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Royal College of Psychiatrists - Celebrating 180 years
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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?
    • 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
    • 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
      • Our strategy
    • Choose Psychiatry: Guidance for Medical Schools
    • Choose Psychiatry
      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • Career essentials
      • What next?
    • 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
    • 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
      • Our strategy
    • Choose Psychiatry: Guidance for Medical Schools
  • Training

    Training

    • Curricula and guidance

      Curricula and guidance

      • GMC approved curricula
      • Curricula review project
      • 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
      • Leadership and management training
      • Training less than full time
      • Routes to Registration
      • Cost of Training
    • 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
      • MRCPsych examinations and COVID-19
      • Webinar: MRCPsych Exam - Changes to exam delivery this autumn
      • Capacity reached for September 2020 CASC
    • Neuroscience in training

      Neuroscience in training

      • About the project
      • Neuroscience events
      • Who is on the commission?
      • Latest news from the neuroscience project
      • Neuroscience history
      • Neuroscience videos
      • Neuroscience resources
    • Information for Local Education and Training Boards (LETBs)
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates

      International Medical Graduates

      • Shortage Occupation List
    • Quality Assurance in Training
    • Curricula and guidance
      • GMC approved curricula
      • Curricula review project
      • 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
      • Leadership and management training
      • Training less than full time
      • Routes to Registration
      • Cost of Training
    • 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
      • MRCPsych examinations and COVID-19
      • Webinar: MRCPsych Exam - Changes to exam delivery this autumn
      • Capacity reached for September 2020 CASC
    • Neuroscience in training
      • About the project
      • Neuroscience events
      • Who is on the commission?
      • Latest news from the neuroscience project
      • Neuroscience history
      • Neuroscience videos
      • Neuroscience resources
    • Information for Local Education and Training Boards (LETBs)
    • Medical training initiative (MTI)
    • Undergraduate education forum
    • International Medical Graduates
      • Shortage Occupation List
    • Quality Assurance in Training
  • 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
    • Submitting your CPD

      Submitting your CPD

      • CPD Submissions FAQs
      • Alterations to CPD during coronavirus pandemic
    • CPD Online
    • 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

      International members

      • International strategy
    • Special Interest Groups

      Special Interest Groups

      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts 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
      • Digital psychiatry
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Your monthly eNewsletter

      Your monthly eNewsletter

      • 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
      • RCPsych eNewsletter June 2020
      • Update 12 June 2020
      • COVID-19 Update 29 May 2020
      • RCPsych eNewsletter May 2020
      • COVID-19 Update 7 May 2020
      • COVID-19 Update 1 May 2020
      • RCPsych eNewsletter April 2020
      • COVID-19 Update April 2020
      • RCPsych eNewsletter February 2020
      • RCPsych eNewsletter January 2020
      • RCPsych eNewsletter December 2019
      • RCPsych eNewsletter November 2019
      • RCPsych eNewsletter October 2019
      • RCPsych eNewsletter September 2019
      • RCPsych eNewsletter July 2019
      • RCPsych eNewsletter June 2019
      • RCPsych eNewsletter May 2019
      • RCPsych eNewsletter April 2019
    • 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
    • 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
    • About CPD Online - elearning
    • 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
    • Submitting your CPD
      • CPD Submissions FAQs
      • Alterations to CPD during coronavirus pandemic
    • CPD Online
    • 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
      • International strategy
    • Special Interest Groups
      • How to join a SIG
      • Adolescent forensic psychiatry
      • Arts 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
      • Digital psychiatry
    • Committees of Council
    • RCPsych Insight magazine
    • Publications and books
    • Your monthly eNewsletter
      • 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
      • RCPsych eNewsletter June 2020
      • Update 12 June 2020
      • COVID-19 Update 29 May 2020
      • RCPsych eNewsletter May 2020
      • COVID-19 Update 7 May 2020
      • COVID-19 Update 1 May 2020
      • RCPsych eNewsletter April 2020
      • COVID-19 Update April 2020
      • RCPsych eNewsletter February 2020
      • RCPsych eNewsletter January 2020
      • RCPsych eNewsletter December 2019
      • RCPsych eNewsletter November 2019
      • RCPsych eNewsletter October 2019
      • RCPsych eNewsletter September 2019
      • RCPsych eNewsletter July 2019
      • RCPsych eNewsletter June 2019
      • RCPsych eNewsletter May 2019
      • RCPsych eNewsletter April 2019
    • 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
    • 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
    • About CPD Online - elearning
  • Events

    Events

    • Conferences and training events

      Conferences and training events

      • Faculty of intellectual Disability Spring Conference 2019
      • Faculty of Forensic Psychiatry Annual Conference 2020 - Register your interest
      • Section 12 and AC – Update for Trainers - Training Day Course Resources
      • Resilience & Wellbeing Course for SAS Doctors
      • Present State Examination Course 17 April - Register your interest
      • Present State Examination Course 1 September - Register your interest
      • Section 12 and Approved Clinician Training
      • Perinatal Psychiatry Masterclasses
      • Women and Mental Health Special Interest Group Annual Conference
      • Faculty of Medical Psychotherapy Annual Conference 2021 - Register your interest
      • Register your interest - Clinical and Educational Supervisor Training future dates
      • Register your interest - Leadership & Management Fellow Scheme 2021/22 (Trainee)
      • Register your interest - Leadership & Management Fellow Scheme 2021/22 (Trust)
      • Register your interest - Leadership & Management Fellow Scheme 2021/22 (Trust)
    • Events held by other organisations
    • Terms and conditions
    • In house training

      In house training

      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Highlights from International Congress 2020 - Webinar Series

      Highlights from International Congress 2020 - Webinar Series

      • Registration
      • Programme
      • FAQs
    • Accommodation List
    • Recruitment events
    • Claiming Expenses
    • International Congress 2021

      International Congress 2021

      • Congress FAQs
      • Exhibition Opportunities 2021
      • Registration
      • IC21 Keynote speakers
      • Programme
      • Presenter information
      • Your guide to Congress
    • Free webinars

      Free webinars

      • Free webinars for members
    • Speaker guidance for online events
    • Conferences and training events
      • Faculty of intellectual Disability Spring Conference 2019
      • Faculty of Forensic Psychiatry Annual Conference 2020 - Register your interest
      • Section 12 and AC – Update for Trainers - Training Day Course Resources
      • Resilience & Wellbeing Course for SAS Doctors
      • Present State Examination Course 17 April - Register your interest
      • Present State Examination Course 1 September - Register your interest
      • Section 12 and Approved Clinician Training
      • Perinatal Psychiatry Masterclasses
      • Women and Mental Health Special Interest Group Annual Conference
      • Faculty of Medical Psychotherapy Annual Conference 2021 - Register your interest
      • Register your interest - Clinical and Educational Supervisor Training future dates
      • Register your interest - Leadership & Management Fellow Scheme 2021/22 (Trainee)
      • Register your interest - Leadership & Management Fellow Scheme 2021/22 (Trust)
      • Register your interest - Leadership & Management Fellow Scheme 2021/22 (Trust)
    • Events held by other organisations
    • Terms and conditions
    • In house training
      • In house training: working with us
      • Health of Nation Outcome Scales
      • Competing interests
    • Highlights from International Congress 2020 - Webinar Series
      • Registration
      • Programme
      • FAQs
    • Accommodation List
    • Recruitment events
    • Claiming Expenses
    • International Congress 2021
      • Congress FAQs
      • Exhibition Opportunities 2021
      • Registration
      • IC21 Keynote speakers
      • Programme
      • Presenter information
      • Your guide to Congress
    • Free webinars
      • Free webinars for members
    • 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
      • Using quality improvement
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
    • 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
      • The Mental Health Act White Paper 2021
    • Planning the psychiatric workforce

      Planning the psychiatric workforce

      • What we do
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
    • Physician Associates

      Physician Associates

      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
    • National Collaborating Centre for Mental Health

      National Collaborating Centre for Mental Health

      • About the NCCMH
      • Mental health care pathways
      • Mental health quality improvement programmes
      • Other programmes
      • Reducing restrictive practice
      • National suicide prevention programme
      • Sexual Safety Collaborative
      • COVID-19 Mental Health Improvement Network
      • RCPsych Enjoying Work Collaborative
    • 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
      • Green care
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • Working sustainably (old)
    • RCPsych Course Accreditation
    • College Centre for Quality Improvement (CCQI)
      • What we do in the CCQI
      • Quality Networks and Accreditation
      • National Clinical Audits
      • Multi-source feedback
      • Using quality improvement
      • CCQI resources
      • CCQI Who we are
      • Research and evaluation
    • 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
      • The Mental Health Act White Paper 2021
    • Planning the psychiatric workforce
      • What we do
      • Job planning and recruitment
      • Our workforce census
      • Campaigning for the mental health workforce of the future
      • Workforce strategy
    • Physician Associates
      • About Physician Associates
      • Employing Physician Associates
      • Becoming a Physician Associate
      • Support for Physician Associates
      • Physician Associates network
    • National Collaborating Centre for Mental Health
      • About the NCCMH
      • Mental health care pathways
      • Mental health quality improvement programmes
      • Other programmes
      • Reducing restrictive practice
      • National suicide prevention programme
      • Sexual Safety Collaborative
      • COVID-19 Mental Health Improvement Network
      • RCPsych Enjoying Work Collaborative
    • Invited Review Service
    • Public Health and its role in mental heath
    • Sustainability and working sustainably
      • In your community
      • In your practice
      • In your trust
      • Green care
      • Sustainability scholars
      • About sustainability in mental health care
      • Sustainability resources
      • Working sustainably (old)
    • RCPsych Course Accreditation
  • 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
      • Depression and men
      • 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)
      • Problem gambling
      • 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
      • Being sectioned
      • Benzodiazepines
      • Bipolar medications
      • 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
      • Mental capacity and the law
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Spirituality and mental health
      • Stopping antidepressants
      • Talking to your GP
      • What to expect of your psychiatrist in the UK
      • Antipsychotics in Pregnancy
      • Lithium in Pregnancy and Breastfeeding
      • Mother and Baby Units (MBUs)
      • Children's Social Services and Safeguarding
      • Valproate in women and girls who could get pregnant
      • What are Perinatal Mental Health Services?
      • Mental health in pregnancy
      • Medication for mental health and COVID-19
      • Remote consultations and COVID-19
      • Attending hospital and COVID-19
      • Monitoring health at home and COVID-19
      • Alcohol and COVID-19
      • Eating disorders and COVID-19
      • Perinatal care and COVID-19
      • COVID-19: Self-harm in young people 
      • COVID-19: Self-harm and suicide 
      • COVID-19: Looking after your mental health – for young people and their parents and carers 
      • COVID-19: Using drugs
      • COVID-19: ASD
    • Young people's mental health
    • Translations

      Translations

      • Arabic عربى
      • Bengali বাঙালি
      • Bulgarian български
      • Chinese 中文
      • French Français
      • German Auf 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
    • Mental health FAQs
    • Order mental health leaflets
    • About our mental health information
    • Disclaimer about our mental health information
    • Choosing Wisely - a national campaign
    • BSL translations
    • MindEd: web tools for those working with young people
    • Order mental health packs for schools
    • Audio 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
      • Depression and men
      • 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)
      • Problem gambling
      • Schizoaffective disorder
      • Schizophrenia
      • Seasonal Affective Disorder (SAD)
      • Self harm
      • Shyness and social phobia
      • Sleeping well
    • Support, care and treatment
      • Alzheimers drug treatments
      • Antidepressants
      • Antipsychotics
      • Being sectioned
      • Benzodiazepines
      • Bipolar medications
      • 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
      • Mental capacity and the law
      • Mental health rehabilitation services
      • Mental health services and teams in the community
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Spirituality and mental health
      • Stopping antidepressants
      • Talking to your GP
      • What to expect of your psychiatrist in the UK
      • Antipsychotics in Pregnancy
      • Lithium in Pregnancy and Breastfeeding
      • Mother and Baby Units (MBUs)
      • Children's Social Services and Safeguarding
      • Valproate in women and girls who could get pregnant
      • What are Perinatal Mental Health Services?
      • Mental health in pregnancy
      • Medication for mental health and COVID-19
      • Remote consultations and COVID-19
      • Attending hospital and COVID-19
      • Monitoring health at home and COVID-19
      • Alcohol and COVID-19
      • Eating disorders and COVID-19
      • Perinatal care and COVID-19
      • COVID-19: Self-harm in young people 
      • COVID-19: Self-harm and suicide 
      • COVID-19: Looking after your mental health – for young people and their parents and carers 
      • COVID-19: Using drugs
      • COVID-19: ASD
    • Young people's mental health
    • Translations
      • Arabic عربى
      • Bengali বাঙালি
      • Bulgarian български
      • Chinese 中文
      • French Français
      • German Auf 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
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South Asian History Month: Dr Raghunandan Gaind

South Asian History Month

30 July, 2020

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Dr Raghunandan Gaind, Past-President and current Vice-President of the Indian Medical Association GB, and Patron of the Amritsar Doctors and Dentists Association, writes for South Asian History Month.

In February 2016, there were 273,853 doctors registered with the General Medical Council (GMC), of which 25,038 are of Indian origin, with 5,622 working in psychiatry. This is a remarkable figure given that ethnic minorities constitute only 8% of the population of the UK.

The NHS has seen substantial expansion since its inception in 1947. During the 1950s and 60s, it recruited large numbers of doctors from India with a further influx following the publication of the NHS plan1 by the Department of Health in 2000. The inclusion of Indian doctors in such large numbers is understandable given the historical relationship between the UK and India. The development of modern medicine in India owes much to British rule and the Indian Medical Service (IMS). The racism and challenges Indian doctors have endured here, despite being so crucial to the system, is in itself a poignant story.

A momentous decision

Lord Macaulay’s2 momentous decision to introduce English into the Indian school system was followed with a vigour never seen before or since for any language. He was a leading Parliamentarian and one of the commissioners of the Board of Control representing the Crown in its relations with the East India Company. Having accepted Membership of the Supreme Council of India, he arrived in Madras, in 1834 returning in 1838. A studious and learned man, his days at the Board of Control helped him to learn much about India – its religions, caste system, missionary work in the country and much more.

By the start of the First World War, a few score Indian doctors were working in the UK, mostly in industrial towns and poor neighbourhoods of London. Their number increased to 3,000 by the end of the Second World War. The period after 1947 saw a great influx. Many came to the UK to undergo training in varied specialities under Commonwealth and other scholarships and often were self-financing.

By the 1960s the number had increased to 15,000. They contributed to the backbone of the NHS. They had arrived full of hope and ambition to work in Medicine and Surgery in teaching hospitals and other Centres of Excellence. Soon they found the employment available to them was in “Cinderella” specialities. In certain areas up to three quarters of GPs and Junior Doctors came from India.

Professor Aneez Esmail3 wrote a seminal article on Asian doctors in the NHS. He observed that the pattern of medical education and training in India was geared towards “meeting the needs of the GMC and IMS”. He wrote, “The failure to produce a coherent medical policy and the absence of public health medicine and health facilities in rural areas meant that Indian doctors were quite suitable for working in England but probably totally irrelevant for working to the benefit of the vast majority of the Indian population... it was the South Asian doctors who have provided a service to these communities. I believe that without them the NHS would have collapsed”.

In 1961, Lord Taylor of Harlow stated in Parliament4 “the Health Service would have collapsed if it had not been for the enormous influx of Junior Doctors from such countries as India and Pakistan … they are here to provide pairs of hands in the rottenest, worst hospitals in the country because there is nobody else to do it”.

Racism and prejudice

An upsurge of racism surfaced within the profession. Enoch Powell5 as Health Minister had encouraged the recruitment of Indian doctors. However, in his speech “Rivers of Blood” he reflected the general prejudice that prevailed at the time about immigrants. Interestingly, when he appealed for help to staff his massively expanded health service nearly 50 years ago, about 18,000 Indian doctors answered his call.

In 1978, Prime Minister Margaret Thatcher expressed similar sentiments “this country is being swamped by people of different cultures.” Comments were published that the standard of overseas qualified doctors was poor. A survey carried out at the time indicated that 17% of overseas qualified doctors had problems communicating with their patients and professional colleagues. In the 1970s, advertisements would be published stating “Only British Graduates need apply for the vacant post”. Following the Race Relations Act., 1976 such overt racism ceased.

In 1927, four Indian doctors established the Indian Medical Practitioners Association later renamed Indian Medical Association (Great Britain).

Historically, Indian medicine owes much to the British Raj, but equally Britain’s National Health Service is today beholden to the Indian physicians who represent such a significant proportion of its staff. Mutual esteem has been established.

With the introduction of TRAB, PLAB and what followed, an era has ended. Immigrant doctors are now obliged to submit themselves to a test of clinical knowledge as well as fluency in English. Following two centuries of close co-operation between medical men and women in the two countries, Britain’s GMC has withdrawn its recognition of Indian Medical Qualifications and the Indian Government has reciprocated. It is possible that fewer Indian doctors may now come to this country and the history of mutually profitable working relationships may decline. It would be sad indeed if this were so.

The majority of Indian doctors came to acquire skills and return. However, from the outset it was obvious that the experience and training available to them would be very restricted. They remained at junior level and very few of them went on to become Consultants.

‘Racism in Medicine’ a report by Kings Fund, edited by Naaz Coker6, Race & Diversity Director, observed that “no aspect of a doctors working life is untouched by racism… discrimination begins in medical school and affects the whole career…” The Ethnic minority doctors are similarly discriminated in the allocation of Distinction Awards / Clinical Excellence Awards A Report by David Smith published in 1987 found that one third of the doctors arriving in the UK during the 1970s achieved their goal and returned home, but the majority did not. Some had married local women settling here but most became indentured workers of the NHS

The saviour of the pariah

The so-called problems of communication with overseas qualified doctors was a red herring. Once the immigrant doctor had worked in the UK for more than three years, the problem disappeared. The racism experienced by Indian doctors was at variance with the needs of the Health Service, which remained dependent on them. Were they, as Professor Esmail commented “the saviour or the pariah“

The work of the Professional Conduct Committee (PCC), shows that ethnic minority doctors are six times more likely to be investigated, twelve times more likely to be charged with sexual misdemeanour and thirty times more likely to be charged with improper demand for fees. Dame Janet Smith7 observed in her Report “thus in the three studies conducted over a period of nine years, the PSI (Policy Studies Institute) found unexplained differences in the treatment … of overseas qualifiers dealing with them more severely. This may, or may not, prove that there is a racial bias ...”

The NHS is described by most in this country as a unique British institution providing a meaningful and effective service to all citizens. The contribution of overseas qualified doctors is significant and sadly overlooked. Feeling treated as pariahs they were dissatisfied, stigmatised and demoralised.

Meanwhile in the context of the continued dependence of the NHS on the injection of carers from India, progress has been made. As talk continues of a further influx to meet the current unmet needs of the NHS, this new intake will hopefully not experience the same trials and tribulations of their predecessors.

Dr Raghunandan Gaind MB FRCP FRCPsych. DPM Lon
Vice-President Indian Medical Association GB
Patron Amritsar Doctors and Dentists Association
Past President Indian Medical Association GB 1972-79

References

  1. Department of Health: The NHS Plan: a plan for investment, a plan for reform, London: The Stationery Office; 2000
  2. Language in India: Volume 3: 4 April 2003: Lord Macaulay The Man Who Started It All, And His Minute. Editor M.S. Thirumalai Ph.D.
  3. Aneez Esmail PhD MRCGP MFPHM, Professor of General Practice
  4. Br J Gen Pract 2007 October 1,57(543) 827-834
  5. Taylor DJ, Esmail A, Retrospective analysis of census data on general practitioners who qualified in South Asia; who will replace them as they retire? BMJ. 1999-318(7179) 306-310
  6. Powell E “Like the Romans, I see the River Tiber foaming with much blood” 1968: Apr 20 The Telegraph
  7. Racism in Medicine An agenda for Change. Edited by Naaz Coker. King’s Fund Publishing. 2001
  8. Smith J Fifth Report. Safeguarding patients’ lessons from the past – proposals for the future, London. The Stationery Office 2004 cm6394
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