Purpose This study aims to review international literature systematically to estimate the prevalence of homelessness among incarcerated persons at the time of imprisonment and the time of discharge. Design/methodology/approach A systematic review methodology was used to identify quantitative observational studies that looked at the prevalence of homelessness at the time of imprisonment, or up to 30 days prior to that point (initial homelessness), and at the time of discharge from prisons. Studies reported in English from inception to 11 September 2019 were searched for using eight databases (PsycInfo, Medline, Embase, CINAHL, PsycArticles, Scopus, Web of Science and the Campbell Collaboration), in addition to grey literature. Studies were screened independently by three researchers. Results of studies meeting inclusion criteria were meta-analysed using a random effects model to generate pooled prevalence data. Findings A total of 18 out of 2,131 studies met the inclusion criteria. All studies originated from the USA, Canada, UK, Ireland or Australia. The estimated prevalence of initial homelessness was 23.41% and at time of discharge was 29.94%. Substantial heterogeneity was observed among studies. Originality/value People in prisons are over twenty times more likely to be homeless than those in the general population. This is likely attributable to a range of health and social factors. Studies in this analysis suggest higher rates of homelessness in minority populations and among those with mental illnesses and neurodevelopmental disorders. While there was significant heterogeneity among studies, the results highlight the global burden of this issue and a clear necessity for targeted interventions to address homelessness in this population.

Background: This cross-sectional study sought to establish the prevalence of homelessness amongst inpatients in two psychiatric units in Ireland, and explore the perceived relationship between psychiatric illness and homelessness.Methods: The study employed a semistructured interview format utilising a specifically designed questionnaire which received ethical approval from the Limerick University Hospitals Group ethics committee. Results: Fifty psychiatric inpatients were interviewed. Fifteen were either "currently" homeless (n=8) or had experienced "past" homelessness (n=7). Those who had experienced homelessness were more likely to have a psychotic illness. A majority of those who had experienced homelessness believed that psychiatric illness contributed to their homelessness. involuntary admission rates were more than double for patients in the homeless group. A number of participants also reported that a lack of accommodation was preventing their discharge. Conclusion: Homelessness affects a significant number of psychiatric patients and can be both a contributory factor to, and consequence of, mental illness. With homelessness at unprecedented levels, there is a need for the development of tailored programmes aimed at supporting these vulnerable groups.

Objectives: To investigate the frequency, characteristics and impact of death threats by patients towards psychiatrists. Methods: A cross-sectional survey of psychiatrists (n = 60) was undertaken to investigate the frequency, characteristics and impact of death threats by patients in one Irish healthcare region serving a mixed urban–rural population of 470,000. Results: Forty-nine responses (82%) were received. Thirty-one per cent of respondents experienced death threats by patients during their careers. Victims were more likely to be male and in a consultant role. Patients making the threats were more likely to be males aged 30–60 with a history of violence and diagnosis of personality disorder and/or substance misuse. A majority of threats occurred in outpatient settings and identified a specific method of killing, usually by stabbing. Prosecution of the perpetrator was uncommon. Of the victimised psychiatrists, 53% reported that such threats affected their personal lives, and 67% believed their professional lives were impacted. In half of the incidents, there were adverse incidents subsequent to the threats, involving either the patient or the clinician. Conclusions: Death threats by patients have significant psychological and professional impacts on psychiatrists. Early liaison with employers and police and transferring the care of the patient to another clinician may be useful measures.

Introduction: Educational Environment (EE) is of paramount importance in Medical Education, but can be intangible and hard to clearly determine. Professional satisfaction and patient care improve in a pleasant learning environment; where postgraduate physicians are encouraged, suitably supervised, and fostered. A negative learning environment can be detrimental to trainees and teams morale and can jeopardize the multidisciplinary working relationship. Objectives: The objective of this study was to measure the Educational Environment (EE) of Psychiatry postgraduate training in the Midwest of Ireland training Deanery; what aspects of training are working well and what areas are seen as not optimal. Methods: This study took place between April and June 2021. A mixed methods approach was adopted, using the Postgraduate Hospital Educational Environment Measure (PHEEM) and semi-structured one-to-one interviews. Results: Response rate was 88% (n=22). The total PHEEM score was 105.64, indicating a postgraduate EE with more positive than negative aspects, but with room for improvement. There were no differences in overall PHEEM and subscale scores between trainees gender, training grades or years of working experience. Three themes were identified that contribute to trainees perception of EE: the commitment of the trainees supervisors to the role they play in trainees overall development, the clinical workload of the trainee, and the day-to-day working conditions of the trainee. Definite disparities between work placements were evident in the collected data across these three themes. Conclusions: Although the training program had an overall positive EE, specific answers and interview themes indicated some areas of weakness that may contribute to trainee dissatisfaction and possible burnout. Planned interventions targeting these areas and tracking changes in EE and burnout rates over time may be useful measures going forward.

Objectives The objectives of this quality assurance project was to assess the practice of electroconvulsive therapy (ECT) in a psychiatric hospital by measuring the degree of compliance with Electroconvulsive Therapy Accreditation Service (ECTAS) standards. Method An audit tool was developed utilizing a quality criteria checklist by examining the ECTAS standards in relation to the requirements for ECT suites and reviewing the case notes of all patients who had ECT during the period between January 2017 and October 2017 (first audit) and January 2018 and October 2018 (re-audit). Data were quantitatively analysed and described. Results The psychiatric unit ECT practice generally was found to adhere to the ECTAS Standards. During the audit period, 29 patients received an ECT course. The mean age was 56 years with equal gender distribution. Bilateral ECT was used in all cases. Severe depressive illness was the most common indication for ECT treatment, followed by catatonia and severe suicidality. The ECT prescription was completed by the treating consultant psychiatrist in all patients’ records (100%) in both audits. However, the signature of the doctor administering ECT was not present in 40% in the first audit and 21% in the second audit. Conclusion High quality ECT is important not only for safe ECT, but is also an important step in removing the stigma that exists around this effective and occasionally lifesaving procedure. This complete audit cycle demonstrates the value of examining ECT care by highlighting areas of accomplishment as well as areas that require further development.