). Results: A total of 28 papers were included. The studies ranged from 12 to 104 participants who were aged between 2 and 18 years from various geographical areas. Majority of studies included faecal samples; however, 4 studies examined mucosal biopsies from different sites. The heterogeneity in ASD diagnostic methodology, gut site sampled and laboratory methods used made meta-analysis inappropriate. Species reported to be significantly higher in abundance in autistic children included Clostridium, Sutterella, Desulfovibrio and Lactobacillus. The findings are however inconsistent across studies. In addition, ­potential confounding effects of antimicrobial use, gastrointestinal symptoms and diet on the gut microbiota are unclear due to generally poor assessment of these factors. Conclusion: It is clear that the gut microbiota is altered in ASD, although further exploration is needed on whether this is a cause or an effect of the condition.

‘Tough love? The hardest challenge is how to hold on to a healthy balance so that it is both tough enough and loving enough.’

Aims and method Capacity legislation in the UK allows substitute decision-making for adults lacking capacity. Research has explored the experiences of such adults and their carers in relation to the Adults with Incapacity (Scotland) Act 2000, and the Mental Capacity Act 2005 in England and Wales. A systematic review of the relevant research was performed using a framework method.Results The legislation provided mechanisms for substitute decision-making which were seen as useful, but there were negative experiences. Decision-making did not always seem to follow the legislative principles. Awareness of the legislation was limited. Most research was qualitative and some was of low methodological quality. Data were too heterogeneous to allow comparisons between English and Scottish law.Clinical implications Capacity legislation was generally viewed positively. However, some experiences were perceived negatively, and the potential benefits of the legislation were not always utilised.