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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?
      • What next?
      • On a break from training?
      • Continuing to choose psychiatry
      • Help support our campaign
      • Choose Psychiatry – Guidance for Medical Schools
      • 'Make this a better world'
    • Sixth formers and school students
    • Medical students

      Medical students

      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National Student Psychiatry 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
      • Applying to Core and Higher Training
    • 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
    • Supporting Medical Students: Medical Schools
    • Careers past events
    • Choose Psychiatry
      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • What next?
      • On a break from training?
      • Continuing to choose psychiatry
      • Help support our campaign
      • Choose Psychiatry – Guidance for Medical Schools
      • 'Make this a better world'
    • Sixth formers and school students
    • Medical students
      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries
      • PsychSocs
      • National Student Psychiatry 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
      • Applying to Core and Higher Training
    • Help us promote psychiatry
      • How can I help?
      • Ideas to inspire you
      • Resources to help you promote psychiatry
      • RCPsych Recruitment Strategy 2022-2027
    • Supporting Medical Students: Medical Schools
    • Careers past events
  • Training

    Training

    • Exams

      Exams

      • Can I take an exam?
      • Contact the Exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • A fair exam
      • Examiners and exam panels recruitment
      • FAQs about applying for exams
      • FAQs about preparing for exams
      • FAQs about the day of the exam
      • FAQs about assessment and results
      • Exams news and updates
      • Invitation to tender to develop an international CASC examination centre
    • Curricula and guidance

      Curricula and guidance

      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
      • Assessment Strategy Review
    • Portfolio Online
    • Your training

      Your training

      • Psychiatric Trainees' Committee: supporting you
      • Time out of training
      • 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
      • Industrial action FAQs
      • Distribution of medical training posts
    • Medical training initiative (MTI)
    • International Medical Graduates
    • Deanery/LETB Hub
    • Undergraduate education forum
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Dean's Quarterly Updates

      Dean's Quarterly Updates

      • Dean's update - 2022
      • Dean's Quarterly Update - March 2023
      • Dean's Quarterly Update - June 2023
      • Dean's Quarterly Update - October 2023
    • Neuroscience in training

      Neuroscience in training

      • About the project
      • Neuroscience resources
      • Multimedia learning
    • Building Capacity in Perinatal Psychiatry

      Building Capacity in Perinatal Psychiatry

      • Perinatal 2023 Masterclass Programme application and process details
      • About the Building Capacity Project
    • Exams
      • Can I take an exam?
      • Contact the Exams team
      • Preparing for exams
      • Applying for your exam
      • Exam results
      • Special notices
      • A fair exam
      • Examiners and exam panels recruitment
      • FAQs about applying for exams
      • FAQs about preparing for exams
      • FAQs about the day of the exam
      • FAQs about assessment and results
      • Exams news and updates
      • Invitation to tender to develop an international CASC examination centre
    • Curricula and guidance
      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
      • Assessment Strategy Review
    • Portfolio Online
    • Your training
      • Psychiatric Trainees' Committee: supporting you
      • Time out of training
      • 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
      • Industrial action FAQs
      • Distribution of medical training posts
    • Medical training initiative (MTI)
    • International Medical Graduates
    • Deanery/LETB Hub
    • Undergraduate education forum
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Dean's Quarterly Updates
      • Dean's update - 2022
      • Dean's Quarterly Update - March 2023
      • Dean's Quarterly Update - June 2023
      • Dean's Quarterly Update - October 2023
    • Neuroscience in training
      • About the project
      • Neuroscience resources
      • Multimedia learning
    • Building Capacity in Perinatal Psychiatry
      • Perinatal 2023 Masterclass Programme application and process details
      • About the Building Capacity Project
  • Members

    Members

    • 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
    • Submitting your CPD
    • Workforce Wellbeing Hub

      Workforce Wellbeing Hub

      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Coaching and mentoring
      • If a patient dies by suicide
      • If a patient commits homicide
    • Supporting your professional development

      Supporting your professional development

      • New consultants (StartWell)
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • Writing clinic letters
      • If a patient dies by suicide
    • CPD eLearning
    • Your Faculties

      Your Faculties

      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic psychiatry
      • General adult psychiatry
      • Intellectual disability psychiatry
      • Liaison psychiatry
      • Medical psychotherapy
      • Neuropsychiatry
      • Old age psychiatry
      • Perinatal psychiatry
      • Rehabilitation and social psychiatry
      • Faculty job descriptions
    • Specialty and Specialist Doctors

      Specialty and Specialist 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
      • SAS Strategy
    • Devolved Nations

      Devolved Nations

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

      English Divisions

      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • South West
      • Trent
      • West Midlands
      • 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
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international (VIPSIG)
      • Women and mental health
      • Annual SIG Newsletters
    • Public members list
    • RCPsych Insight magazine

      RCPsych Insight magazine

      • RCPsych Insight Cover Art Exhibition
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Jobs board
    • Committees of Council
    • 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
    • eLearning Hub
    • Obituaries

      Obituaries

      • Submit an obituary
      • Remembering Dame Fiona Caldicott
      • Memorial service for Professor Andrew Sims
    • Mindmasters quiz

      Mindmasters quiz

      • Attend Mindmasters 2023
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • RCPsych ceremonies

      RCPsych ceremonies

      • New Members Ceremonies
      • Fellowship ceremonies
      • Specialist Registration Ceremonies
    • 2021 membership survey
    • 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
    • Submitting your CPD
    • Workforce Wellbeing Hub
      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Coaching and mentoring
      • If a patient dies by suicide
      • If a patient commits homicide
    • Supporting your professional development
      • New consultants (StartWell)
      • Revalidation
      • Assessing and managing risk of patients causing harm
      • Leadership and management
      • Working less than full time
      • Writing clinic letters
      • If a patient dies by suicide
    • CPD eLearning
    • Your Faculties
      • Academic psychiatry
      • Addictions psychiatry
      • Child and adolescent psychiatry
      • Eating disorders psychiatry
      • Forensic psychiatry
      • General adult psychiatry
      • Intellectual disability psychiatry
      • Liaison psychiatry
      • Medical psychotherapy
      • Neuropsychiatry
      • Old age psychiatry
      • Perinatal psychiatry
      • Rehabilitation and social psychiatry
      • Faculty job descriptions
    • Specialty and Specialist 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
      • SAS Strategy
    • Devolved Nations
      • RCPsych in Scotland
      • RCPsych in Wales
      • Coleg y Seiciatryddion
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions
      • Eastern
      • London
      • Northern and Yorkshire
      • North West
      • South Eastern
      • South West
      • Trent
      • West Midlands
      • 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
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international (VIPSIG)
      • Women and mental health
      • Annual SIG Newsletters
    • Public members list
    • RCPsych Insight magazine
      • RCPsych Insight Cover Art Exhibition
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Jobs board
    • Committees of Council
    • President's lectures
      • Declaration of competing interests (President's lectures)
      • List of president's lectures competing interests
      • Past President's lectures
    • Retired members
    • eLearning Hub
    • Obituaries
      • Submit an obituary
      • Remembering Dame Fiona Caldicott
      • Memorial service for Professor Andrew Sims
    • Mindmasters quiz
      • Attend Mindmasters 2023
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • RCPsych ceremonies
      • New Members Ceremonies
      • Fellowship ceremonies
      • Specialist Registration Ceremonies
    • 2021 membership survey
  • Events

    Events

    • Conferences and training events

      Conferences and training events

      • Register your interest - CESR in Psychiatry Training
      • MHA Section 12 and Approved Clinician Training
      • Subscribe to receive the Events eNews
      • RCPsych Certification Courses
      • Grand Rounds
    • International Congress 2023

      International Congress 2023

      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Programme
      • Social Media
      • Exhibition opportunities 2023
      • Your guide to Congress
      • Social and Fringe Events
      • Congress 23 Webinar Package
    • International Congress 2024

      International Congress 2024

      • Poster Presentations 2024
      • Exhibition opportunities 2024
    • 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
      • Subscribe to receive the Events eNews
      • RCPsych Certification Courses
      • Grand Rounds
    • International Congress 2023
      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Programme
      • Social Media
      • Exhibition opportunities 2023
      • Your guide to Congress
      • Social and Fringe Events
      • Congress 23 Webinar Package
    • International Congress 2024
      • Poster Presentations 2024
      • Exhibition opportunities 2024
    • 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

      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position Statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • 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

      • Partnerships and events  
      • How to work with the Public Mental Health Implementation Centre
      • About the PMHIC
      • Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
      • PMHIC Commercial Determinants of Mental Health (CDoMH) Symposium 
      • PMHIC Parliamentary Roundtable 
    • National Collaborating Centre for Mental Health

      National Collaborating Centre for Mental Health

      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reports and research
      • Service design and development
      • Work with us
    • 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
    • Act Against Racism

      Act Against Racism

      • Tackling racism in the workplace
      • Adopt the guidance and join our network
      • Act Against Racism: a toolkit to support the campaign
      • If you're experiencing racism at work
      • Allies: information and signposting
      • FAQs about the campaign
      • Act Against Racism campaign films
      • Resources
    • Sustainability and mental health

      Sustainability and mental health

      • Why is sustainability important?
      • In your community
      • In your practice
      • In your trust
      • Sustainability at RCPsych
      • Nature matters
      • Sustainability scholars
      • Sustainability resources
      • College position on sustainability
      • RCPsych at COP26
      • The eco-crisis and CAMHS
    • Invited Review Service
    • Public Health and its role in mental heath
    • RCPsych Course Accreditation
    • Using quality improvement
    • Net Zero Mental Health Care Guidance and Education
    • Mental Health Awareness Week
    • 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
      • Five Year Forward View
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Join our Research Panel
      • College Reports
      • Position Statements
      • Process for College publications
      • Other policy areas
      • Mental Health Watch
      • 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
      • Partnerships and events  
      • How to work with the Public Mental Health Implementation Centre
      • About the PMHIC
      • Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
      • PMHIC Commercial Determinants of Mental Health (CDoMH) Symposium 
      • PMHIC Parliamentary Roundtable 
    • National Collaborating Centre for Mental Health
      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reports and research
      • Service design and development
      • Work with us
    • 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
    • Act Against Racism
      • Tackling racism in the workplace
      • Adopt the guidance and join our network
      • Act Against Racism: a toolkit to support the campaign
      • If you're experiencing racism at work
      • Allies: information and signposting
      • FAQs about the campaign
      • Act Against Racism campaign films
      • Resources
    • Sustainability and mental health
      • Why is sustainability important?
      • In your community
      • In your practice
      • In your trust
      • Sustainability at RCPsych
      • Nature matters
      • Sustainability scholars
      • Sustainability resources
      • College position on sustainability
      • RCPsych at COP26
      • The eco-crisis and CAMHS
    • Invited Review Service
    • Public Health and its role in mental heath
    • RCPsych Course Accreditation
    • Using quality improvement
    • Net Zero Mental Health Care Guidance and Education
    • Mental Health Awareness Week
  • Mental health

    Mental health

    • Mental illnesses and mental health problems

      Mental illnesses and mental health problems

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

      Support, care and treatment

      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benefits, financial support and debt advice
      • Benzodiazepines
      • Caring for someone with a mental illness
      • 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)
      • Hypnosis and hypnotherapy
      • 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
      • Mental Health Tribunals
      • 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: for patients and carers
      • Veterans' mental health
    • Young people's mental health

      Young people's mental health

      • Bipolar disorder for young people
      • Cannabis and mental health: for young people
      • Club drugs
      • Cognitive behavioural therapy (CBT) for young people
      • Coping with stress for young people
      • Depression in children and young people
      • Drugs and alcohol for young people
      • Eco distress: for young people
      • Physical activity, exercise and mental health for young people
      • OCD for young people
      • Psychosis in young people
      • Schizophrenia: for young people
      • When a parent has a mental illness
      • When bad things happen
      • Who is who in CAMHS?: for parents, teachers, young people and carers
      • Anxiety: for young people
      • Weight, exercise and eating disorders in young people
      • Preparing for a blood test or vaccine for young people
      • Use of digital media for young people
    • Translations

      Translations

      • Arabic عربى
      • Bengali বাঙালি
      • Chinese 中文
      • French Français
      • German Deutsch
      • Greek Ελληνική
      • Gujarati ગુજરાતી
      • Hindi हिंदीहिंदी
      • Italian Italiano
      • Japanese 日本語
      • Lithuanian Lietuvių kalba
      • Marathi मराठी
      • Pashto پښتو
      • Persian (Farsi) فارسی
      • Polish Polski
      • Portuguese (Brazil) Português (Brasil)
      • Punjabi (Pakistan) پنجابی
      • Romanian Română
      • Russian Pусский
      • Sindhi سنڌي
      • Somali
      • Spanish Español
      • Swahili Kiswahili
      • Tamil தமிழ்
      • Telugu తెలుగు
      • Turkish
      • Ukrainian украї́нська
      • Urdu اردو
      • Vietnamese Việt
      • Welsh Cymraeg
      • התמודדות לאחר אירוע טראומטי Coping after a traumatic event in Hebrew
      • Mijûlbûna piştî bûyerekê trawmatîk Coping after a traumatic event in Kurdish
    • Order mental health resources

      Order mental health resources

      • Order mental health packs for schools
    • About our mental health information
    • Mental health information disclaimer
    • Mental health and psychiatry FAQs
    • Choosing Wisely - a national campaign
    • Mental illnesses and mental health problems
      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety and generalised anxiety disorder (GAD)
      • Avoidant/restrictive food intake disorder (ARFID)
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Catatonia
      • Club drugs
      • Cocaine dependence
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • Hoarding
      • Isotretinoin and mental health
      • Learning disabilities
      • Medically unexplained symptoms
      • Memory problems and dementia
      • Obsessive-compulsive disorder (OCD)
      • Perinatal OCD
      • Perinatal OCD for carers
      • Personality disorder
      • Physical illness and mental health
      • Postnatal depression
      • Postnatal depression key facts
      • Postnatal depression: information for carers
      • Postpartum psychosis
      • Postpartum Psychosis in Carers
      • Post-traumatic stress disorder (PTSD) 
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self-harm
      • Shyness and social phobia
      • Sleeping well
    • Support, care and treatment
      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Antipsychotics in pregnancy
      • Being sectioned
      • Benefits, financial support and debt advice
      • Benzodiazepines
      • Caring for someone with a mental illness
      • 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)
      • Hypnosis and hypnotherapy
      • Liaison psychiatry services
      • Lithium in pregnancy and breastfeeding
      • Mental capacity and the law
      • Mental health in pregnancy
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Pauper lunatics were not paupers

History, Archives and Library blog

23 February, 2022

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History BannerBy Dr Claire Hilton, Historian in Residence at the RCPsych.

One hundred years ago, the only way most of the population could access psychiatric treatment was by “certification” and admission to a local authority lunatic asylum under the Lunacy Act 1890 (England and Wales)1. The Act automatically designated these asylum patients by the stigmatising term “pauper lunatic”. If you were wealthy, you could avoid this label, such as by seeking outpatient consultation or admission to a private institution.

For the majority of the population, obtaining any psychiatric treatment carried multiple stigmas: of certification, lunacy, pauper, and asylum admission.  We shall unwrap this a little, and ask whether we have anything to learn from it today. 

 Paupers and pauper lunatics

 To many people today, the term pauper conjures up Dickensian, Oliver Twist like images, of absolute poverty, destitution, hunger and ragged clothes, or life in a workhouse with enforced manual labour and little to eat except gruel. Being a pauper indicated dependence upon the much-hated Poor Law. Occasionally, one of these paupers became mentally unwell and was admitted to an asylum. Most people admitted to asylums, though, were in employment or were housewives, supporting their family until their illnesses began. So why were they designated pauper lunatics? Even the passionate advocate for “lunacy reform”, Earl Russell, was baffled by this, and at the Royal Commission on Lunacy and Mental Disorder in 1924 Russell asked Sir Frederick Willis of the Ministry of Health for clarification, whether “a man who has been paying his rent and paying his way, and who does not owe anybody anything and is earning his wages, may suddenly be called a pauper when he comes to be certified, although in the ordinary sense of the word he is not a pauper at all?” Sir Frederick answered him simply and clearly: “Yes”.

 Once certified and admitted, the Poor Law Board of Guardians would assess the patient’s finances. After this means-testing, if the Board was required to make any financial contribution whatsoever, the patient remained designated as a pauper lunatic. A few who were assessed as able to afford the full cost of their in-patient stay were reclassified as private patients. Private patients often had more choice and autonomy about their care and treatment. They often received better food, had the option of wearing their own clothes, were less likely to have their letters intercepted, and the person responsible for paying for them could request their discharge.  

 During the First World War, military authorities, the government and the general public were eager to avoid casualties suffering from combat-related “shell shock” being classed as paupers.  They argued that it was a disrespectful label for those harmed while serving King and country. They identified a solution: the Army Act 1881 designated mentally unwell soldiers and sailors as “service” patients, and, if they were admitted to an asylum, their fees were paid through national resources rather than through the Poor Law. Some of the civilian asylum leadership argued at that time that all patients should have the same status, that no patient should have the opprobrious label of pauper and that the status given to mentally traumatised soldiers should “be extended at the earliest practicable moment to the civilian population.”[2]

 The pauper lunatic label was a legal technicality, but it was likely to be detrimental to patients. Its stigma probably contributed to deterring people from seeking help, resulting in “serious and even disastrous delay.” (Journal of Mental Science 1914, 60: 667-74) In the words of one senior psychiatrist: “classified alike with the others who cannot pay their maintenance and are dependent on the rates, they are stamped as paupers; and I think all these things help to push the unfortunate lunatic further down, and bring contempt on mental hospitals as a whole.”

Some thoughts for today

 The scenarios described around a century ago make me ever grateful that we have a National Health Service (NHS), and that healthcare is, in the main, not means tested (although some things are: e.g. prescriptions, spectacles, dental treatment and so-called “social” care for illnesses such as Alzheimer’s). Today, private healthcare exists, but as a choice rather than a means-tested division imposed by statute.

 Fortunately the term “pauper lunatic” disappeared from official language almost a century ago.  New terminology can acquire stigma and there is still debate about the right language to use when referring to people requiring help for mental disorders. Stefan Priebe (BJPsych Bulletin 2021, 45:327-8) recently argued that “Patients in mental healthcare should be referred to as patients and not service users” as the term service user is discriminating, cynical, patronising and detrimental, and “these effects are not intentional, but that does not prevent their ultimate harm.” Arguably, deprecating language may reflect values and attitudes of those in authority, which may influence decision making about NHS resource allocation, and have adverse effects on what we can provide for the people we serve.

 Changing terminology may help to reframe ideas and values and may help find solutions but will not solve societal inequity.  Nevertheless, there is one thing we can all do which may make our language about mentally unwell people (and others), more humane. That is, to remove the definite article. Never say “the mentally ill”, “the elderly”, “the disabled” etc: instead say: “mentally ill people”, “elderly people”, “disabled people” etc. Who knows, if it catches on, it may help to make attitudes just a little more compassionate.

 Frontispiece from: A treatise on the nature, symptoms, causes, and treatment of insanity by Sir William Charles Ellis, 1838.  (Public Domain), Wellcome Collection

Frontispiece from: A treatise on the nature, symptoms, causes, and treatment of insanity, with practical observations on lunatic asylums, and a description of the pauper lunatic asylum for the county of Middlesex, at Hanwell, with a detailed account of its management by Sir William Charles Ellis, 1838. (Public Domain, Wellcome Collection)

Notes:

  1.  Today, the nearest equivalent to Lunacy Act certification is admission under a “section” of the Mental Health Act 1983, but in most ways, the two legal processes have little in common.
  2. E Marriott Cooke and C Hubert Bond, History of the Asylum War Hospitals in England and Wales.  London: HMSO, 1920.  29.


Blog Author
Claire Hilton

Historian in Residence, RCPsych

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