AimsPatients often have negative experiences of police in their daily lives. Police involvement in mental health services can make an encounter feel disciplinary rather than therapeutic and exacerbate mental distress. People with mental illness, especially of minoritised backgrounds, are more likely to die after police contact, than other groups. Our aims were to: 1) explore patient experiences of being admitted onto the ward under section via the police, 2) explore patient understanding of the role the police play in mental health services 3) Use experiential data towards introducing trauma informed care in an inpatient settingMethodsA clinician administered questionnaire was conducted on an acute male inpatient ward, with 12 consenting male inpatient participants. All were involuntarily detained, ranging in age from 22 to 56 years; 11 out of 12 were of an ethnic minority background.The questionnaire consisted of a mixture of open-ended questions and closed Likert scale questions with answers ranging from “strongly agree” to “strongly disagree”. Questions covered themes relating to the experience of admission and the ward environment, personal and communal experiences of policing, views on the role of policing in mental health service provision. Data were collated and presented in a local QIP showcase.ResultsA significant split was identified between answers to open-ended and closed questions. When offering Likert based responses, 66% of participants felt safe with the police and believed that the police had a role in keeping people with mental health problems safe; 50% felt the police role should be greater in the future.When responding to discussion-based questions, participants were critical of policing in relation to managing mental crises. Participants offered elucidative answers covering themes ranging from feeling a lack of agency, and the traumatic nature of criminalising mental distress, to concerns about abuse of power, the desire to limit the policing role to criminality and lack of trust engendered from experiences of racial injustice.ConclusionOur results demonstrate that patient views on policing roles in mental health service provision are complex. The experiences of involuntary admission through the police are often traumatic, rooted in past police involvement in patient's lives. Although it is acknowledged that at times no feasible alternative is available in hostile situations, this QIP opened an important, previously avoided, discussion. This will hopefully lead to introduction of more trauma informed care in an inpatient setting.

Purpose The Dementia Questionnaire for People with Learning Disabilities (DLD) is one of the main screening and monitoring tools for dementia in people with Down’s syndrome (DS). As part of a quality improvement project to improve the care for people with DS and dementia in an intellectual disability service, the authors studied the screening and monitoring process by retrospectively investigating the use of DLD and exploring clinicians’ experience of using it. Design/methodology/approach DLDs completed in the service was retrospectively assessed. Changes in DLD scores were matched against people who received a clinical diagnosis of dementia. Data were analysed to estimate sensitivity, specificity and predictive values of DLD. A questionnaire was used to assess clinicians’ experience. Findings Data for 20 service users was collected. DLD cognitive scores showed 80% sensitivity and 60% specificity for the diagnosis of dementia, with a positive predictive value of 40% and negative predictive value of 90%. Staff found DLD to be easy to perform but time consuming. This led to the preparation of a decision tool for appropriateness of performing a DLD. Originality/value The results show that a negative DLD helps to exclude dementia where there is concern over cognitive decline, but a positive result is not specific enough to suggest the possibility of dementia. This shows that DLD may have limitations if used as a screening tool alone but could be used for the monitoring of the disease trajectory of those with a confirmed diagnosis as well as to establish a baseline DLD when a person is screened for dementia first.

AimsTrainees in Barnet, Enfield and Haringey (BEH) Mental Health Trust reported feeling isolated and burnt out after COVID-19. Offers of "online mindfulness" or "resilience training", as a substitute for in-person gatherings, felt very inadequate. Well-being initiatives are known to improve staff morale, mental health, patient care, recruitment and retention of trainees. We created and delivered a pilot well-being programme to improve the well-being of trainee psychiatrists working within BEH between September 2022 and January 2023.MethodsWe developed a WellBEHing brand for our trust and a committee of trainees dedicated to improving the well-being of themselves and their colleagues.We ran a focus group for all trainees to submit ideas for sessions and activities they would enjoy.We developed a programme of monthly WellBEHing events during protected well-being time, that was funded by medical education and the local division.We surveyed trainees pre and post WellBEHing autumn/winter programme to record the impact on their sense of well-being. We also collected qualitative data on their experiences of being part of a WellBEHing community.ResultsPrior to the WellBEHing autumn/winter programme we surveyed 40 trainees in BEH and only 12.5% of them rated their well-being as good or great. 35% of trainees felt unvalued or uncared about at work.At the end of the autumn/winter WellBEHing programme 73% of trainees felt valued at work, with 60% of trainees feeling "happy and cared for".Some of the qualitative feedback showed the impact well-being events can have on trainees “Seeing everyone in person, and being able to do so during the working day made me feel that BEH values me enough as an employee to prioritise my well-being. The quiz was also excellent and had clearly had a lot of effort put into it.”ConclusionMeaningful well-being initiatives take time, effort and funding. They require the support of management and consultants. Our results demonstrate that when well-being is designed and led by trainees, they feel valued and cared for as employees. We are beginning the second phase of project development where we will focus on making the programme sustainable and embedded in trainee life at BEH long-term.

Background: Tooth loss is associated with numerous factors which includes smoking, systemic diseases, age, poor oral hygiene, level of education and socio economic status etc. Association of tobacco and tooth loss is known but relationship of other modes of tobacco i.e. smokeless tobacco (chewable) with tooth loss is in dearth. Aim: To figure out the relationship oftooth loss with smokeless tobacco along with other variables such as presence of tobacco use (both smoked and smokeless), age and gender. Methodology: Three hundred and thirty six participants were included in this study. ‘Controls’ were based on the presence of all teeth and ‘Cases’ were based on one or more than one tooth missing. Participants’ were questioned about use of smokeless tobacco (chewable), presence of tobacco use (both smokeless and smoked), age (> than 30 or < less than 30) and gender (male or female). Results: There was no statistically significance of tooth loss (dependent variable) with any of the independent variables such as smokeless tobacco, age and gender. However presence of tobacco use i.e. both smokeless and smoked has 1 time more chance of tooth loss (OR=1.535) (C.I=0.54-4.335) as compared to absence of tobacco use. Practical implication: This study will figure out the association of tooth loss with use of smokeless tobacco because research in this aspect is insufficient. Results of this study would help in determining smokeless tobacco as a reason of tooth loss. Conclusions: Presence of tobacco use either smokeless or smoked can lead to tooth loss. Keywords: Tooth loss, Smoked and smokeless tobacco, Gender, Age