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In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response to this situation, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHUs) to every district. This study evaluates the barriers and facilitators to mental health service delivery in decentralised MHUs in Sierra Leone using key informant interviews and focus group discussions with 13 purposefully sampled clinical staff and senior management personnel. The interviews were audio-recorded, translated from Krio if necessary, transcribed, and analysed using manifest content analysis. The findings suggest that factors affecting nurse-led mental health service delivery include small workforce and high workload, culture and beliefs, risks, lack of safety measures and required resources, outdated policies, poor salaries, lack of funds for medication, distance, power, influence, and stigma. Factors that could facilitate nurse-led mental health services include: increasing motivation, increasing the workforce, knowledge sharing, mentorship, availability of medication, passion and modern psychiatry. The findings contribute towards understanding the challenges and opportunities faced by the recently established nurse-led decentralised mental health services across Sierra Leone, in order to address the large mental health treatment gap. We hope the findings will inform further policy and planning to improve the quality of decentralised mental healthcare.

To date, little guidance exists on how to design safe and effective online programming on sensitive and/or controversial topics. Massive online open courses (MOOCs) represent a unique opportunity for delivering inclusive and accessible teaching to international learner audiences. This paper provides an insight into designing and delivering the first internationally accessible MOOC on suicide prevention in the global context in 2019-highlighting insights into best practice as well as pertinent challenges. The results from two runs of this MOOC indicate that there appears to be a global demand for education on suicide prevention. Our practice suggests that new knowledge on extremely sensitive topics such as suicide can be safely and effectively delivered through a MOOC to an international community of learners. Learner safety needs to be carefully considered when developing and delivering online learning. Thorough and careful moderation is essential to ensure that learners engage safely and sensitively with the content and with one another. The involvement of diverse stakeholders, including people with lived experience, in the MOOC design is recommended to enhance the authenticity, inclusiveness and rigour of the curriculum.

The mental health and wellbeing of students is of upmost importance and it is becoming increasingly recognised that students at universities in the UK are experiencing more mental health problems such as anxiety and depression. \ud \ud Some estimate that up to 1 in 4 students may experience a mental health problem. Some universities have observed an increase in students dropping out and a number of student suicides have occurred. \ud \ud With the pivot to remote teaching and learning that has occurred due to the COVID-19 pandemic, ensuring the mental health and wellbeing of students, is crucial. \ud \ud We have experience of teaching a number of potentially distressing and/or triggering topics remotely on platforms such as Zoom, MS Teams, Moodle and FutureLearn. Such sensitive topics include child abuse and neglect, torture, gender-based violence, suicide and chaining. \ud \ud In recognition of the sensitive content that has been delivered online, we have developed a number of strategies to promote the well-being of our students and ensure as much as possible that the learning environment remains safe. \ud \ud In this presentation we explore some of our experiences of developing self-care resources for students. We discuss our experiences of moderating student comments when delivering online learning about suicide prevention and post-traumatic stress disorder and we present some student feedback about embedding self-care resources in the learning material.

The routes to optimising the authenticity of assessments in different organisational and disciplinary contexts have been ambiguous and challenging. This paper offers a case study of diversifying the assessments in a taught Master’s Programme by integrating disciplinary practices to design alternative assessments. Embedding discipline-specific principles and perspectives was found to be key to achieving authenticity of assessments. This paper reports on a descriptive mixed-method study that the authors conducted to evaluate current students’ perceptions of and experiences with the diversified assessments in the Programme. Overall, the findings demonstrate students’ acknowledgement of the importance of a diverse mix of assessments, especially in terms of fostering the development of several graduate attributes. The findings also highlight several opportunities for enhancing the constructive alignment of the curriculum. Alternative assessments can be feasibly designed to promote many of the graduate attributes necessary to create ‘global students’ in an increasingly competitive and internationalised job market.

The COVID-19 pandemic has forced a range of changes on working practices and intra-team collaboration within higher education which have had an effect on the planning, development, and delivery of teaching materials. The requirement across the University to adapt content to better fit a blended-teaching approach provides an excellent opportunity to update and improve learning materials.\ud \ud Since the start of the pandemic, the Global Mental Health (GMH) team have collaboratively produced a range of new learning materials, including a 4-week Massive Open Online Course on Post-Traumatic Stress Disorder and a 10-week SFC Funded Micro-Credential on the Impact of Trauma on Mental Health, in addition to adapting the existing Programme content to meet student needs. This presentation will highlight some examples of innovative practice which will be useful in guiding other educators to design and refine their learning materials.\ud \ud Remote working has made co-ordination of course development challenging. To overcome this, the GMH team relied on a range of technological tools, including MS Teams, OneNote, and Excel. Previous experience of effective working with the MVLS and Wiley Digital Learning Teams led to a OneNote template for course development being established. Steps within the template were developed, and once a draft created, the content within the step could be iteratively refined by different team members. All the learning materials under development were fully visible and editable to everyone simultaneously.\ud \ud In addition, a regularly updated open access spreadsheet allowed for progress to be clearly and effectively tracked across multiple courses, which helped motivate and encourage team members as they could physically observe the progress being made through the collaborative process. MS Teams further facilitated the sharing of information and requests for help or guidance.\ud \ud The process outlined above has proven equally useful in refining existing course content.

Deliberate self-harm (DSH) is a major global health problem and a significant risk factor for death by suicide. Despite this, those who suffer are often confronted with negative attitudes from healthcare professionals whilst seeking help, with detrimental consequences for treatment outcomes. While several factors may affect attitudes to DSH amongst healthcare professionals, there is now growing evidence to suggest an association with burnout. As current levels of burnout amongst junior doctors are estimated to be high, understanding the nature of this association is crucial. The over-arching aim of this project is therefore to explore junior doctors' attitudes toward DSH in comparison with other presenting conditions and to explore any possible relationship these may have with features of burnout. We conducted an online cross-sectional survey of junior doctors working within NHS Greater Glasgow and Clyde. After collecting sociodemographic information, participants were presented with both the abbreviated Maslach Burnout Inventory and the Medical Condition Regard Scale for patients presenting with; Chronic Obstructive Pulmonary Disease (COPD), Type I Diabetes Mellitus (T1DM), Schizophrenia and DSH. Significant differences in attitudes according to presenting complaints/conditions were identified. Participants reported the highest regard for TIDM and lowest regard for DSH, varying as a function of speciality and years of NHS service. 21% of participants were experiencing 'burnout' to a high degree, and scores also varied as a function of speciality and years of NHS service. No association between burnout and attitudes were observed for any of the investigated diagnoses. Our findings highlight the desperate need for evidence-based interventions to address burnout and negative attitudes toward DSH amongst junior doctors. Moreover, they may suggest that these attitudes worsen through the course of junior doctor training. We would therefore advocate for further research to assess the efficacy of interventions designed to address this.

Background: In Leverndale Hospital, approximately 30 patients receive over 300 ECT treatments per year. Currently ECT consultants provide dosage recommendations after each ECT treatment to the Responsible Medical Officer (RMO) who prescribes treatment and completes the T5 paperwork. Scottish ECT Audit Network (SEAN) ECT standards state that a T5 should be completed after at least every second treatment. In some cases, dose recommendations are not adhered to and T5 forms are not completed.\ud \ud Aim(s): To determine whether adherence to advice regarding dosage given by electroconvulsive therapy (ECT) consultants and T5 post treatment evaluation completion rates improved after the introduction of an “ECT sticker”. We hypothesised that a standardised approach to communication would improve adherence. \ud \ud Approach/Method(s): A retrospective case notes audit was undertaken 6 months before and 6 months after the “ECT sticker” was introduced. Information regarding T5 completion and adherence to ECT dose recommendations was gathered. Patients undergoing maintenance ECT were excluded.\ud \ud Discussion/Findings: Cycle 1 (October 2017-March 2018): 13 patients had 14 episodes of ECT resulting in 155 ECT treatments. 2.6% (N=4) were delivered at a dose that varied from the recommendation. For T5’s, 59.3% (38/64) were completed. One of the 14 episodes had no T5 forms completed (7.1%).\ud Cycle 2 (April 2018-November 2018) – 10 patients had 11 episodes of ECT resulting in 110 ECT treatments. 2.7% (N=3) were delivered at an alternative dose to that recommended by the ECT consultant. Over 70% (71.1%, 32/45) of T5 forms were completed. None of the 11 episodes had no forms completed.\ud Conclusions: The introduction of the “ECT sticker” had minimal effect on adherence to the prescribing recommendation. However, T5 completion improved. Further work is required to ensure T5 completion continues to improve.

This article was migrated. The article was not marked as recommended. Amidst the ongoing global recruitment crisis in psychiatry there are compelling reasons to rethink the approach to, and the content and structure of, educational and experiential opportunities for medical students and foundation doctors. Medical students' attitudes to mental illness and psychiatry have been a topic of interest for many decades. The literature identifies the undergraduate years as pivotal in the formation of attitudes towards psychiatry and it has been suggested that medical students' attitudes towards psychiatry worsen as they progress through undergraduate education. The aim of this study was to explore University of Glasgow medical students' attitudes towards psychiatry and possible reasons for not choosing psychiatry as a viable career option. An electronic survey was emailed to all medical students in October 2017. A response rate of 24.5% (N=324) was achieved which was representative across year groups one to five. The findings identified generally positive attitudes towards psychiatry as a specialty. However, year group analysis demonstrated a declining level of interest in pursuing psychiatry as a career choice. Negative attitudes towards psychiatry clustered in common themes, namely: stigmatised views about psychiatry and people with mental illness; perceived limited exposure to psychiatry in the curriculum and for experiential learning opportunities. This paper proposes that enhanced coverage of, and exposure to, psychiatry in undergraduate and postgraduate training may provide avenues into reducing negative attitudes towards psychiatry within medicine. This in turn may support national campaigns to 'rebrand' psychiatry and reinvigorate the psychiatry core trainee (CT) supply chain.

Introduction: Suicide prevention is a global public health challenge. Increasing evidence-based knowledge and understanding of suicide needs to be central to suicide prevention efforts worldwide. We aimed to design a 3 week Massive Open Online Course (MOOC) to allow students to gain a broader understanding of suicide as a global issue. \ud \ud Methods: A multidisciplinary team of psychiatrists, psychologists, suicide researchers, people with lived experience and digital learning technologists developed the educational content. To ensure a safe learning environment, the World Health Organisation (WHO) guidelines on safe reporting of suicides was adhered to. Self–care activities were embedded throughout each week of the MOOC and wellbeing resources were signposted at the end of each step. Once the draft MOOC was completed, extensive consultation occurred. External feedback was obtained from a range of key stakeholders and a number of organisations were approached for endorsement or accreditation. Five teaching assistants were employed to aid course moderation.\ud \ud Results/Discussion: The MOOC launched in March and September 2019 with five organisational endorsements and one accreditation. Over 3,000 students engaged in the MOOC with 4,410 discussion comments. Student discussions were monitored by staff. The MOOC appeared to have a global reach with 51% of learners residing in the UK, 5% in Australia, 4% in the United States, 3% in Mexico, 2% in Canada, India and China and 1% in Russia and Saudi Arabia. Completion data from 276 learners reported that 93.5% (n=258) felt the course met or exceeded expectations and 95.7% (n=264) reported new learning. \ud \ud Conclusion: There appears to be a global demand for education on suicide prevention. Early outcome data suggested that new knowledge can be delivered through a MOOC. Learner safety needs to be carefully considered when developing and delivering online learning. Thorough and careful moderation is essential to ensure that learners engage safely with the content.

The mental health and wellbeing of students is of upmost importance and it is becoming increasingly recognised that students at universities in the UK are experiencing more mental health problems such as anxiety and depression. Some estimate that up to 1 in 4 students may experience a mental health problem. In some Universities there has been an increase in students dropping out and in others, more worryingly there have been a number of student suicides. As such addressing the mental health and wellbeing of students is of importance. \ud \ud Within the Global Mental Health Masters, we discuss a number of topics (such as child abuse and neglect, torture, gender based violence, suicide and chaining), which may adversely affect student’s mental health and wellbeing. In recognition of this, we have embedded a number of self-care resources and activities within our learning materials. \ud \ud In this presentation we explore what self-care is and describe our experiences of embedding self-care activities within the learning materials of our taught modules. We present some provisional feedback from students on their views of these activities.

This chapter provides an assessment of studies on mobile health (mHealth) tools for development in addressing diseases relating to mental health, informs the current publications trends, identifies research gaps in the existing literature, and suggests a future research agenda that can help address these gaps. We, therefore, assessed empirical studies using a Systematic Mapping Study approach. We searched five academic databases as well as Google Search Engine and Google Scholar. Based on the inclusion and exclusion criteria, 54 full-text papers were included in this chapter. The findings suggest a growing trend in the use of various mHealth tools for mental health, such as mobile apps and text messaging. The findings also suggest that the responsibility of health monitoring and management can be shared between the medical practitioner and the patient in mental healthcare. Research gaps were identified and areas for future research are proposed.

Obsessive compulsive disorder (OCD) is a neuropsychiatric disorder with a global prevalence of 2-3%. OCD can have an enormous impact on the lives of those with the disorder, with some studies suggesting suicidal ideation is present in over 50% of individuals with OCD, and other data showing a significant number of individuals attempt suicide. It is therefore important that individuals with OCD receive the best possible treatment. A greater understanding of the underlying pathophysiology of neuropsychiatric disorders among professionals and future clinicians can lead to improved treatment. However, data suggests that many students and clinicians experience "neurophobia", a lack of knowledge or confidence in cases involving the nervous system. In addition, research suggests that the relationship many students have with neurological conditions deteriorates over time, and can persist into practice.If individuals living with conditions such as OCD are to receive the best possible treatment, it is crucial that those administering care are equipped with a thorough understanding of such disorders. While research has shown that the use of interactive 3D models can improve anatomy education and more specifically neurology education, the efficacy of using of such models to engage with neuropsychiatric conditions, specifically OCD, has not been assessed. This study seeks to address this gap.In this study an interactive application for Android devices was designed using standardised software engineering methods in order to improve neuropsychiatry literacy by empowering self-pace learning through interactive 3D visualisations and animations of the neural circuitry involved in OCD. A pilot test and a usability assessment were conducted among five postgraduate life science students. Findings relating to user experience were promising, and pre-test vs. post-test evaluation suggested encouraging outcomes regarding the effectiveness of the application in improving the knowledge and understanding of OCD. In short, this study suggests that interactive 3D visualisations can improve neuropsychiatry education. For this reason, more efforts should be made to construct similar applications in order to ensure patients always receive the best possible care. Fig. 2.1 A diagrammatic representation of the CSTC circuit, based on a similar diagram by Robertson et al. (2017).

Background:\ud Suicide is a major issue for global public health. Suicidality describes a broad spectrum of thoughts and behaviours, some of which are common in the general population. Although suicide results from a complex interaction of multiple social and psychological factors, predisposition to suicidality is at least partly genetic.\ud \ud Methods:\ud Ordinal genome-wide association study of suicidality in the UK Biobank cohort comparing: ‘no suicidality’ controls (N = 83,557); ‘thoughts that life was not worth living’ (N = 21,063); ‘ever contemplated self-harm’ (N = 13,038); ‘act of deliberate self-harm in the past’ (N = 2498); and ‘previous suicide attempt’ (N = 2666).\ud \ud Outcomes:\ud We identified three novel genome-wide significant loci for suicidality (on chromosomes nine, 11 and 13) and moderate-to-strong genetic correlations between suicidality and a range of psychiatric disorders, most notably depression (rg 0·81).\ud \ud Interpretation:\ud These findings provide new information about genetic variants relating to increased risk of suicidal thoughts and behaviours. Future work should assess the extent to which polygenic risk scores for suicidality, in combination with non-genetic risk factors, may be useful for stratified approaches to suicide prevention at a population level.

Obsessive compulsive disorder (OCD) is a neuropsychiatric disorder with a global prevalence of 2-3%. OCD can have an enormous impact on the lives of those with the disorder, with some studies suggesting suicidal ideation is present in over 50% of individuals with OCD, and other data showing a significant number of individuals attempt suicide. It is therefore important that individuals with OCD receive the best possible treatment. A greater understanding of the underlying pathophysiology of neuropsychiatric disorders among professionals and future clinicians can lead to improved treatment. However, data suggests that many students and clinicians experience "neurophobia", a lack of knowledge or confidence in cases involving the nervous system. In addition, research suggests that the relationship many students have with neurological conditions deteriorates over time, and can persist into practice.If individuals living with conditions such as OCD are to receive the best possible treatment, it is crucial that those administering care are equipped with a thorough understanding of such disorders. While research has shown that the use of interactive 3D models can improve anatomy education and more specifically neurology education, the efficacy of using of such models to engage with neuropsychiatric conditions, specifically OCD, has not been assessed. This study seeks to address this gap.In this study an interactive application for Android devices was designed using standardised software engineering methods in order to improve neuropsychiatry literacy by empowering self-pace learning through interactive 3D visualisations and animations of the neural circuitry involved in OCD. A pilot test and a usability assessment were conducted among five postgraduate life science students. Findings relating to user experience were promising, and pre-test vs. post-test evaluation suggested encouraging outcomes regarding the effectiveness of the application in improving the knowledge and understanding of OCD. In short, this study suggests that interactive 3D visualisations can improve neuropsychiatry education. For this reason, more efforts should be made to construct similar applications in order to ensure patients always receive the best possible care. Fig. 2.1 A diagrammatic representation of the CSTC circuit, based on a similar diagram by Robertson et al. (2017).

Recent genome-wide association studies have demonstrated that the genetic burden associated with depression correlates with depression severity. Therefore, conducting genetic studies of patients at the most severe end of the depressive disorder spectrum, those with treatment resistant depression and who are prescribed electroconvulsive therapy (ECT), could lead to a better understanding of the genetic underpinnings of depression. Despite ECT being one of the most effective forms of treatment for severe depressive disorders, it is usually placed at the end of treatment algorithms of current guidelines. This is perhaps because ECT has controlled risk and logistical demands including use of general anaesthesia and muscle relaxants and side effects such as short-term memory impairment. Better understanding of the genetics and biology of ECT response and of cognitive side effects could lead to more personalized treatment decisions. To enhance the understanding of the genomics of severe depression and ECT response, researchers and ECT providers from around the world and from various depression or ECT networks, but not limited to, such as the Psychiatric Genomics Consortium, the Clinical Alliance and Research in ECT (CARE), and the National Network of Depression Centers (NNDC) have formed the Genetics of ECT International Consortium (Gen-ECT-ic). Gen-ECT-ic will organize the largest clinical and genetic collection to date to study the genomics of severe depressive disorders and response to ECT, aiming for 30,000 patients worldwide using a GWAS approach. At this stage it will be the largest genomic study on treatment response in depression. Retrospective data abstraction and prospective data collection will be facilitated by a uniform data collection approach that is flexible and will incorporate data from many clinical practices. Gen-ECT-ic invites all ECT providers and researchers to join its efforts.

Background: Diabetes, obesity and metabolic syndrome are highly prevalent in patients with severe mental illness and can impose a major physical health burden. Objective: To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with Severe Mental Illness living in Cheshire, UK. Methods: In all, 1307 individuals on the severe mental illness Register were followed up between 2002 and 2012 in UK general practice. Subjects were identified through a pseudanonymised search of general practice registers. Results: Baseline body mass index was 28.6 kg/m2 increasing to 31.0 at 10-year follow-up ( r2 = 0.84; p = 0.0002). There was a significant increase in fasting blood glucose from 5.72 to 6.79 mmol/L ( r2 = 0.48; p = 0.026). Correspondingly, there was a strong positive univariate relation between increase in body mass index and fasting blood glucose ( r2 = 0.54; p 2 = 0.88; p = 0.0001), as did low-density lipoprotein cholesterol from 3.43 to 2.35 mmol/L ( r2 = 0.94; p = 0.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in body mass index (odds ratio = 1.07 [1.01, 1.13]; p = 0.031) and triglycerides (odds ratio = 1.28 (1.06, 1.55); p = 0.009) was independently associated with an increased risk of having type 2 diabetes. Conclusion: Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.

Background Suicide is a major issue for global public health. Suicidality describes a broad spectrum of thoughts and behaviours, some of which are common in the general population. Although suicide results from a complex interaction of multiple social and psychological factors, predisposition to suicidality is at least partly genetic. Methods Ordinal genome-wide association study of suicidality in the UK Biobank cohort comparing: ‘no suicidality’ controls (N = 83,557); ‘thoughts that life was not worth living’ (N = 21,063); ‘ever contemplated self-harm’ (N = 13,038); ‘act of deliberate self-harm in the past’ (N = 2498); and ‘previous suicide attempt’ (N = 2666). Outcomes We identified three novel genome-wide significant loci for suicidality (on chromosomes nine, 11 and 13) and moderate-to-strong genetic correlations between suicidality and a range of psychiatric disorders, most notably depression (rg 0·81). Interpretation These findings provide new information about genetic variants relating to increased risk of suicidal thoughts and behaviours. Future work should assess the extent to which polygenic risk scores for suicidality, in combination with non-genetic risk factors, may be useful for stratified approaches to suicide prevention at a population level. Fund UKRI Innovation-HDR-UK Fellowship (MR/S003061/1). MRC Mental Health Data Pathfinder Award (MC_PC_17217). MRC Doctoral Training Programme Studentship at the University of Glasgow (MR/K501335/1). MRC Doctoral Training Programme Studentship at the Universities of Glasgow and Edinburgh. UKRI Innovation Fellowship (MR/R024774/1).

Background: Suicide is a major issue for global public health. ‘Suicidality’ describes a broad clinical spectrum of thoughts and behaviours, some of which are common in the general population.Methods: UK Biobank recruited ∼0·5 million middle age individuals from the UK, of whom 157,000 completed an assessment of suicidality. Mutually exclusive groups were assessed in an ordinal genome-wide association study of suicidality: ‘no suicidality’ controls (N=83,557); ‘thoughts that life was not worth living’ (N=21,063); ‘ever contemplated self-harm’ (N=13,038); ‘an act of deliberate self-harm in the past’ (N=2,498); and ‘a previous suicide attempt’ (N=2,666). Linkage of UK Biobank to death certification records identified a small sub-group of ‘completed suicide’ (N=137).Outcomes: We identified three novel genome-wide significant loci for suicidality (on Chromosomes 9, 11 and 13) and moderate-to-strong genetic correlations between suicidality and a range of psychiatric disorders, most notably depression (rg 0·81). Higher polygenic risk scores for suicidality were associated with increased risk of completed suicide relative to controls in an independent sub-group (N=137 vs N=5,330, OR 1·23, 95%CI 1·06 to 1·41, p=0.03). Rs598046-G (chromosome 11) demonstrated a similar effect size and direction (p=0·05) within a Danish suicidality study.Interpretation: These findings have significant implications for our understanding of genetic vulnerability to suicidal thoughts and behaviours. Future work should assess the extent to which polygenic risk scores for suicidality, in combination with non-genetic risk factors, may be useful for stratified approaches to suicide prevention at a population level.Funding: UKRI Innovation-HDR-UK Fellowship (MR/S003061/1). MRC Mental Health Data Pathfinder Award (MC_PC_17217).

Background: This study aimed to evaluate students’ satisfaction, perceived utility and engagement with a range of Blended Learning (BL) resources, in the context of the staged introduction of BL within the MSc Global Mental Health Programme. Methods: A descriptive mixed methods design was employed. An electronic questionnaire was completed by 18 (90%) of the enrolled on-campus students. Eight of them opted to participate in a collaborative workshop aiming to corroborate and expand upon the questionnaire findings, and generate ideas for optimising the BL components. Results: Overall, students were satisfied with the quantity and usefulness of the BL materials. Specifically, the easy access to, and diversity of, learning activities were recognised as instrumental in stimulating innovative ways of thinking, in addition to improving subject-specific knowledge. Students starkly diverged according to their reported use of materials as the foundation of independent study as well as perceptions of the difficulty level of the modules. Students reported lacking the confidence and knowledge regarding integrating the breadth of learning resources effectively to support their learning. Collaboratively, the students helped generate actionable programmatic changes aimed at improving the curriculum cohesion and enhancing learner engagement. Conclusion: Systematic evaluation of the initial stages of BL is critical. This study demonstrated the complexities of the staged introduction of BL in terms of ensuring learning efficiency, student satisfaction, learner development and programme cohesion. This study enabled the identification of strategic and feasible high-impact areas for optimising BL, and transforming them into stages of change. Keywords: BLENDED LEARNING, BLENDED TEACHING, STUDENT ENGAGEMENT, EVALUATION

The Master’s Degree in Global Mental Health (GMH) is in its sixth year as an on-campus course and in its second year as an online distance learning (ODL) course. A significant review of ILOs, course content, Moodle resource, the role of graduate attributes and assessment types was undertaken prior to the 2017/18 launch. The optimisation of agility and cohesion between Programmes has provided an opportunity to introduce blended learning materials for the on-campus students as a means of supporting learning. \ud \ud With the introduction of blended learning into the on-campus course we wish to ensure that it is embedded robustly, efficiently and effectively.

ObjectiveTo identify factors associated with: admission to a specialist mother and baby unit (MBU) and the impact of perinatal mental illness on early childhood development using a data linkage approach in the 2 years prechildbirth and postchildbirth.MethodsScottish maternity records (SMR02) were linked to psychiatric hospital admissions (SMR04). 3290 pregnancy-related psychiatric admissions for 1730 women were assessed. To investigate factors associated with MBU admission, the group of mothers admitted to an MBU were compared with those admitted to general psychiatric wards. To assess the impact of perinatal mental illness on early child development, a pragmatic indicator for ‘at potential risk of adversity’, defined as a child who was recorded as requiring intensive treatment at any time under the health plan indicators (HPI) and/or who had no record of completing three doses of the 5-in-1 vaccine by 12 months was generated. Logistic regression models were used to describe the association between each variable and the risk of admission between those with a history of prior psychiatric admission and those without.ResultsWomen admitted to an MBU were significantly more likely to be admitted with non-affective psychosis (OR=1.97, 95% CI 1.22 to 3.18), affective psychosis (OR=2.44, 95% CI 1.37 to 4.33) and non-psychotic depressive episodes (OR=1.93, 95% CI 1.42 to 2.63). They were less likely to come from deprived areas (OR=0.68 95% CI 0.49 to 0.93). Women with a previous history of psychiatric admission were significantly more likely to be located in the two most deprived quintiles. Almost one-third (29%) of children born to mothers with a pregnancy-related psychiatric admission were assessed as ‘at potential risk of adversity.’ConclusionsA health informatics approach has potential for improving understanding of social and clinical factors, which contribute to the outcomes of perinatal mental illness, as well as potential adverse developmental outcomes for offspring.

Objective: To describe weekly admission rates for affective and non-affective psychosis, major depression and other psychiatric disorders in the early and late postpartum periods. To assess the impact of socioeconomic status, age and parity on admission rates.\ud \ud Methods: Scottish maternity records were linked to psychiatric hospital admissions. 3290 pregnancy-related psychiatric admissions were assessed. Weekly admission rates were calculated for the pregnancy period, early postpartum period (6 weeks after birth) and late postpartum period (up to 2 years after birth), and compared with pre-pregnancy rates (up to 2 years before pregnancy). Admission rates were generated by calculating the total number of admissions for each time period divided by the number of weeks in the period. Incidence rate ratios (IRRs) were generated for each time period, using deprivation, age, parity and record of previous psychiatric hospital care-adjusted Poisson regression models.\ud \ud Results: Women from more deprived social quintiles accounted for the largest proportion of admissions across all time periods. Compared with pre-pregnancy period, admission rates fell during pregnancy, increased markedly during the early postpartum period, and remained elevated for 2 years after childbirth. Within the most affluent quintile, admission IRRs were higher in the early postpartum period (IRR=1.29, 95% CI 1.02 to 1.59) than in the late postpartum period (IRR=0.87, 95% CI 0.74 to 0.98). For the late postpartum period, there was a positive association between higher maternal age and admission IRRs (ages 20–35 years, IRR=1.35, 95% CI 1.16 to 1.54 and age>40 years IRR=1.72, 95% CI 1.41 to 2.09).\ud \ud Conclusions: Rates of psychiatric admission fell during pregnancy and increased in the early postpartum period (particularly during the first 2 weeks after birth), and remained elevated above baseline during the 2-year late postpartum period. An understanding of how social deprivation, age and parity might influence risk of psychiatric admission at different time points could help to target perinatal mental health services more effectively.

Neuroleptic malignant syndrome (NMS) is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system, most commonly antipsychotics. While it is generally recognized that all antipsychotics may cause NMS, it is more commonly associated with first-generation antipsychotics such as haloperidol and fluphenazine as well as chlorpromazine, trifluoperazine, and prochlorperazine. However the newer atypical antipsychotic agents, such as amisulpride, clozapine, risperidone, quetiapine, and olanzapine have all been reported to cause NMS. There is evidence for a possible underlying genetic predisposition to NMS, with CYP2D6 gene variants coding for lower metabolism also being associated with a higher risk. There are many aspects of its epidemiology, etiology, and pathophysiology which remain poorly understood and its management can pose significant challenges for clinicians confronted with the life-threatening potential of this condition.

People with severe mental illness have a higher risk of developing cardiovascular disease and die sooner than the general population. This study of a national sample of primary care patients in the United Kingdom compared screening for cardiometabolic risk factors among patients with severe mental illness and diabetes.Screening for cardiovascular disease among 2,488,948 patients with diabetes (2010-2011) and 422,966 patients with severe mental illness (2011-2012) at 8,123 primary care practices was compared.The percentage of patients who received screening across four parameters (body mass index, blood pressure, blood glucose, and cholesterol) in the previous 15 months was higher among patients with diabetes than among those with severe mental illness (97.3% versus 74.7%, p.001).The proportion of patients in primary care who were given screening for cardiometabolic risk was much lower among those with severe mental illness than among those with diabetes.

Background The Quality and Outcomes Framework (QOF) has specific targets for body mass index (BMI) and blood pressure recording in major mental illness (MMI), diabetes, and chronic kidney disease (CKD). Although aspects of MMI (schizophrenia, bipolar disorder, and related psychoses) are incentivised, barriers to care may occur. Aim To compare payment, population achievement, and exception rates for blood pressure and BMI recording in MMI relative to diabetes and CKD across the UK. Design and setting Analysis of 2012/2013 QOF data from 9731 UK general practices 2 years after the introduction of the mental health, BMI, and blood pressure QOF indicators. Method Payment, exception, and population achievement rates for the MMI and CKD blood pressure indicators and the MMI and diabetes BMI indicators were calculated and compared. Results UK payment and population achievement rates for BMI recording for MMI were significantly lower than for diabetes (payment: 92.7% versus 95.5% and population achievement: 84.0% versus 92.5%, P