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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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Hot cross buns on Good Friday – then and now

History, Archives and Library blog

13 April, 2022

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

April 1919: the management committee of the 2,000 bed Colney Hatch Mental Hospital in North London agreed that “authority be given for the issue of Hot Cross Buns to the patients and staff on Good Friday.” Two years later they did not have hot cross buns as they were too expensive. The hot cross buns story is emblematic of persisting financial challenges which impair provision of best quality, timely and appropriate mental health services, delivered by excellent staff and in suitable environments, and which help patients keep well long term.

In this blog, I will start by telling you what happened a century ago, and then discuss why it is relevant today.

A century ago

Dr Samuel Gilfillan was senior psychiatrist and medical superintendent at Colney Hatch. The committee there sought his opinion on almost every administrative decision which might somehow affect the mental and physical wellbeing of patients, including about staffing, food, farming, managing the sewage works and balancing the books. He advised on arranging escorts for repatriating German prisoner of war patients, and others. He was consulted on poultry rearing, and what to do when the hospital had “been invaded by hordes of rats.” Regarding staff, there were decisions to make on the feasibility of laying lawn tennis courts for the nurses, many of whom lived on site in hospital accommodation, and making “arrangements as he may find desirable for nurses who may wish to smoke when off duty”. His agreement was needed when additional expenditure was proposed, such as for patients to go on outings, for materials to make new costumes for their fancy-dress ball, and whether to serve hot cross buns on Good Friday.

The hot cross buns for patients and staff in 1919 cost £10.7.10d. (£10.39p) in total (when in-patient treatment cost about £1 a week per patient). Two years later, in 1921, there were no hot cross buns, but cake instead. The management committee minutes do not explicitly tell us why, but cake cost less, around £7 for the entire institution.

By 1921, the euphoria and economic boom immediately following the First World War had given way to recession, austerity and public sector cuts. Even the need for medical equipment was re-evaluated. An X-ray machine would have been useful, to save having to take Colney Hatch in-patients to the general hospital a couple of miles away in the event of injury, but even a second-hand one was too dear.

Costs soared throughout the country in the early 1920s. In the mental hospitals, better working hours, more staff and improved salaries were all needed. Some progress was made. The nurses’ working week was reduced from over 66 to 48 hours, but recruitment and retention were still major problems. Staff were exhausted, under paid, overworked, and hardly likely to be able to provide optimum care for patients.

Healthcare was only one of many government concerns. Physical health, particularly public health and maternal and child welfare took priority on the health agenda. The Ministry of Health’s report Future Provision of Medical and Allied Services (1920) regarded the mental hospitals as a “Supplementary Service”, outside the main primary and secondary care scheme, hardly likely to encourage prioritisation.

Wooden box on wheels with metal crane like appendage.

Mobile x-ray set, England, 1920-1930. (Credit: Science Museum Group Collection, Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence

 

Colney Hatch Mental Hospital: inpatient costs
Financial Year
Average inpatient cost, per week
1913-1410s 9d (54p)
1918-1916s 9d (84p)
1919-2022s 4d (£1.12)
1920-2128s 1d (£1.40)

Handwritten running order for a day of celebrations

Celebrations at Colney Hatch during the economic boom post-First World War (Credit: Medical Superintendent's Reports ref: H12/CH/A/08/001, London Metropolitan Archives, City of London)

Fast forward to today

The RCPsych’s recent report Investing in England’s mental health: 2021 Comprehensive Spending Review emphasised the need for investment in buildings and estates “to make them safer, more suitably therapeutic environments, providing patients dignity, and clinicians a pleasant working environment.” Services also “need investment both to ensure people can get timely help in the right service…[and] to help keep people as well as possible.” And the “Workforce needs investment so that we have a more sustainable mental health workforce supply to meet current and future levels of demand.” On 8 March 2022 Sajid Javid, the Health and Social Secretary, gave a speech on healthcare reform. RCPsych President Adrian James noted “Why was mental health largely forgotten, yet again, in the Health Secretary’s speech on healthcare reform?”

Discussions on hot cross buns a century ago were symptomatic of the profound struggles then to provide good standards of care for mentally unwell patients, and suitable working conditions for staff. In essence, the issues at stake in the early 1920s resonate with current concerns. The bare essentials were provided: the extras, to help make life as fulfilling and rewarding as possible, for patients and staff, were neglected. The Medico-Psychological Association, the RCPsych’s forebear, had a “Parliamentary Committee” but did relatively little active campaigning to improve services, unlike the College at the present time.

Reflecting on historical evidence, we all need to be playing our part, supporting RCPsych campaigns, and not sitting back or taking the pressure off the authorities even when we see improvements … we need the hot cross buns consistently, without fail, every year.

Blog Author
Claire Hilton

Historian in Residence, RCPsych

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