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INTRODUCTION: Problem-solving skills (PSS) help to provide a systematic approach to dealing with and managing complex problems. The overall aim of this study was to assess the acceptability and feasibility of developing and adapting a prison-based PSS  workbook for adults within a medium- and low-secure hospital. METHOD: We used the Medical Research Council framework in our participatory mixed methods study incorporating an adapted survey (to identify what types of problems people experience in secure hospitals), a series of three interactive workshops (to co-produce two case study examples for a workbook) and we gathered feedback from patients and hospital staff on the acceptability and feasibility of the workbook. Data from the survey were used to inform the case study examples, and the feedback from patients and hospital staff was descriptively summarised and the results consolidated. RESULTS: In total, 82 (51%) patients took part in the survey; 22 patients and 49 hospital staff provided feedback on the workbook. The survey results indicated that patients regularly experience problems while in the hospital. Patients reported problems relating to restrictions of freedom and boredom. The workshops produced two case studies for the workbooks, with mainly positive patient and staff feedback. More work is required to improve the visual representation of the characters in the case studies, the amount and content of the language and the mechanism of the intervention delivery. CONCLUSION: The adaptation process proved acceptable and feasible to both patients and staff. The co-production methodology for the workbook and feedback from patients and staff was an effective way of iteratively refining the materials to ensure that they were both meaningful and acceptable to staff and patients. Subsequent work is required to develop the workbook and evaluate the feasibility of the intervention delivery, recruitment rates, uptake and adherence to the PSS using a randomised controlled trial. PATIENT OR PUBLIC CONTRIBUTION: At each stage of the project consultation with patients and/or hospital staff was involved.

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Background: COVID-19 pandemic disrupted all routine and emergency hospital services, including our out-and-in-patient psychiatric services. Aim: To study the effect of the COVID-19 pandemic and subsequent lockdown in providing in-and-out-patient psychiatric services and the experience of tele-consultation services in our level-3 COVID hospital. Materials and Methods: We conducted a retrospective observational study using an administrative database at psychiatry in-and-out-patient department. All the cases that were reported to us, through emergency Out-Patient Department (OPD) and tele-consultation OPD, from April 2020 to October 2020, were included in the study. Data, thus obtained, were compared with the out-and-in-patient data during the same period on the previous year. Results: During the study period, there was a decline in out-patient registration of patients by 94.5%, and a reduction in admission rate was 75.5%, in comparison with the previous year. During 3 months of tele-consultation service provided, 23.5% of patients had the diagnosis of depression, 21.4% of them had various types of headaches, 15.9% of patients had psychosis, 15.3% had anxiety disorders, and 8.8% had a bipolar-affective disorder. Conclusion: Being a level-3 COVID hospital, our hospital suffered significantly in relation to psychiatric in-and-out-patients attendance and service recipients during the study period of COVID-19 pandemic.

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BACKGROUND: Recovery-promoting and occupation-oriented interventions for people with schizophrenia who receive in-patient services are scarcely investigated, limiting our understanding of the factors affecting intervention effectiveness and hindering occupational inclusion. AIMS: To investigate the impact of contextual factors on the effectiveness of 'Occupational Connections' (OC) - occupational intervention for in-patient psychiatric settings. MATERIALS AND METHODS: Quasi-experimental, single-blind study compared between inpatients with schizophrenia participating in OC (N = 14) and those receiving treatment as usual only (N = 16) on primary outcomes of participation dimensions and recovery-orientation of the service, and on secondary outcomes of cognition, symptom severity, and functional capacity. RESULTS: Participation in OC in a new context appears to contribute to improvement in cognitive fluency and flexibility, schizophrenia symptoms, and functional capacity (-2.8 0.05) or reduction (-2.25

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In-patient service is a crucial link in the whole medical chain,how to construct an economical and efficient inpatient service model,so as to let patients spend the least amount of money,get the best quality medical service,and effectively improve their sense of well-being and sense of acquisition is a social problem that needs to be solved urgently.From the perspective of economics and combined with practical experience,a new inpatient service model(pre-hospitalization and pre-discharge model)is constructed,which is an upgrading and transformation of the original model on the basis of the existing business system,simplifies the existing service process of hospitalization and discharge,effectively reduces the average hospitalization day and the subperiod average hospitalization cost,and significantly improves the evaluation indexes of inpatient service compared with the traditional inpatient service model.

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We describe mental health services in Luxembourg and how they have evolved over the past 50 years. Health services in Luxembourg are provided through a social health insurance-based system and mental health services are no exception. Additional services are offered through mixed-funding avenues drawing on social care budgets in the main. Luxembourg is closely connected with neighbouring countries, where a large proportion of its workforce live. No run-through medical training exists and the entire medical workforce, including psychiatrists, have trained in other countries. This is reflected in a rich but often non-uniform approach to the provision of psychiatric care.

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BACKGROUND: Research suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require. AIMS: To identify which individuals require what services, at what cost. METHOD: A 'balance of care' (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach. RESULTS: Community care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week. CONCLUSIONS: The findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used. DECLARATION OF INTEREST: None.

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BACKGROUND: In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability. AIMS: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England. METHOD: File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported. RESULTS: Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores. CONCLUSIONS: In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.