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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?
      • Choose Psychiatry 2021 video
      • Continuing to choose psychiatry
      • Hear more from the stars of our 2022 film
    • 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
    • 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
    • Careers past events
    • Choose Psychiatry
      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • What next?
      • On a break from training?
      • Choose Psychiatry 2021 video
      • Continuing to choose psychiatry
      • Hear more from the stars of our 2022 film
    • 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
    • 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
    • Careers past events
  • Training

    Training

    • Curricula and guidance

      Curricula and guidance

      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
    • 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
      • 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
    • 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 Psychiatry Masterclass for New consultants resources
      • About the Building Capacity Project
      • Perinatal Psychiatry Masterclass for Senior Trainees resources
      • Perinatal Psychiatry Top - up masterclass for consultants resources
      • Perinatal Psychiatry Masterclass for Senior Trainees Jan 2023 resources
    • Dean's annual update
    • Curricula and guidance
      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual 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
      • 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
      • 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
    • 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 Psychiatry Masterclass for New consultants resources
      • About the Building Capacity Project
      • Perinatal Psychiatry Masterclass for Senior Trainees resources
      • Perinatal Psychiatry Top - up masterclass for consultants resources
      • Perinatal Psychiatry Masterclass for Senior Trainees Jan 2023 resources
    • Dean's annual update
  • Members

    Members

    • Workforce Wellbeing Hub

      Workforce Wellbeing Hub

      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Mentoring and coaching
      • 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
    • 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
    • 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
    • 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 and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international
      • Women and mental health
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Public members list
    • Jobs board
    • 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
    • 2021 membership survey
    • Mindmasters quiz

      Mindmasters quiz

      • About the quiz
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • eLearning Hub
    • Workforce Wellbeing Hub
      • Psychiatrists' Support Service
      • How the College supports workforce wellbeing
      • Top 10 tips for wellbeing
      • Mentoring and coaching
      • 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
    • 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
    • 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
    • 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 and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international
      • Women and mental health
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Members' eNewsletters
    • Posts for members
    • Public members list
    • Jobs board
    • 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
    • 2021 membership survey
    • Mindmasters quiz
      • About the quiz
      • Who won in 2022?
      • The rules of the quiz
      • Sample quiz questions 
    • eLearning Hub
  • 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
      • Congress Webinar Package
      • 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
      • Rapid Fire and Poster Prize Winners
    • International Congress 2023

      International Congress 2023

      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Social Media
    • 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
      • Congress Webinar Package
      • 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
      • Rapid Fire and Poster Prize Winners
    • International Congress 2023
      • Register your interest - Congress 2023 exhibitors
      • Travel and accommodation guidance 
      • Registration
      • Congress 2023 FAQs
      • Poster Presentations 2023
      • Social Media
    • 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
      • 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
      • PMHIC Parliamentary Launch 
    • 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
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and mental health

      Sustainability and mental health

      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • College position on sustainability
      • Attending COP26
    • 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
      • 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
      • 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
      • PMHIC Parliamentary Launch 
    • 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
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and mental health
      • In your community
      • In your practice
      • In your trust
      • Nature matters
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • College position on sustainability
      • Attending COP26
    • 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 and generalised anxiety disorder (GAD)
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Catatonia
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • 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) 
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self-harm
      • Shyness and social phobia
      • Sleeping well
      • Avoidant/restrictive food intake disorder (ARFID)
      • Cocaine dependence
    • 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)
      • 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
      • Hypnosis and hypnotherapy
      • Benefits, financial support and debt advice
      • Caring for someone with a mental illness
    • 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
      • Swahili Kiswahili
    • 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

      Order mental health packs for schools

      • Order form for mental health factsheets for young people
    • Audio resources
    • Veterans' mental health
    • Suicide resources
    • Problems and disorders
      • ADHD in adults
      • Alcohol and depression
      • Alcohol and older people
      • Anorexia and bulimia
      • Anxiety and generalised anxiety disorder (GAD)
      • Anxiety, panic and phobias
      • Bereavement
      • Bipolar disorder
      • Cannabis
      • Catatonia
      • Club drugs
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • 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) 
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self-harm
      • Shyness and social phobia
      • Sleeping well
      • Avoidant/restrictive food intake disorder (ARFID)
      • Cocaine dependence
    • 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)
      • 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
      • Hypnosis and hypnotherapy
      • Benefits, financial support and debt advice
      • Caring for someone with a mental illness
    • Young people's mental health
    • 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
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“Old Problems, New Solutions” to admitting patients out of area

History, Archives and Library blog

20 September, 2022

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

Today, the term “Inappropriate out of area placement” refers to the situation when a patient is admitted to an inpatient unit over 50 km away from their home “because no appropriate bed is available locally.” The Crisp Commission was set up to address this and other issues, to ensure that patients in England have swift access to intensive high quality care when it is needed, whether in hospital or under a Crisis Resolution Home Treatment Team (CRHT). The Commission’s report (2016) emphasised that long distance admissions are mainly due to difficulties in finding acute inpatient beds or a suitable CRHT in their home area, “a symptom of far more widespread problems in the functioning of the whole mental health system.”  The report was called Old Problems, New Solutions. Old problems they are indeed: but so far, judging by the RCPsych policy briefing (2022) regarding out of area placements, it is hard to see any new solutions coming into play.

The old problems: pounds (shillings) and pence

Moving patients to an inpatient unit far from their home, family and friends, has long been practiced and the emotional harm recognised. The Lunacy Act 1890 permitted an overcrowded public asylum to establish contracts to transfer patients elsewhere. The receiving asylum often charged a higher fee for these “out-county” contract patients compared to patients from their local population. For example, in 1925, the Three Counties Mental Hospital at Stotfold, Bedfordshire, estimated that it cost 20s 6½d (103p) a week to treat a patient in their institution, but it charged 23s 11d (120p) for “home-county” patients, and 29s 2d (146p) for those on contract. Around the same time, the local authorities also used private sector mental hospitals for publicly funded patients.  We know of patients from north London transferred to the Old Manor Hospital (Fisherton House) in Salisbury, around 150 km away.  

Alongside under-provision of beds being associated with moving patients out of area, there were also rules regarding which locality was obliged to pay for a patient’s treatment. Until 1930, in-patient admission was funded through the Boards of Guardians and means tested under the Poor Law. The Poor Law designated responsibility for funding to the patient’s official parish of “settlement”, rather than where they lived when they became ill.  Generally, parish of settlement was the parish of birth, or for a married woman, the parish of her husband’s birth, although it could change over the lifetime, such as through apprenticeship or living elsewhere for a set period of time. Under the scheme, if someone required mental hospital admission, they could be moved hundreds of miles from family and friends to the mental hospital serving their official parish of settlement.

The Royal Commission on Lunacy and Mental Disorder, 1924-6, received evidence on this.  Drs Helen Boyle and Henry Devine both advocated for care close to home, preferably in the towns where their friends and family lived, so that patients could interact with them and their community. As Dr Devine put it: “The more social contact of the ordinary kind that a mental case can have, so much the better for him.” Dr Boyle was also clear: “We should not be so hidebound about settlement. Sometimes their settlement is miles from their friends, and they do not want to go such a long way away.”

Distress caused

We hear of patients’ distress at being moved between institutions early in the First World War, when civilian patients were transferred from asylums requisitioned as military hospitals. One medical superintendent described the patients when they left his asylum in 1915:

“the whole gamut of emotion was exhibited by the patients on leaving, ranging from acute distress and misery, through gay indifference, to maniacal fury and indignation….I did not realise the strong mutual attachment till it was severed.”

The asylums were by no means ideal, and the dependence which they created for their patients probably contributed to their sense of loss. Nevertheless, meaningful human relationships still existed within them.

Letters from Colney Hatch Mental Hospital files (now at London Metropolitan Archives ref: H12/CH/B/47/037) add to the picture. Unfortunately, the hospital’s method of filing papers by gluing them together at their corners has obscured details in the letter below: the gaps are indicated by […]. Note also that the writer’s shillings and pence notation is a forward slash /.

 

1.5.1928

Dear Mother

How are you?  Isn’t this weather changeable?  Mid-summer one day, freezing the next. Enclosed please find 1/6 not much but all I can afford at present.  Have you received your goods from Highgate because I went up after them.  Then they sent me a written notice to attend a committee meeting. I replied that I could not attend as they arranged it for 2.30 on a Tuesday afternoon […]

I shall not come out to Southgate this weekend as I really can’t afford it.  Have you heard from Lily yet?  If you haven’t its because she hasn’t been very well. I think I am going away with her to Ramsgate for the holidays. The air is quite decent there.  So it will do her good.  I sold three hats today 39/11, 12/11 and 10/11.  Good, eh?  I feel quite pleased […]

Well Goodbye Mama

Lots of […]

PS Excuse the awful scribble but I am very tired. Goodnight now. 

 

The letter did not reach the mother. She was transferred 200 miles away to the Yorkshire mental hospital which served her parish of settlement. In the days of few cars and many financial pressures, her husband and daughters living and working in London would have had little opportunity of visiting her.  

New solutions?

Unlike beds in hospital corridors or dilapidated buildings which are highly visible to the public and attract attention, moving patients far from home is an invisible cruelty perpetuated over generations. Placing patients out of area makes me wonder whether the attitudes and priorities of the authorities who design the mental health services and allocate funding today have, in essence, changed from those of their predecessors.  A century or more of old problems and plenty of evidence and ideas, but we have still not implemented adequate new solutions, to mend a broken system.

Blog Author
Claire Hilton

Historian in Residence, RCPsych

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