F27. North Thames Genomic Medicine Service Alliance Local Transformation Project: Embedding Genomic Medicine In Mental Health Services - A Pilot Project In Intellectual Disability And Dementia Services (Raheem, Gaynair, Mikova, Nelson, Eady, 2023)

Bass N., Ryves P., Trim C., Faravelli F., Raheem A., Ambreen A., Gaynair N., Mikova J., Nelson S., Eady N.

European Neuropsychopharmacology 2023;75(Supplement 1): S234-S235.

Background: The NHS Genomic Medicine service for England (GMS) was established in 2018 to "harness the power of genomic technology and science to improve the health of our population and deliver on the commitments in the NHS Long Term Plan". These commitments include being the first national health care system to offer WGS as part of routine care. The GMS comprises of 7 Genomic Laboratory Hubs (GLH) and associated Genomic Medicine Service Alliances (GMSAs). The GMSAs are working with health providers, patients and the public to embed genomics into mainstream healthcare and ensure easy and equitable access to the genomic investigations specified in the NHS Genomic Test Directory. There are approximately 50 NHS Mental Health Trusts in England which provide mental health services (including dementia, learning disability and autism services). The directory includes genetic tests relevant to the assessment of intellectual disability (ID) and dementia - for example microarray and the WGS neurodegeneration panel. There is little data on the use of genetic investigations within mental health services but what there is suggests overall low use with large variability in practice. A NTGMSA transformation project was commissioned to: 1) map the utilisation of genomics investigations by NHS mental health trust in the North Thames (North London) region 2) develop model "end to end" genomic testing pathways for adult ID services and dementia services. 3) develop a strategy to increase genomic testing and improve equity of access

Methods: Request data was extracted from the North Thames GLH (at Great Ormond Street hospital). Consultants in the Psychiatry of ID and psychiatrists working in dementia services in the North Thames region were surveyed about genomic testing. Model genomic testing pathways were developed using the "Clinical Pathway Initiative" framework (NHS Genomic Education Programme). Extensive consultation with stakeholders and in particular patient/carer groups was undertaken to create the pathways. Clinical nurse specialist posts have been created and QI projects set up to increase testing and address equity of access.

Result(s): 10 Mental Health Trust are covered by the NTGMSA footprint. It appears that genetic investigation of adults with ID is seldom initiated in mental health services with less than 10 requests over an 18 month period. We were unable to identify any requests for the dementia panel originating from Mental Health Trusts over the same period. Overall, the survey highlighted the need for further education/training about and support for genomic testing among the psychiatry workforce. Two model testing pathways have been developed. These can be adapted to fit the needs of individual services. The consultation process revealed broad support for the aims of the project. Services users and carers identified difficulties with the logistics of testing and lack of post diagnostic support as key areas for improvement. Mental and GMS clinicians and scientists highlighted the need for strong links between GMS and mental health services and the need for basic competencies in genomic medicine across the wider mental health workforce.

Discussion(s): The level of genetic testing in mental health services in North London is currently very low. People who meet criteria for genomic investigation (as laid out in the directory) should have easy and equitable access. It appears there is still much work to be done to support the workforce with the integration of genomic medicine in mental health settings.Copyright © 2023