Background A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum. Aims We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic. Method We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020. Results There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown. Conclusions UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.

ObjectiveUsing simulation, we developed an advanced communication skill training programme with the objective of improving core psychiatry trainees’ confidence in managing difficult situations at work.DesignTwo simulation courses, comprising six scenarios, were developed for psychiatry core trainees (CTs) on the University College London Partners (UCLP) training scheme. Trainees were divided into small groups. Each trainee undertook two scenarios each. Feedback was delivered by facilitators, peers and the simulated patients. Written feedback was also given.SettingThe courses were delivered in a local postgraduate medical education centre.PatientsActors were used to simulate adult psychiatric patients and their relatives. Other scenarios involved actors portraying colleagues.InterventionsThe simulations offered an opportunity for experiential learning while the debriefs allowed for focused feedback on trainees’ communication styles.Main outcome measuresChanges in trainees’ perception of their ability to deal with difficult situations at work were measured. Semistructured interviews further explored trainees’ experience of the course and its educational impact.Results100% (n=39) of the trainees felt that their communication skills had improved after the training. 97% felt more able to defuse an angry/tense situation at work while 92% felt more able to deal with a difficult situation requiring sophisticated communication skills. 97% felt that regular simulation training would be valuable while 100% (n=24) of facilitators agreed that the experience was valuable to the trainees’ professional development. Qualitative analysis showed that trainees found the scenarios realistic, that the experience had led to an increased awareness of their communication style and that original improvements in confidence had translated to their clinical work.ConclusionsThe programme demonstrates that it is possible to use simulation in a simple, inexpensive and time-effective manner to provide realistic, enjoyable and educationally beneficial advanced communication skill training relevant to psychiatric practice.

Background: The COVID-19 pandemic presents challenges to substance misuse services. Patients face a higher risk of infection and transmission to others. Services were required to reconfigure quickly in response to the government lockdown. These changes had to be completed before national guidance was published. Method: To examine the strategy and operational delivery of two London boroughs and measure how convergent they were with national guidelines. Referral data were analyzed and compared to a similar time frame pre-COVID-19. Results: Both services adopted similar strategies and pace of change. Longer supplies of opiate substitution therapy (OST) were prescribed, with less restrictive arrangements for collection. There was an increase in opiate assessments and a reduction in alcohol assessments. There was no overall increase in mortality. There was minor deviation from national guidance when it was initially published. Conclusions: The services were well equipped to respond to the rapid changes demanded during early lockdown. Reduced restrictions in OST may not be associated with negative service or patient outcomes. The move to remote consultations and home working are likely to have value in substance misuse services after the pandemic. The long-term impact of lockdown presents uncertainties in terms of clinical safety and requires evaluation.

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