Aims and methodCrisis resolution and home treatment (CRHT) teams began operating in Edinburgh in late 2008. We ascertained service users' and carers' experiences of CRHT using a standardised questionnaire. We also assessed the impact of CRHT on psychiatric admissions and readmissions by analysing routinely collected data from November 2003 to November 2009.ResultsThere was a 24% decrease in acute psychiatric admissions in the year after CRHT began operating, whereas the previous 5 years saw an 8% reduction in the admission rate. The mean duration of in-patient stay fell by 6.5 days (22% decrease) in the 12 months following CRHT introduction, alongside a 4% decrease in readmissions and a 17% reduction in Mental Health Act 1983 admissions. Although the mean response rate was low (29%), 93% of patients reported clinical improvement during CRHT care, 27% of patients felt totally recovered at discharge from CRHT, 90% of patients felt safe during CRHT treatment, and 94% of carers said their friend or relative got better with CRHT input.Clinical implicationsCrisis resolution and home treatment service in Edinburgh had a positive impact during the first 12 months in terms of reduced admissions, reduced duration of in-patient stay and reduced use of the Mental Health Act. The service can catalyse a more efficient use of in-patient care. Service users and carers report high rates of improvement and satisfaction with CRHT.

Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.

Background: Non-attendance rates in psychiatric outpatient clinics have been a topic of considerable interest. It is measured as an indicator of quality of service provision. Failed attendances add to the cost of care as well as having an adverse impact on patients leading to missing medications, delay in identifying relapses and increasing waiting list time. Recent trials have demonstrated that prompting letters sent to patients led to a decrease in non-attendance rates. We applied this evidence based practice in our community mental health setting to evaluate its impact.

AimsThe Scottish psychiatric workforce has remained largely static; in June 2022, there were 1,164.7 whole-time equivalent (WTE) psychiatrists across all grades. RCPsych In Scotland recognise the importance of focussing on, and improving, the recruitment and retention of trainees in Psychiatry in Scotland by undertaking a number of different projects.MethodsWe understand that trainees have differing needs and therefore since 2018 have looked at different ways to attract and retain trainees using different mediums. These included membership benefits, written information, policy work, and events.With funding from NHS Education for Scotland we focussed on undergraduate students creating bursaries, a new RCPsych In Scotland welcome pack and ran summer schools.Focussing on existing trainees we had a stand at the virtual international congress, training events including ST4 interview skills webinars, bursaries for trainees to attend conferences and a workforce report to illustrate the likely gaps in future consultant posts as well as barriers to recruitment and retention throughout the work span.ResultsDue to the lengthy duration of psychiatric training it is not possible to evaluate an immediate impact of the campaign on Scotland's workforce however we have seen benefit by looking at other measurable objectives. The work focussing on undergraduates had led to a 333% increase in student associate membership of RCPsych in Scotland.In 2018 there was a 63.08% fill rate for core psychiatry posts compared to 100% in 2022. As recruitment is now national, it is not possible to get Scotland only data for competition ratios however the 2021 competition ratio for the UK was 2.99 compared to 1.48 in 2018.We are starting to see a change in higher training fill rates. In 2022 there was a 69% fill rate over all specialties with Psychiatry of Older Adults and Medical Psychotherapy both having a 100% fill rate. This is a slight improvement from 2019 where there was a 61% fill rate.ConclusionThe work undertaken by RCPscyh in Scotland has increased interest in psychiatry both at an undergraduate and post graduate level although there is still work to be done with regards to retention, both into higher training and also to consultant level posts. The work we are currently undertaking with the workforce report hopes to focus on the reasons that trainees leave training and we aim to use it to advocate for policy change with regards to training numbers and pathways in Scotland.