Explore the vast range of titles available.

Background The rising prevalence of adolescent mild depression in the UK and the paucity of evidence-based interventions in non-specialist sectors where most cases present, creates an urgent need for early psychological interventions. Randomised controlled trials (RCTs) are considered the gold standard for obtaining unbiased estimates of intervention effectiveness. However, the complexity of mental health settings poses great challenges for effectiveness evaluations. This paper reports learning from an embedded process evaluation of the ICALM RCT which tested the feasibility of delivering Interpersonal Counselling for Adolescents (IPC-A) plus Treatment as Usual (TAU) versus TAU only for adolescent (age 12–18) mild depression by non-qualified mental health professionals in non-specialist sectors. Methods A qualitative mixed methods process evaluation, drawing on Bronfenbrenner’s socioecological model to investigate key influences on trial delivery across macro-(e.g. policy), meso-(e.g. service characteristics) and micro-(e.g. on-site trial processes) contextual levels. Data collection methods included 9 site questionnaires, 4 observations of team meetings, policy documents, and 18 interviews with stakeholders including therapists, heads of service and managers. Thematic analysis focused on understanding how contextual features shaped trial implementation. Results The ICALM trial concluded in 2022 having only randomised 14 out of the target 60 young people. At a macro-level, trial delivery was impacted by the COVID-19 pandemic, with services reporting a sharp increase in cases of (social) anxiety over low mood, and backlogs at central referral points which prolonged waiting times for mild cases (e.g. low mood). An interaction between high demand and lack of capacity at a meso-service level led to low prioritisation of trial activities at a micro-level. Unfamiliarity with research processes (e.g. randomisation) and variation in TAU support also accentuated the complexities of conducting an RCT in this setting. Conclusions Conducting a RCT of IPC-A in non-specialist services is not feasible in the current context. Failure to conduct effectiveness trials in this setting has clinical implications, potentially resulting in escalation of mild mental health problems. Research done in this setting should adopt pragmatic and innovative recruitment and engagement approaches (e.g. creating new referral pathways) and consider alternative trial designs, e.g. cluster, stepped-wedge or non-controlled studies using complex systems approaches to embrace contextual complexity. Trial registration ISRCTN registry, ISRCTN82180413. Registered on 31 December 2019.

AimsAs the number of forced migrants continues to raise every year due to conflicts, wars, climate change, and other factors, mental health services need to find innovative and new solutions to meet the needs of these vulnerable groups. We present here our experience of establishing the first mental health clinic for asylum seekers and refugees in Norwich, Norfolk (United Kingdom).MethodsThe clinic was established as part of the Advancing Mental Health Equalities QI Collaborative, which the Royal College of Psychiatrists launched to reduce barriers to accessing mental health services for disadvantaged populations. QI methodology was used to promote equality, increase access and improve outcomes over the next three years.The monthly clinic has no funding and is run by a consultant psychiatrist (Yasir Hameed) and GP (Hannah Fox). Two research assistant psychologists offered the administration support. Another assistant psychologist and two core trainees joined the small team to offer reviews and follow-ups for the patients.The monthly clinics are based away from the mental health settings (as some patients might be reluctant to attend these clinics) and are held in a friendly well-being hub run by the MIND organisation close to the city centre, which is easily accessible.The clinic receives referrals from primary care, social services, charity organisations (such as the British Red Cross), Well-being service (Psychological Therapies), and inpatient and Community Mental Health Teams.The clinic aimed to offer a person-centred, trauma-informed approach and improve the communication between services (through regular meetings with various services on a monthly basis), and enable access to appropriate treatment.In addition, the team of the clinic run drop-in session in local hotels where asylum seekers are housed to talk about mental health and access mental health services.Finally, the clinic offered training opportunities in transcultural psychiatry and working with interpreters.ResultsBetween March 2022 to January 2023, 40 referrals were received, mainly from primary care.Nearly 20% had a diagnosis of PTSD.We followed nearly half of these patients in the clinic in subsequent visits and worked closely with the psychological therapy to refer patients for appropriate therapies.ConclusionThe clinic improved the access of forced migrants to comprehensive, trauma-focused mental health assessments and improved communication and collaboration amongst services. It provided training opportunities. The drop-in sessions were a great opportunity to meet asylum seekers in their accommodation. Lessons learned and full data analysis will be shared in the poster.