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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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RCPsych Wales - Louis Mertens, The Foundational Economy and Mental Health

RCPsych in Wales blog

21 August, 2019

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Historically, the Welsh Government have put a significant emphasis on evidence-based policy (EBP) which has put the focus for addressing mental illness onto treatment and mental health services. EBP has always been about accountability, and it is relatively easy to prove the cost-value of mental health services, medicines and therapies.

However, with the Welsh Government's plans to shift its focus onto investment into the foundational economy, there is an opportunity to address some of the deep-rooted issues for mental health in Wales that don’t typically factor in Government mental health strategies: financial stress, environmental stress and working conditions.

Both the World Health Organisations’ Health Equity Status Report Initiative (2018) and commissioning guidance issued by the Centre for Sustainable Health Care and the Joint Commissioning Panel for Mental Health (2015) recognise the value of appropriate housing to population mental health, access to which is heavily influenced by socio-economic status. It should be a key tenet of any government focused on designing a sustainable mental health plan that they shouldn’t just improve the treatment of mental health issues, but they should attempt to prevent them.

There have been some attempts in Wales to focus on prudent healthcare and preventative measures, but we are still not quite at the level where we can think about preventing poor mental health through whole policy programmes. A Wales wellbeing budget, of the same ilk as that put forward in New Zealand would be a good start. To means test every policy by the mental health impact would be desirable, but before we go redesigning the entire process of government in Wales, perhaps first we should look at how we can explore the potential of existing projects of work such as the foundational economy. The impact this might have on population mental health could set a precedent for how Wales thinks about mental health, and how we design our society around well being.

Some context

The foundational economy was an economic model that was developed in response to the financial crisis of 2008. At that time Preston in Lancashire, like many other cities and towns across the UK, was hit hard. In 2011, seven-hundred million pounds was meant to be invested by a large national retail brand to redevelop a large portion of Preston’s city centre. But this funding was withdrawn, and the redevelopment abandoned.

At this time, these big businesses defined the economy. Councils relied on them to bring investment into town-centres. Their size and plurality of job offerings could make towns, but equally their lack of solid roots meant they could just as easily break them. Ford Bridgend plant in South Wales is one of these businesses.  The approach of successive UK governments has been to work with these large employers under the illusion that these employers and their jobs will hang around. However, many are now threatening to leave, Ford Bridgend included, and all local politicians can offer them to stay put is nostalgia.

In 2013, it was recognised in Preston (Cllr Brown, 2019) and it is being recognised in Wales now: The true anchors of the economy are SMEs and anchor institutions supplying foundational goods and services like utilities, housing, food, healthcare and education. Many of these institutions largely spend from the public purse through single large contracts. A local high school, for example, might have a catering contract to offer worth £2 million that smaller local businesses wouldn’t have the capacity to be able to fulfil. Consequently, that money slips through the fingers of local businesses and into the pockets of big business that may operate UK wide and with very little stake in the local economy.

However, through the foundational economy model which has been successfully piloted by Preston City Council and is being championed here in Wales by Lee Waters AM, Deputy Minister for Economy and Transport, you can keep wealth within the local economy (Cllr Brown, 2019). Instead of having anchor institutions offer the whole contract to a single large business, you can split these contracts into more manageable sizes for local businesses. The high school then becomes a much greater source of income for local businesses, and a greater anchor for the community. The greengrocers who supply them, buying from their local farmers market, can employ more local people. Businesses in the local economy have a chance to grow and aren’t tempted to uproot like some of the larger businesses because their trade relies so heavily on local anchor institutions.

You may have gotten this far and be rightly wondering at what point does this allow us to tackle poor mental health? To that, there are as many as three answers.

Financial stress

The first relates back to preventative measures. In Wales, there are many levers of policy that affect our day to day lives that are not fully devolved. Zero hours contracts and the minimum rate of pay for example, cannot be banned or altered by Welsh Government. However, these things make a significant difference to social quality (Tomlinson et al, 2016), the stresses we face, our financial security or insecurity and in-work poverty.

In Wales, the prevalence of common mental health disorders can be linked to socioeconomic and income deprivation (Fone et al, 2013). Research suggests that people who perceive themselves to have a lower socio-economic status than those around them are disproportionately affected by mental health issues (Skapinakis et al, 2006; Wetherall et al, 2019).  As the price of living continues to rise against wages then the impact of financial stress on population mental health should become more and more relevant, not least because in a survey of workers, Welsh workers were more likely to describe symptoms of stress, loss of sleep and fatigue as a result of their financial situation (BITC, 2018). Access to the lifeline of benefits (Galloway et al, pp. 204, 2018) for people with mental health disorders or access to paid employment, can be central to recovery and human psychological health. These opportunities depend on the local labour market (O’Flynn, 2001) and the local economy.

This is what the foundational economy model has an intimate hold over. Although the levers to be rid of zero hours contracts and to introduce the real living wage do not exist as primary legislative powers in Wales, they can be introduced in part through the foundational economy. Welsh Government could insist that all local businesses and employers who want to take on public contracts offer their employees the option of a permanent contract with fixed hours and pay their employees the real living wage. They can set the bar for others, too.

Mike Hedges, AM for Swansea East, suggests this should go further. Not only should it be a pre-condition for contracting with public sector bodies via the Welsh Government, but it should also be a pre-condition for awarding Welsh Government grants and loans to private companies (Member Debate: Tackling Poverty, 2019). This of course is not a panacea, but there is the potential to mitigate some of factors contributing to mental illness through a fair wage and reliable contracts.

Environmental stress

The second answer to the impact of the foundational economy on mental health stems from something called the environment stress hypothesis. Simply put, this is the hypothesis that the quality of the environment we operate in is linked to the amount of stress we experience. This in turn has its own impacts upon population mental health.

Internationally or nationally mobile businesses might exist largely in industrial estates and out-of-town retail centres. Sometimes they might offer rejuvenation into highstreets if they bring in investment through flagship store redevelopments but as Preston shows, it isn’t a reliable way to seek investment. The picture across the UK would suggest that it doesn’t happen too often.

In contrast, local SMEs (small-medium sized enterprises) and institutions have a greater stake and a bigger role to play in developing the landscape of our towns and living spaces. Foundational SMEs have struggled since the economic crash and so has the aesthetic of our high street. It is not uncommon to walk up a high-street in the South Wales Valleys and see empty shop fronts and abandoned retail units. There are similar pictures all the way through the UK.

A healthy work life is good for our mental health, but so is living in a high quality, green neighbourhood. The image of a struggling high street is distinctly the furthest thing from a high-quality neighbourhood, and that might reflect in the mental health of the local population too. Studies of Dutch cohorts and their neighbourhoods (Dalgard and Tambs, pp. 530-536, 1997; Generall et al, 2019) and studies of depression in older populations in neighbourhoods with varying green coverage (Perrino et al, pp. 476-480, 2019) both draw similar conclusions. If you live in a good quality neighbourhood you are less likely to suffer from poor mental health.

It is not such a big stretch, therefore, to imagine that investment into foundational SMEs, which decorate our local highstreets might also provide for the local population a more positive, higher quality neighbourhood too. Not least because local businesses often have one foot in the local charity sector, or have an eye on a charitable partnership. In this way, the foundational economy might provide mental health benefits not only for the local workforce through gainful employment, but to some extent, all residents.  

Work-place stress

A third answer to how the foundational economy can benefit population mental health is more direct but still feasibly significant. There is no reason why the influence of the foundational economy over mental health should be limited to the residual benefits of contracts, pay and encouraging high quality neighbourhoods. In addition, the Welsh Government could insist that all these employers taking business from public contracts sign up to a mental well being in work scheme.

The statistics for how mental health is approached in the workplace are frightening. In 2018, The Business in the Community Mental Health at Work Wales Spotlight pointed out that 61% of employees have experienced mental health issues because of work, only 18% feel able to disclose a mental health issue to their line manager and just 30% of line managers had received any training in mental health.

The response of employers to their employee’s mental health is generally poor, and incredibly overlooked as a factor by government. These statistics certainly justify such a scheme, co-designed by employees and mental health professionals, that guarantee employees certain liberties that are beneficial to their mental health. Employers and line managers could be asked to undertake mental health first aid training and stress risk assessments. Employees could be offered e-learning opportunities to make them more aware of their own mental well being.

Obligations could be scalable to the size of the contract that companies are taking on, so as not to over burden smaller businesses, but similarly, resources should be offered which tackle the unique challenges of mental health in small businesses.

Concluding thoughts

Perhaps it is an abstract idea for now that needs more development, but the issues that contribute to mental health are broad and societal and we can’t shy away from addressing them.

The foundational economy has the potential to, not resolve in all entirety, but at least address some of these issues as a piece in a much larger Wales-wide puzzle. There is the potential here to guarantee some financial security, to relieve environmental stress, and to introduce a duty on employers benefiting from public procurement to promote the mental well being of their employees.

But from all this comes a lesson, that in order for the investment into the foundational economy pilots to reach their full potential, the Welsh Government need to ensure that they don’t repeat the mistakes of the past. GDP must not be relied upon as an effective tool to measure society. Welsh Government must not consider the foundational economy’s contribution to existing measures of economic growth as the only indicator of success when this project has the potential to bring about so much more.

If we are to think about mental health in a truly preventative way, we need to consider the impact that projects of work like the foundational economy pilots have on communities, and use these to justify preventative measures for mental health in other areas.

If you have any more thoughts on preventative mental health policies, sustainable psychiatry or the environmental stress hypothesis please get in touch at: louis.mertens@RCPsych.ac.uk

References

Business in the Community. 2018. Mental Health at Work. Available at: https://wellbeing.bitc.org.uk/system/files/research/mental_health_at_work_-_survey_report_2018_-_23oct2018new.pdf

Cllr Brown, M. in: Access to Banking and the Foundational Economy: Preston City Council. 2019. Economy, Infrastructure and Skills Committee. Available Here: http://record.assembly.wales/Committee/5482#C205606

Fone, D., Green, G., Farewell, D., White, J., Kelly, M., Dunstan, F. 2013. Common Mental Disorders, Neighbourhood Income Inequality and Income Deprivation: Small-area multilevel analysis. The British Journal of Psychiatry. 202(4). Pp. 286-293

Galloway, A., Boland, B., Williams, G. 2018. Mental Health Problems, Benefits and Tackling Discrimination. BJPsych Bulletin 42. Pp. 200-205. Doi: 10.1192/bjb.2018.43

Generaal, E., et al. 2019. Neighbourhood characteristics and prevalence and severity of depression: pooled analysis of eight Dutch cohort studies. British Journal of Psychiatry 215(2) pp. 468-475. Doi: 10.1192/bjp.2019.100

Hedges, M. 2019. In: Member Debate: Tackling Poverty. National Assembly for Wales. Available at: http://record.assembly.wales/Plenary/5663#C199487

Joint Commissioning Panel for Mental Health., Centre for Sustainable Healthcare. 2015. Financially, Environmentally and Socially Sustainable Mental Health Services (future proofing services). Available at: https://www.jcpmh.info/wp-content/uploads/jcpmh-sustainable-guide.pdf

O’Flynn, D. 2001. Approaching employment: Mental health, work projects and the Care Programme Approach. The British Journal of Psychiatry 25(5). Pp. 169-171. Doi: 10.1192/pb.25.5.169

Perrino, T. et al. 2019. Neighbourhood greenness and depression among older adults. British Journal of Psychiatry 215(2) pp. 476-480. doi:10.1192/bjp.2019.129

Skapinakis, P. et al. 2006. Socio-economic position and common mental disorders. Longitudinal study in the general population in the UK. British Journal of Psychiatry 189. Pp. 109. Available at:  http://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=25178524&site=eds-live

Tomlinson, M., Walker, A., Foster, L. 2016. Social Quality and Work: What Impact Does Low Pay Have on Social Quality? Journal of Social Policy 45(2) pp. 35-371. Doi: 10.1017/S0047279415000732

Wetherall, K., Robb, K., O’Connor, R. 2019. Social rank theory of depression: A systematic review of self-perceptions of social rank and their relationship with depressive symptoms and suicide risk. Journal of Affective Disorders 246. Pp. 300-319. Doi: 10.1016/j.jad.2018.12.045

WHO European Office for Investment in Health and Development Italy. 2018. Health Equity Status Report Initiative. 

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RCPsych Wales

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