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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
      • RCPsych Recruitment Strategy 2022-2027
    • 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
      • RCPsych Recruitment Strategy 2022-2027
    • 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 2023 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 2023 Masterclass Programme application and process details
      • Perinatal project resources
      • About the Building Capacity Project
  • Members

    Members

    • Supporting your professional development

      Supporting your professional development

      • 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

      • 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

      • Members' update 9 June 2022
      • 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 
    • Workforce wellbeing hub

      Workforce wellbeing hub

      • How the College supports workforce wellbeing
    • Supporting your professional development
      • 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
      • 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
      • Members' update 9 June 2022
      • 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 
    • Workforce wellbeing hub
      • How the College supports workforce wellbeing
  • 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
      • Grand Rounds
    • International Congress 2022

      International Congress 2022

      • Congress 2022 FAQs
      • Registration
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Speaker information
      • 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
      • Grand Rounds
    • International Congress 2022
      • Congress 2022 FAQs
      • Registration
      • Poster Presentations 2022
      • Exhibition Opportunities 2022
      • Your guide to Congress
      • IC22 Keynote speakers
      • Programme
      • Speaker information
      • 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)
      • Catatonia
    • 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)
      • Catatonia
    • 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
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Psychiatric care and the 1918 flu pandemic by Dr Claire Hilton

History, Archives and Library blog

07 April, 2020

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By Dr Claire Hilton, Historian in Residence at the RCPsych.

Influenza 1918-1919

The devastating “Spanish Flu” pandemic of 1918-19 hit the UK in three waves; in spring and autumn 1918 and in spring 1919. It coincided with the end of the First World War.

An eminent psychiatrist recently asked me if there were any inspiring stories of how psychiatrists supported patients in that epidemic. I love writing upbeat accounts of the past, but scrupulous honesty is vital for historical analysis, and so far, I have found little positive on this subject. Nonetheless, I have decided to put pen to paper about some aspects of influenza and other infectious diseases, mainly in the asylums, at that time.

The wider scene

Bacteriologist Frederick Twort wrote in the Lancet in 1915:

It is quite possible that an ultra-microscopic virus belongs somewhere in this vast field of life more lowly organised than the bacterium or amoeba. It may be living protoplasm that forms no definite individuals, or an enzyme with power of growth.1

“Viruses” would pass through filters which trapped bacteria, but little else was known about them. The term was used generically, derived from the Latin virus meaning poison or venom, without the understanding we have today.

In November 1918, two days after Armistice Day marking the end of the war, and when death rates from flu were rising, the chief medical officer (England and Wales), Sir Arthur Newsholme, addressed the Royal Society of Medicine: influenza was

a disease which, with the exception of plague and cholera, has on occasion travelled farther and more rapidly over the world than any other recognized disease. It differs from these two diseases in that their pandemic course can be stayed by organized measures which are well within human capacity. I know of no public health measures which can resist the progress of pandemic influenza.

He commented on the problems of overcrowding on

trains, trams, and omnibuses. These, doubtless, are prolific sources of infection, but the service cannot immediately be increased, and meanwhile the vast army of workers must not be impeded by regulations as to overcrowding of vehicles in their efforts to go to work and to return home, and I have had no hesitation in recommending the Local Government Board to advise police authorities to this effect. 

Confusingly, he also advocated the benefits of isolating sick individuals and of social distancing.

The circumstances in 1918 were vastly different from today, but the messages conveyed uncertain medical direction, similar to our recent experience. At the end of the war, the mass movement of troops in confined spaces of ships and trains probably increased the spread. In the euphoria of the Armistice, there was no “lockdown” and a dutiful and stoical population accustomed to following orders “carried on” despite the recognised hazards.2

Armistice celebration group of people in a car

A group of women in an American automobile, London, 11 November 1918. © IWM (Q 65858)

In the asylums

In 1918 most people designated “insane” were detained in public asylums under the Lunacy Act 1890. Asylums had experienced four years of intense hardship, including overcrowding (20% of all asylum beds were requisitioned for military casualties) and inadequate food, heating and clothing. Asylum patients suffered from catastrophic neglect. Their death rate from three potentially preventable infections—tuberculosis (TB), dysentery and typhoid—far exceeded that of the rest of the civilian population, including in the prisons. Regarding mental health, public and government largely ignored the plight of civilian patients and staff, focussing instead on shell-shocked soldiers. At a time of crisis, the well-being of the already deprived population of mentally unwell civilians dropped even lower on the scale of the public hierarchy of need.

The most devastating wave of influenza hit the UK in autumn 1918. At that time, the Board of Control, which regulated asylums in England and Wales, faced numerous problems, such as escalating asylum deaths from TB and strikes by discontented staff after four years of derisory wartime working conditions, hours and pay. To add to the challenges, disturbed patients probably suffering from flu-related delirium were transferred from general hospitals to asylums. One patient at the Worcester County Asylum at Powick “recently admitted with severe influenza…was found not to be insane, and will be removed as soon as she is able to travel.” In that asylum, of 1,000 in-patients, nine died from influenza in 1918—and 158 died from TB.3

Across English and Welsh asylums in 1918, 20,000 patients died from all causes, one-fifth of the entire asylum population. Seven thousand deaths were caused by potentially preventable infections, particularly TB. Influenza killed a further 1,300. Flu was only one cause of many disturbing asylum deaths on a background of sub-standard care.

Very few staff spoke out about poor standards. Dr Montagu Lomax was one who had the courage to do so (but only after leaving asylum employment). Based on his war-time work at Prestwich Asylum, he wrote about infectious diseases:

…though exposure to wet and cold, and improper diet, do not of themselves produce consumption [TB], they are the most potent accessory factors in its production among those predisposed to it. The same holds good of that dreadful scourge influenza.…I wonder if it has ever occurred to these learned gentlemen to connect this excessive mortality with the facts of deficient clothing and defective feeding, in addition to the imperfect isolation, and the want of proper consumptive wards.4

Lomax openly criticised the asylum authorities for neglecting patients’ basic needs. His report shocked public and officials alike. It also became central to the process of liberalising mental health law and making other useful changes over the following decade.5

References

1. Frederick Twort, “An investigation on the nature of ultra-microscopic viruses” Lancet, 4 December 1915: 1241-43.

2. Arthur Newsholme, “Discussion on influenza” Proc RSM, 1919: Gen Rep, 12, 1-18. 3, 13. 

3. Sixty-sixth annual report of the County and City of Worcester Lunatic Asylum, Powick, for 1918-19 Worcester, 1919: 11, 27.

4. Montagu Lomax, The Experiences of an Asylum Doctor London: Allen and Unwin, 1921: 60, 61.

5. TW Harding, “‘Not worth powder and shot’: A reappraisal of Montagu Lomax's contribution to mental health reform” BJPsych 1990: 156, 180-87.

Blog Author
Claire Hilton

Historian in Residence, RCPsych

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