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  • Become a psychiatrist

    Become a psychiatrist

    • Choose Psychiatry

      Choose Psychiatry

      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • Career essentials
      • What next?
      • Choose Psychiatry 2021 video
    • Sixth formers and school students
    • Medical students

      Medical students

      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National conference
      • Summer and autumn schools
      • FuturePsych – the student associate magazine
      • The Student Psychiatry Audit and Research Collaborative (SPARC)
    • Foundation doctors

      Foundation doctors

      • Foundation doctor associates
      • Making the most of your psychiatry placement
      • Opportunities for foundation doctors
      • FuturePsych - the associate magazine
    • Help us promote psychiatry

      Help us promote psychiatry

      • How can I help?
      • Ideas to inspire you
      • Resources to help you promote psychiatry
    • Choose Psychiatry: Guidance for Medical Schools
    • Supporting Medical Students: Medical Schools
    • Choose Psychiatry
      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • Career essentials
      • What next?
      • Choose Psychiatry 2021 video
    • Sixth formers and school students
    • Medical students
      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National conference
      • Summer and autumn schools
      • FuturePsych – the student associate magazine
      • The Student Psychiatry Audit and Research Collaborative (SPARC)
    • Foundation doctors
      • Foundation doctor associates
      • Making the most of your psychiatry placement
      • Opportunities for foundation doctors
      • FuturePsych - the associate magazine
    • Help us promote psychiatry
      • How can I help?
      • Ideas to inspire you
      • Resources to help you promote psychiatry
    • Choose Psychiatry: Guidance for Medical Schools
    • Supporting Medical Students: Medical Schools
  • Training

    Training

    • Curricula and guidance

      Curricula and guidance

      • GMC approved curricula
      • RCPsych Curricula Review 
      • Specialty guides
      • Dual Training
      • Curricula Implementation
    • Your training

      Your training

      • Psychiatric Trainees Committee: supporting you
      • Time out of training
      • Training resources
      • Run-through training
      • Prizes and bursaries for trainees
      • Training less than full time
      • Routes to Registration
      • Cost of Training
      • Leadership and Management Fellow Scheme
      • Understanding Career Choices in Psychiatry
    • Exams

      Exams

      • Can I take an exam?
      • Contact the exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • Exam FAQs
      • A fair exam
      • Exams Help Centre
      • Examiners and exam panels recruitment
    • Neuroscience in training

      Neuroscience in training

      • About the project
      • Neuroscience events
      • Who was on the commission?
      • Neuroscience history
      • Neuroscience resources
      • Multimedia learning
    • Deanery/LETB Hub
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates

      International Medical Graduates

      • Shortage Occupation List
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Building Capacity in Perinatal Psychiatry

      Building Capacity in Perinatal Psychiatry

      • Perinatal 2022 Masterclass Programme application and process details
      • Perinatal project resources
      • About the Building Capacity Project
    • Curricula and guidance
      • GMC approved curricula
      • RCPsych Curricula Review 
      • Specialty guides
      • Dual Training
      • Curricula Implementation
    • Your training
      • Psychiatric Trainees Committee: supporting you
      • Time out of training
      • Training resources
      • Run-through training
      • Prizes and bursaries for trainees
      • Training less than full time
      • Routes to Registration
      • Cost of Training
      • Leadership and Management Fellow Scheme
      • Understanding Career Choices in Psychiatry
    • Exams
      • Can I take an exam?
      • Contact the exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • Exam FAQs
      • A fair exam
      • Exams Help Centre
      • Examiners and exam panels recruitment
    • Neuroscience in training
      • About the project
      • Neuroscience events
      • Who was on the commission?
      • Neuroscience history
      • Neuroscience resources
      • Multimedia learning
    • Deanery/LETB Hub
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates
      • Shortage Occupation List
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Building Capacity in Perinatal Psychiatry
      • Perinatal 2022 Masterclass Programme application and process details
      • Perinatal project resources
      • About the Building Capacity Project
  • Members

    Members

    • Supporting you

      Supporting you

      • Psychiatrists Support Service
      • New consultants (StartWell)
      • Mentoring and coaching
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • If a patient dies by suicide
      • Writing clinic letters
      • Looking after yourself
    • CPD eLearning
    • Submitting your CPD

      Submitting your CPD

      • CPD Submissions FAQs
      • Alterations to CPD during coronavirus pandemic
    • Membership

      Membership

      • Members login
      • Receipts
      • Pay Your Subscription
      • Direct Debit
      • Your subscription
      • Grades of membership
      • Benefits of membership
      • Fellowship and other Honours
      • Applying for Fellowship
      • Nominations for Honorary Fellows
      • Nominations for National Honours
    • Your Faculties

      Your Faculties

      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic Psychiatry Faculty
      • General adult psychiatry
      • Intellectual disability psychiatry faculty
      • Liaison psychiatry faculty
      • Medical psychotherapy faculty
      • Neuropsychiatry faculty
      • Old age psychiatry faculty
      • Perinatal psychiatry faculty
      • Rehabilitation and social psychiatry faculty
      • Faculty job descriptions
    • Devolved Nations

      Devolved Nations

      • RCPsych in Scotland
      • RCPsych in Wales
      • Coleg Cymraeg
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions

      English Divisions

      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • Trent
      • West Midlands
      • South West
      • Executive Committee job descriptions
      • NW and NY mentorship
    • International members
    • Special Interest Groups

      Special Interest Groups

      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts psychiatry
      • Digital psychiatry
      • Evolutionary psychiatry
      • History of psychiatry
      • Neurodevelopmental psychiatry
      • Occupational psychiatry
      • Philosophy
      • Private and independent practice PIPSIG
      • Rainbow SIG
      • Spirituality
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international
      • Women and mental health
      • Special Interest Group Job Descriptions
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Your monthly eNewsletter

      Your monthly eNewsletter

      • RCPsych eNewsletter May 2022
      • Members' update 12 May 2022
      • RCPsych eNewsletter April 2022
      • Members' update 14 April 2022
      • RCPsych eNewsletter March 2022
      • Members' update 10 March 2022
      • RCPsych eNewsletter February 2022
      • Members' update 10 February 2022
      • RCPsych eNewsletter January 2022
      • Members' update 13 January 2022
      • RCPsych eNewsletter December 2021
      • RCPsych eNewsletter November 2021
      • Members' update 11 November 2021
      • RCPsych eNewsletter October 2021
      • Members' update 14 October 2021
      • RCPsych eNewsletter September 2021
      • Members' update 26 August 2021
      • RCPsych eNewsletter July 2021
      • RCPsych eNewsletter June 2021
      • Members' update 10 June 2021
      • RCPsych eNewsletter May 2021
      • Members' update 13 May 2021
      • RCPsych eNewsletter April 2021
      • Members' update 8 April 2021
      • RCPsych eNewsletter March 2021
      • Members' update 11 March 2021
      • RCPsych eNewsletter February 2021
      • Members' update 11 February 2021
      • RCPsych eNewsletter January 2021
      • Members' update 14 January 2021
      • RCPsych eNewsletter December 2020
      • RCPsych eNewsletter November 2020
      • Members' update 12 November 2020
      • RCPsych eNewsletter October 2020
      • Members' update 8 October 2020
      • RCPsych eNewsletter September 2020
      • Members' update 11 September 2020
      • Members' update 1 September 2020
      • Members' update 14 August 2020
      • RCPsych eNewsletter July 2020
      • Members' update 10 July 2020
    • Posts for members
    • Public members list
    • Jobs board
    • Specialist and Associate Specialty Doctors

      Specialist and Associate Specialty Doctors

      • A message from the Chair
      • Who are SAS Doctors?
      • How to enter the SAS grade
      • SAS career development
      • SAS doctors resources
      • College SAS training and events
      • Startwell and Staywell
    • President's lectures

      President's lectures

      • Declaration of competing interests (President's lectures)
      • List of president's lectures competing interests
      • Past President's lectures
    • Retired members
    • New Members Ceremonies
    • Obituaries

      Obituaries

      • Submit an obituary
      • Remembering Dame Fiona Caldicott
    • Membership survey
    • Mindmasters quiz

      Mindmasters quiz

      • About the quiz
      • The draw for the quiz
      • The rules of the quiz
      • Sample quiz questions 
    • Supporting you
      • Psychiatrists Support Service
      • New consultants (StartWell)
      • Mentoring and coaching
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • If a patient dies by suicide
      • Writing clinic letters
      • Looking after yourself
    • CPD eLearning
    • Submitting your CPD
      • CPD Submissions FAQs
      • Alterations to CPD during coronavirus pandemic
    • Membership
      • Members login
      • Receipts
      • Pay Your Subscription
      • Direct Debit
      • Your subscription
      • Grades of membership
      • Benefits of membership
      • Fellowship and other Honours
      • Applying for Fellowship
      • Nominations for Honorary Fellows
      • Nominations for National Honours
    • Your Faculties
      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic Psychiatry Faculty
      • General adult psychiatry
      • Intellectual disability psychiatry faculty
      • Liaison psychiatry faculty
      • Medical psychotherapy faculty
      • Neuropsychiatry faculty
      • Old age psychiatry faculty
      • Perinatal psychiatry faculty
      • Rehabilitation and social psychiatry faculty
      • Faculty job descriptions
    • Devolved Nations
      • RCPsych in Scotland
      • RCPsych in Wales
      • Coleg Cymraeg
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions
      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • Trent
      • West Midlands
      • South West
      • Executive Committee job descriptions
      • NW and NY mentorship
    • International members
    • Special Interest Groups
      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts psychiatry
      • Digital psychiatry
      • Evolutionary psychiatry
      • History of psychiatry
      • Neurodevelopmental psychiatry
      • Occupational psychiatry
      • Philosophy
      • Private and independent practice PIPSIG
      • Rainbow SIG
      • Spirituality
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international
      • Women and mental health
      • Special Interest Group Job Descriptions
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Your monthly eNewsletter
      • RCPsych eNewsletter May 2022
      • Members' update 12 May 2022
      • RCPsych eNewsletter April 2022
      • Members' update 14 April 2022
      • RCPsych eNewsletter March 2022
      • Members' update 10 March 2022
      • RCPsych eNewsletter February 2022
      • Members' update 10 February 2022
      • RCPsych eNewsletter January 2022
      • Members' update 13 January 2022
      • RCPsych eNewsletter December 2021
      • RCPsych eNewsletter November 2021
      • Members' update 11 November 2021
      • RCPsych eNewsletter October 2021
      • Members' update 14 October 2021
      • RCPsych eNewsletter September 2021
      • Members' update 26 August 2021
      • RCPsych eNewsletter July 2021
      • RCPsych eNewsletter June 2021
      • Members' update 10 June 2021
      • RCPsych eNewsletter May 2021
      • Members' update 13 May 2021
      • RCPsych eNewsletter April 2021
      • Members' update 8 April 2021
      • RCPsych eNewsletter March 2021
      • Members' update 11 March 2021
      • RCPsych eNewsletter February 2021
      • Members' update 11 February 2021
      • RCPsych eNewsletter January 2021
      • Members' update 14 January 2021
      • RCPsych eNewsletter December 2020
      • RCPsych eNewsletter November 2020
      • Members' update 12 November 2020
      • RCPsych eNewsletter October 2020
      • Members' update 8 October 2020
      • RCPsych eNewsletter September 2020
      • Members' update 11 September 2020
      • Members' update 1 September 2020
      • Members' update 14 August 2020
      • RCPsych eNewsletter July 2020
      • Members' update 10 July 2020
    • Posts for members
    • Public members list
    • Jobs board
    • Specialist and Associate Specialty Doctors
      • A message from the Chair
      • Who are SAS Doctors?
      • How to enter the SAS grade
      • SAS career development
      • SAS doctors resources
      • College SAS training and events
      • Startwell and Staywell
    • President's lectures
      • Declaration of competing interests (President's lectures)
      • List of president's lectures competing interests
      • Past President's lectures
    • Retired members
    • New Members Ceremonies
    • Obituaries
      • Submit an obituary
      • Remembering Dame Fiona Caldicott
    • Membership survey
    • Mindmasters quiz
      • About the quiz
      • The draw for the quiz
      • The rules of the quiz
      • Sample quiz questions 
  • Events

    Events

    • Conferences and training events

      Conferences and training events

      • Register your interest - CESR in Psychiatry Training
      • MHA Section 12 and Approved Clinician Training
      • Register your interest - Present State Examination Course 2022
      • Subscribe to receive the Events eNews
      • Register your interest - ICD-11 events
      • RCPsych Certificated Courses
    • International Congress 2022

      International Congress 2022

      • Congress 2022 FAQs
      • Registration
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Travel and accommodation guidance 
      • Social and Fringe Events
      • #RCPsychIC
    • In-house training

      In-house training

      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Events held by other organisations
    • Free webinars

      Free webinars

      • Free webinars for members
    • Recruitment events
    • Claiming Expenses
    • Terms and conditions
    • Speaker guidance for online events
    • Conferences and training events
      • Register your interest - CESR in Psychiatry Training
      • MHA Section 12 and Approved Clinician Training
      • Register your interest - Present State Examination Course 2022
      • Subscribe to receive the Events eNews
      • Register your interest - ICD-11 events
      • RCPsych Certificated Courses
    • International Congress 2022
      • Congress 2022 FAQs
      • Registration
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Travel and accommodation guidance 
      • Social and Fringe Events
      • #RCPsychIC
    • In-house training
      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Events held by other organisations
    • Free webinars
      • Free webinars for members
    • Recruitment events
    • Claiming Expenses
    • Terms and conditions
    • Speaker guidance for online events
  • Improving care

    Improving care

    • College Centre for Quality Improvement (CCQI)

      College Centre for Quality Improvement (CCQI)

      • What we do in the CCQI
      • Quality Networks and Accreditation
      • National Clinical Audits
      • Multi-source feedback
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
      • CCQI news
    • Campaigning for better mental health policy

      Campaigning for better mental health policy

      • The Mental Health Act (MHA)
      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • COVID-19: Guidance for clinicians
      • Reforming The Mental Health Act
      • Don't overlook mental health campaign
      • The Mental Health Policy Group (MHPG)
    • Planning the psychiatric workforce

      Planning the psychiatric workforce

      • About workforce
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
      • Job description approval process
    • Public Mental Health Implementation Centre

      Public Mental Health Implementation Centre

      • Our partners and first partnership activity 
      • How to work with the Public Mental Health Implementation Centre
      • Who's involved in the Public Mental Health Implementation Centre?
      • Aims and objectives
      • Reports
      • About public mental health
    • National Collaborating Centre for Mental Health

      National Collaborating Centre for Mental Health

      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • COVID-19 Mental Health Improvement Network
      • Mental health quality improvement programmes
      • National suicide prevention programme
      • Reports and research
      • RCPsych Enjoying Work Collaborative
      • Reducing restrictive practice
      • Service design and development
      • Sexual Safety Collaborative
      • Work with us
      • Improving Quality in Inpatient Mental Health Settings Scoping and Design Exercise
    • Physician Associates

      Physician Associates

      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
      • The Competence Framework for Physician Associates in Mental Health
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and working sustainably

      Sustainability and working sustainably

      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • Working sustainably (old)
      • College position on sustainability
      • Attending COP26
    • RCPsych Course Accreditation

      RCPsych Course Accreditation

      • Apply for accreditation
    • Using quality improvement
    • College Centre for Quality Improvement (CCQI)
      • What we do in the CCQI
      • Quality Networks and Accreditation
      • National Clinical Audits
      • Multi-source feedback
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
      • CCQI news
    • Campaigning for better mental health policy
      • The Mental Health Act (MHA)
      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • COVID-19: Guidance for clinicians
      • Reforming The Mental Health Act
      • Don't overlook mental health campaign
      • The Mental Health Policy Group (MHPG)
    • Planning the psychiatric workforce
      • About workforce
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
      • Job description approval process
    • Public Mental Health Implementation Centre
      • Our partners and first partnership activity 
      • How to work with the Public Mental Health Implementation Centre
      • Who's involved in the Public Mental Health Implementation Centre?
      • Aims and objectives
      • Reports
      • About public mental health
    • National Collaborating Centre for Mental Health
      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • COVID-19 Mental Health Improvement Network
      • Mental health quality improvement programmes
      • National suicide prevention programme
      • Reports and research
      • RCPsych Enjoying Work Collaborative
      • Reducing restrictive practice
      • Service design and development
      • Sexual Safety Collaborative
      • Work with us
      • Improving Quality in Inpatient Mental Health Settings Scoping and Design Exercise
    • Physician Associates
      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
      • The Competence Framework for Physician Associates in Mental Health
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and working sustainably
      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • Working sustainably (old)
      • College position on sustainability
      • Attending COP26
    • RCPsych Course Accreditation
      • Apply for accreditation
    • Using quality improvement
  • Mental health

    Mental health

    • Problems and disorders

      Problems and disorders

      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Eating well and mental health
      • Feeling on the edge
      • Feeling overwhelmed
      • Feeling stressed
      • Hoarding
      • Learning disabilities
      • Medically unexplained symptoms
      • Memory problems and dementia
      • Obsessive-compulsive disorder (OCD)
      • Perinatal OCD
      • Perinatal OCD for carers
      • Personality disorder
      • Physical illness
      • Postnatal depression
      • Postnatal depression key facts
      • Postnatal depression: information for carers
      • Postpartum psychosis
      • Postpartum Psychosis in Carers
      • Post-traumatic stress disorder (PTSD) 
      • Gambling disorder
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self harm
      • Shyness and social phobia
      • Sleeping well
      • Anxiety and generalised anxiety disorder (GAD)
    • Support, care and treatment

      Support, care and treatment

      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benzodiazepines
      • Children's social services and safeguarding
      • Cognitive Behavioural Therapy (CBT)
      • Complementary and alternative medicines: herbal remedies
      • Complementary and alternative medicines: physical treatments
      • Depot medication
      • Deprivation of Liberty Safeguards
      • Electroconvulsive therapy (ECT)
      • Electronic health records in mental health services in England
      • Guide to mental health tribunals
      • Liaison psychiatry services
      • Lithium in pregnancy and breastfeeding
      • Mental capacity and the law
      • Mental health in pregnancy
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Mother and baby units (MBUs)
      • Neuromodulation
      • Perinatal mental health services: what are they?
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Social prescribing
      • Spirituality and mental health
      • Stopping antidepressants
      • Valproate in women and girls who could get pregnant
      • What to expect of your psychiatrist in the UK
      • COVID-19: Medication for mental health
      • COVID-19: Remote consultations
      • COVID-19: Going to hospital for a physical illness or injury
      • COVID-19: Eating disorders
      • COVID-19: Perinatal care
      • COVID-19: Using drugs
      • Hypnosis and hypnotherapy
    • Young people's mental health
    • Translations

      Translations

      • Arabic عربى
      • Bengali বাঙালি
      • Bulgarian български
      • Chinese 中文
      • French Français
      • German Deutsch
      • Greek Ελληνική γλώσσα
      • Gujurati ગુજરાતી
      • Hindi हिंदीहिंदी
      • Italian italiano
      • Japanese 日本語
      • Lithuanian Lietuvių kalba
      • Pashto پښتو
      • Persian (Farsi) فارسی
      • Polish Polski
      • Punjabi ਪੰਜਾਬੀ
      • Romanian Română
      • Russian Pусский
      • Somali
      • Spanish Español
      • Turkish
      • Tamil தமிழ்
      • Urdu اردو
      • Welsh Cymraeg
      • Sindhi سنڌي
      • Ukrainian украї́нська
    • Mental health and psychiatry FAQs
    • Order mental health leaflets
    • About our mental health information
    • Disclaimer about our mental health information
    • Choosing Wisely - a national campaign
    • BSL translations
    • MindEd – free mental health eLearning
    • Order mental health packs for schools
    • Audio resources
    • Veterans' mental health
    • Suicide resources
    • Problems and disorders
      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Eating well and mental health
      • Feeling on the edge
      • Feeling overwhelmed
      • Feeling stressed
      • Hoarding
      • Learning disabilities
      • Medically unexplained symptoms
      • Memory problems and dementia
      • Obsessive-compulsive disorder (OCD)
      • Perinatal OCD
      • Perinatal OCD for carers
      • Personality disorder
      • Physical illness
      • Postnatal depression
      • Postnatal depression key facts
      • Postnatal depression: information for carers
      • Postpartum psychosis
      • Postpartum Psychosis in Carers
      • Post-traumatic stress disorder (PTSD) 
      • Gambling disorder
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self harm
      • Shyness and social phobia
      • Sleeping well
      • Anxiety and generalised anxiety disorder (GAD)
    • Support, care and treatment
      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benzodiazepines
      • Children's social services and safeguarding
      • Cognitive Behavioural Therapy (CBT)
      • Complementary and alternative medicines: herbal remedies
      • Complementary and alternative medicines: physical treatments
      • Depot medication
      • Deprivation of Liberty Safeguards
      • Electroconvulsive therapy (ECT)
      • Electronic health records in mental health services in England
      • Guide to mental health tribunals
      • Liaison psychiatry services
      • Lithium in pregnancy and breastfeeding
      • Mental capacity and the law
      • Mental health in pregnancy
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Mother and baby units (MBUs)
      • Neuromodulation
      • Perinatal mental health services: what are they?
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Social prescribing
      • Spirituality and mental health
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Depression and the daily grind: Michael Levall on his game Please Knock on My Door

Cultural blog, Gaming the mind

31 October, 2017

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When I sat down to speak to Michael Levall, the Swedish main developer of Please Knock on My Door, my first instinct was to tell him that I enjoyed the game. On reflection, I wondered if 'enjoy' was the right term to use for a game about depression. Levall saw this as an issue with how games are typically perceived. 'There are books that are not supposed to be strictly fun,' he said. 'There are movies that deal with very heavy things, and I feel games have this idea connected to them that they are supposed to make you laugh, but I don't think that's the case at all.'

Please Knock on My Door focuses on a fortnight in the life of a character who experiences symptoms of depression. It's a down-to-earth tale, with the player seeing the main character through everyday tasks at work and at home. In portraying this, the game shows how deepening depression can affect daily functioning.

Initially a prototype he had developed at university, Levall's game was inspired by his own experiences. 'I wanted to use the game medium as someone else would use a diary. When you use a diary, you write with the purpose of having a moment of reflection. I decided to use game development for that same purpose.'

He returned to the prototype three years ago to begin development proper. The writing process for the game was stressful, at times. 'I would write late in the evening. I would prepare myself mentally for an entire day just to get a couple of hours of writing done. I have a ton of respect for the subject matter, which means that I would rather release nothing than release a game that deals with this poorly. So it was very important for me to make sure all of the texts were serious, genuine and respectful to the subject matter and to people who had similar experiences.'

The scenarios within the game offer a candid view of the trials someone with depression can face. 'I had done the initial prototype when I was depressed,' Levall said. 'That was a way for me to cope and to deal with what I was going through. Many of the stories I wrote for the game are actually taken from my own life.'

On top of this true-to-life foundation, Levall elaborated with fictional elements, as he 'didn't want to create an autobiography in game form.'

As a result of Levall's perspective, Please Knock on My Door is a particular take on depression that won't necessarily ring true to all people. 'I felt there was some higher value in the player being forced into this specific narrative that followed only one person and their struggles. As long as there are parts of it you can connect with, you can still empathise with the main character.'

Levall resisted taking a broad view in order to preserve the 'soul' of the game. 'I don't think you can generalise too much. If the game was entirely relatable to any other person, would it still be personal?'

However the game resonates with players, Levall intends for the game to have a wide appeal. 'One core idea was that I wanted someone who was depressed to be able to use the game as a catalyst for discussion, essentially offering the game to a family member or friend and going 'Hey, I can't explain what I'm going through, but if you play this game, maybe you'll be able to understand, and we can talk.''

Central to the game is the main character's 'mental fortitude', a measure that isn't explicitly explained, but might be thought of as a summary value of the character's mood, energy, motivation and confidence. As this value decreases, the player becomes less able to engage in certain actions.

The first actions to become unfeasible involve communicating with others. As the mental fortitude continues to dwindle, even simpler tasks become impossible to complete. 'I wanted to convey that when things are going your way, you're able to deal with things and talk to people about how you're feeling, but when your mental state declines, all your effort goes into, for example, being able to do the dishes.'

Almost every action in the game has either a positive or negative effect on the mental fortitude value. 'It is a way to make the player explore how their actions affect the mind state of the character,' said Levall. 'If you don't eat, if you don't sleep well, if you don't talk to people, that's going to have its effect on you.'

Some actions can have different effects in the short term compared to their eventual long term effect, as Levall explained: 'I made that to show that some things can make you feel worse at the moment, but they can have positive effects in the long run.

For instance, facing difficult thoughts or talking to people about difficult things; those might be difficult to do, and might make you feel worse in the moment, but can increase your mental state going forward. In the opposite way, if you use games as escapism, or watch TV shows to avoid dealing with life, that might make you feel better for the moment, but in the long run that's only going to bring you down.'

Stacking the odds

Levall is open about the fact the game stacks the odds against the player. Maintaining mental fortitude is difficult, and all the more difficult when you can't do things that might be helpful, such as reaching out to others. 'I wanted players to always feel the weight of every choice,' he said. 'I get the sense that most people feel like there's something that they could do, but they simply can't figure out what that thing is, which to me is one of the central emotions when you are depressed. You feel like there should be something for you to do, like you should be able to deal with this, you should be able to snap out of it, but it's just impossible.'

The main character bounces back and forth from home to work, but as depression creeps in, it becomes difficult to maintain this routine. At home, it is up to you to pass the time, which can be hard when there is little your character wants to do. 'One thing I felt was a common thread for people with depression, and that resonated strongly with me, was that hobbies stopped being fun or interesting. For me, that meant playing games in the evening wasn't something I did for fun, it was something I did to pass time, because I wasn't tired enough to go to sleep. I wanted that to be part of the game.'

If passing time is hard, equally hard is keeping to time. You need to leave for work in the morning, but with a growing tendency to oversleep, and a morning routine that can take longer than anticipated, chances are you'll eventually show up late to the office. 'In the game, you don't get to decide how long actions are going to take you,' said Levall, 'because you don't sit down to watch TV and decide exactly how many minutes you're going to spend there. Of course that has implications during the morning ritual, like do you have time to eat? What kind of food should you make? Do you have time to shower? Should you just take a quick shower? That information on timing isn't there; it's all hidden. I wanted to capture the sense that you merely push the character in certain directions, but you're never in complete control, just like you're never in complete control in reality, either.'

Spiralling out of control

It shouldn't come as surprise that things begin to spiral out of control, both at work and at home. If you are used to feeling rewarded by games, this might be tough to take. 'It was actually very difficult to write in a way that the player wouldn't just get frustrated,' said Levall. 'How do you write a character that has weaknesses that don't come off as frustrating for the player? Usually that's a no-no as far as games go; you want the player to feel powerful and in control.'

The game creates an excellent tension between the mindsets of the player and the character they are playing as. For example, it may seem obvious to the player that the character should cook and eat a comforting meal, but that may be beyond the character's capability.

Similarly, at work, the player may notice social support is available that the character isn't able to appreciate. 'In this case, I had to write characters that would give enough hints so that the player would know 'Okay, these characters care'. They try to reach out to the main character, however they still have to be obtuse enough for it to make sense that the main character, in the state they are in, would not be able to understand or would not have the energy to pick up on it.'

As the game draws to a conclusion, things become increasingly desperate for the main character and their ability to cope. How things turn out depend on the player's choices, with three possible endings. There are no 'good' or 'bad' outcomes, with all endings operating on what Levall labels a greyscale.

Of course, one outcome is worse than the others, and I had to ask Levall about this. 'Personally,' he replied, 'I didn't want it to be too obvious a thing. Think: what could be the most horrendous thing to happen in response to depression? Of course, suicide comes to mind. I didn't want people to expect that to happen, and for me to just give in to those expectations. But, at the same time, if I didn't deal with that, would I still be doing the theme justice? I decided to keep it in, but with my own twist to it. I feel like the most important thing is to be honest and upfront with players, so that someone who does not want to be subjected to that would not be shocked. I wanted to be very upfront with players about what this game is, so that they don't expect this game to be something else.'

Seeing the hope

Such themes can be distressing, but Levall wants players to see the hope in each ending. 'I never wanted to leave the player in a dark place, so I usually tell people to not stop playing once they start. The second week pushes the player very far down, but I wanted to leave the player with an idea that things get better. That was very important to me. I feel some responsibility as a creator that if someone who is depressed plays my game, I don't want to leave them feeling like everything is hopeless, so it was very important for me to make sure all of the endings had some kind of positive connotation to them.'

Like many games that tackle the subject of depression, the prospect of seeking medical attention is not covered. While Please Knock on My Door touches on themes of recovery, Levall is clear that he wasn't producing a guide on how to get better. 'I'm not a psychiatrist, so I don't feel comfortable talking in those terms,' he said. 'All I could do was to try and offer an individual perspective and hopefully add something valuable to the overall discussion about mental illness. I can't say for sure if someone who is depressed would gain something from playing this; I have heard from people that the game was able to strike a chord with them. In the end, I made it more as entertainment than as a tool, but I feel entertainment has a strong place in our culture for dealing with difficult themes and making them more available and approachable to people.'

While Levall is keen for Please Knock on My Door to contribute to the conversation on mental illness, he recognises that encouraging people to play it remains a hurdle, once again striking on the idea that games should be only for enjoyment. 'One of the bigger challenges has been to convince people that the game is actually worth their time. As it is a commercial product, people are choosing between this and whatever other game is made for them to feel happy. So it can be a bit of a rough sell. The way I try to frame it is that this game won't simply last two hours and be over; hopefully it will give you some kind of a takeaway that you can then bring with you during the rest of your life. I feel it has been able to do that, at least for some people.'

Please Knock on My Door is currently available for Windows.

Authored by Sachin Shah

Blog Author
Gaming the mind team

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