Cancer incidence rates in the UK have increased by more than a third over the last four decades, so the likelihood of requiring concurrent chemotherapy and clozapine is increasing. In this situation clinicians are faced with a clinical conundrum: to stop clozapine and risk a psychotic relapse, or to continue clozapine and risk a potentially fatal agranulocytosis. This case report describes how a multidisciplinary team (MDT) worked together to balance the mental and physical health needs of a patient.

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Purpose This study aims to explore current attitudes among doctors working in psychiatry, with regard to their perceived role and their confidence in managing their patients’ physical health problems. Design/methodology/approach A 20-item electronic questionnaire was distributed to doctors working in psychiatry within two large UK mental health trusts in 2018. Quantitative analysis was conducted, alongside qualitative analysis of free-text comments made by participants. Findings Many participants perceived their physical examination skills to have deteriorated since working in psychiatry (78 per cent). Participants were questioned on which professional group should hold responsibility for managing the physical health of patients under psychiatric services. A minority felt it should be psychiatrist-led (5 per cent), followed by general practitioner (GP)-led (42 per cent) and then shared responsibility (47 per cent). The majority felt there should be more focused training on physical health in the Core (72 per cent) and Advanced (63 per cent) psychiatry training. Key themes from a framework analysis of qualitative data included potential barriers to shared care, psychiatrists’ concerns regarding their experience and confidence in managing physical health, reasons in favour of shared responsibility, ideas for training and suggestions for improving the current situation. Originality/value Psychiatric patients may engage less well with health services, yet psychiatric medication often impacts significantly on physical health. In this context, there is often a blurring of role boundaries between a psychiatrist and a GP, and there is considerable variation between individual teams. There is a consistent call for more physical health training opportunities for psychiatrists and for mental health services to more proactively promote the physical health of their patients.

Background Depression is common and the prevalence increasing worldwide; at least 1 in 10 people will experience depression in their lifetime. It is associated with economic costs at the individual, healthcare and societal level. Recommended treatments include medication and psychological therapies. However, given the long waiting times, and sometimes poor concordance and engagement with these treatments, a greater range of approaches are needed. Evidence for the potential of outdoor swimming as an intervention to support recovery from depression is emerging, but randomised controlled trials (RCTs) evaluating clinical and cost-effectiveness are lacking. This study seeks to investigate the feasibility of conducting a definitive superiority RCT, comparing an 8-session outdoor swimming course offered in addition to usual care compared to usual care only, in adults who are experiencing mild to moderate symptoms of depression. Feasibility questions will examine recruitment and retention rates, acceptability of randomisation and measures, and identify the primary outcome measure that will inform the sample size calculation for a definitive full-scale RCT. This study will also explore potential facilitators and barriers of participation through evaluation questionnaires, focus-group discussions and interviews. Methods/design To address these aims and objectives, a feasibility superiority RCT with 1:1 allocation will be undertaken. We will recruit 88 participants with mild to moderate symptoms of depression through social prescribing organisations and social media in three sites in England. Participants will be randomised to either (1) intervention (8-session outdoor swimming course) plus usual care or (2) usual care only. Both groups will be followed up for a further 8 weeks. Discussion If findings from this feasibility RCT are favourable, a fully powered RCT will be conducted to investigate the clinical- and cost-effectiveness of the intervention. Findings from the definitive trial will provide evidence about outdoor swimming for depression for policymakers and has the potential to lead to greater choice of interventions for adults experiencing symptoms of depression. Trial registration Current controlled trial registration number is ISRCTN 90851983 registered on 19 May 2022.