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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
      • Choose Psychiatry: Guidance for Medical Schools
    • 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
    • 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
      • Choose Psychiatry: Guidance for Medical Schools
    • 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
    • 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
      • Assessment Strategy Review
    • 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
      • Industrial action FAQs
      • Distribution of medical training posts
    • 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
      • Perinatal Psychiatry Masterclass for SAS Doctor resources
    • Dean's 2022 update
    • Curricula and guidance
      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty guides
      • Dual Training
      • Assessment Strategy Review
    • 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
      • Industrial action FAQs
      • Distribution of medical training posts
    • 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
      • Perinatal Psychiatry Masterclass for SAS Doctor resources
    • Dean's 2022 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
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international (VIPSIG)
      • 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
    • Obituaries

      Obituaries

      • Submit an obituary
      • Remembering Dame Fiona Caldicott
      • Memorial service for Professor Andrew Sims
    • 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
      • Rainbow SIG
      • Spirituality and Psychiatry 
      • Sport and exercise psychiatry (SEPSIG)
      • Transcultural psychiatry
      • Volunteering and international (VIPSIG)
      • 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
    • Obituaries
      • Submit an obituary
      • Remembering Dame Fiona Caldicott
      • Memorial service for Professor Andrew Sims
    • 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
      • Programme
      • Social Media
      • Your guide to Congress
      • Social and Fringe Events
    • 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
      • Programme
      • Social Media
      • Your guide to Congress
      • Social and Fringe Events
    • 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
    • Net Zero Mental Health Care Research, Resources and Education

      Net Zero Mental Health Care Research, Resources and Education

      • Net Zero Mental Health Care Call for Evidence
    • 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
    • Net Zero Mental Health Care Research, Resources and Education
      • Net Zero Mental Health Care Call for Evidence
  • 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 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
      • 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
      • Kurdish Kurdî
    • 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 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
      • 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
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Assignment with WHO to Syria – Dr Peter Hughes, February 2014

The RCPsych blog

08 February, 2014

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This blog is a personal account of an assignment with WHO to Syria in February 2014. It is my personal blog and does not reflect the views of the College or any political views of the Syrian crisis.

I am a Consultant Psychiatrist in South London. I have been involved over many years in international mental health and particularly in Primary care low resource settings. Mostly I have been doing assignments in Africa.

This assignment began with an email in January from WHO asking me if I was interested or available to do a training in Beirut. More recent requests that I have had include challenging environments like Iraq – which, incidentally I loved. So Beirut sounded wonderful to me. I know many think of Beirut from the war days but to me Beirut is an oasis of peace with beautiful climate and beaches. I was even more delighted to hear my old colleague from Haiti and Sudan days would be my co trainer.

The project was to train health processionals in how to use the WHO mhGAP manual, which is a tool to integrate mental health into primary care in low resource settings. I am in the position of being an expert in delivering this training. Our task was to train 30 mental health professionals from Damascus in Beirut in using the manual.

About 3 weeks before going we received an email saying that, for convenience, the training would now be held in Damascus, Syria. I had lived in Syria many years previously so I knew it reasonably well from the days of peace. However, the past 3 years, as everyone knows, have been dominated in the news about the human catastrophe occurring in Syria and amongst its refugees.

There are millions of refugees who have left the country. When you ask a Syrian what the population is, you can see they start at 22 million and work out the millions of refugees that have now left.

Syria itself is scarred by frontlines of conflict. A geopolitical map of the country doesn't actually help much. There are hot spots of government control around Damascus and Latakia. The rest of the country seems to be a mishmash of competing forces dominated by the Free Syria army. The conflict is so chronic that it is no longer front page but atrocities continue to occur every day.

So the decision to travel or not took some thinking – at least a minute or two - on the risks of going into an area of active conflict.

Day 1

I arrive on a pretty empty flight from London to Beirut. The city is beautiful with a gorgeous cornice and waterfront walks.

I meet my colleague who has been working with Syrian refugees in Turkey. We head down town and enjoy a beautiful meal followed by Hubble-bubble.

We go to find the old market only to find a concrete market about 5 years old. Life is buzzing here with lots of nightlife. This is a nice place to live - at least this part of Beirut. There was a checkpoint to go down to South Beirut. This is a place with some security problems.

Day 2

A taxi arrives at an unearthly time of 6am for us. We head out east for an hour or two. I was fast asleep in car at this stage. We get to the Syrian border. This is the official government crossing.

This was a place of chaos. Lots of people hanging around and the border seeming impenetrable. There were many cars packed inside and out, but no one seeming to be moving very fast. But the movement was definitely west to Lebanon and not the other way round. After a while we see our armoured Land Cruiser to bring us to Damascus and WHO driver. This was a regular looking vehicle. However the window was the toughest I have ever seen and the door so heavy. This reassured, and at the same time, alarmed us for the journey ahead.

Next was getting stamped for exit from Lebanon. I didn’t quite know what was happening but there was a mass of human beings, being human. It was a pitiful scene -100s of people crammed into a shed like building. Being with WHO gave us an advantage and we could beat the queue. This was the first face-to-face contact with the conflict as these were clearly people desperate to get away.

Next a few more check points, a no man’s land and then Syria border post. This time the building was almost empty and not many seeking Syrian entry visa. We saw a forlorn counter for tourist groups. Empty for 3 years. After this, pictures of President Asad just about everywhere – in buildings, outside buildings, on walls , on streets, on cars – everywhere you could think of. The picture is ubiquitous. We did see a few pictures defaced on the road to Damascus but that is a dangerous thing to do.

We then went on a journey for a couple of hours through a green hilly and empty landscape punctuated by frequent checkpoints. Before we know it, and relatively easily apart from Damascus traffic, we end up in the Sheraton in Damascus. Because of security there is clearance to stay in only 2 of Damascus’ hotels, this being one of them.

The hotel is situated in front of a large square framed by a military camp on one side and the TV station on the other.

This made it the safest place in some ways, as it was heavily fortified but one could also argue vulnerable to opposition forces. What I didn't realise is that when we entered the hotel we would not be able to step out again.

Next we go straight into the training. We have 30 people waiting. There are roughly 60 psychiatrists in Syria they tell me, but almost all but one of these participants are from the Damascus area. There were a few psychologists and a social worker. Participants were from the ministry of health, UNHCR, WHO and some NGOs.

Day 3

We ask for cases that people have seen that we can use for mental health training. Almost all these cases were harrowing accounts of killings, rape and civil unrest.

Sample of cases:

  • Single, employed male in his 50’s, with explosion in front of his house a few months ago. His mother was wounded and he took her to hospital himself. Currently, he cannot go out of his house unless his brother accompanies him. He is hesitant in selecting the roads to go where he wants to go. He sleeps with earplugs, hiding because he fears another explosion or mortar attack. In addition, he has started using alcohol to control his anxiety.
  • 32 year old single male came to the centre after stress because of random bombardment in his area. He left to a safer place and is now an IDP. He used to work in a shop. He now suffers from headache, difficulty breathing, stomach cramps, racing heart, difficulty sleeping, feeling of tension whenever there is any noise or sound even if it’s soft, dizziness and sweating of hands.

We settle in for our night in the hotel. There is hardly anyone present and definitely no tourists. The shops are closed. We go to the swimming pool, which is waterless. This place is not built for tourists now.

Syrians say they looked at Iraq and Lebanon in the past and said that it could never happen in Syria They still cannot believe what has happened.

What was clear is that for Syrians there is no luxury of being able to choose to think of one side or the other. It is a matter of survival. Damascus is a bastion of government so this was the framework of all what we heard and saw for our week in Damascus.

For us, we had the luxury of being able to be neutral and step back from being partisan. What we definitely were committed to was peace and Syrians finding a peaceful path for the future. Then about midnight: the first sound of mortar. First I thought it was lightening and looked out for the rain but none present. Next bang is without any flash so I realise that this is mortar fire. I learn later that there is a front line about 1 kilometre away.

Day 4

Breakfast and I'm the only one there for an extensive buffet of delicious Syrian foods. My memory from when I lived here before was the fantastic food and cakes.

The Psychiatrists, and other professionals have a high standard of mental health knowledge and application. We do the training through an Arabic interpreter. It is a testament to his skills that we often forgot he was there.

We started with Depression, as this is a key component of the manual and most often missed at Primary care. Feedback from the group is that currently the most frequent cases they see are stress related. However after going through the module there is a sense that this is missed more than they had thought.

A long and fruitful day.

Dinner in the hotel that evening where we have a singer singing traditional songs. Men play backgammon and every single person smokes.

1am - I wake to hear gunfire. I remember my rule of thumb: gunfire on one side is ok, but both sides - not. When on both sides - then time to panic.

If the floor shakes time to panic!

Here, gunshot and mortar fire was sporadic and seemed far away enough not to get alarmed. At least hearing the gunfire and mortars at a distance means they are not on your doorstep.

Day 5

The Participants improve markedly each day in their teaching skills in using the manual. There are some excellent videos of International medical corps in Arabic with subtitles. We cover more and more modules – developmental, behavioural disorders, substance abuse, Suicide. We get a chance to speak to the participants. It seems that life is indeed very hard for the people of Damascus.

Our participants tell us of the difficulties of getting to the venue across so many checkpoints. Some of the group live in insecure areas and I can only imagine what life is like. I know the area that I lived in before is safe which is nearby.

They tell me most of the group have had to move because of the conflict. They are crowded onto homes in safe areas. Some have moved from rural areas. I did not go into the politics of the group. That is not something to talk about too loudly in Syria.

They tell me that there is fighting in the suburbs. There is a front line 1 and 3 kilometre around where we are. They tell us the mortars are from inside going out. They also tell us they are only on the daytime because then the firing can be visualised. However we heard mortars at all hours and so weren’t quite convinced by the explanations.

My colleague took to phoning me whenever there was a loud mortar –“did you hear that one “ It assumed a crazy normality after a day or 2. This is how Damascene people live. They told me it was much worse about 2 months before.

Sanctions are in place so credit cards are not usable here. The economy has taken a hit and people are suffering.

Day 6

We are progressing nicely in our training. We cover the important chapters of psychosis, bipolar, somatisation. But everything is prismed through the stories of the crisis.

Evening time – the weather is beautiful. We go for a walk around the grounds of the hotel. We ask at the gate if we can go out to take pictures of the square. They indicate that we could get shot so we think better of that plan. We are going a bit stir crazy now. We are desperate to get out of the hotel but we don't have a clear idea of how safe that is or not. I have seen the sights before but my colleague hasn't.

Day 7

We are told we can go out in the evening. We can hardly wait. Life does go on as normal in Damascus as much as it can. In fact one of the participants asked us if we would go to a dangerous place if asked by WHO. They had not considered Damascus, as it is – a dangerous place.

Disappointment arrives. For whatever reason we cannot go out today and some security problems. We stay back in our 5 star “prison”. We go to another restaurant in the hotel. They tell us that most of the menu is not available and we need to double the costs displayed. We can still get some falafel sandwich and delicious with Arabic coffee

Day 8

A productive training day. The participants are skilled at teaching and can task shift (have a mindset for primary care) to deliver mental health at a primary care level. We emphasise the supervision that is absolutely necessary to make the programme work of mental health in primary care. The Psychiatrists also have the role of being expert advisors and manage the most difficult cases.What is unclear is how the programme will be rolled out and the supervision mechanisms that are needed in such a volatile region.

Evening time, we are very excited to be able to step out the door of the hotel and go on a trip into town. We both know there are risks to this but there have been fewer mortars. Life going on as “normal” means people can be a bit detached from making a real assessment of risk. We go to the old city. The market is teeming with people and life really does go as usual. The shops are open. We go for ice cream in a packed shop. There are no foreigners apart from us. We go to the beautiful Umayyad mosque.

Following this a dinner with our colleagues from Damascus in a packed restaurant. Beautiful food. Strange with wall-to-wall smoking.

Back to hotel and our Damascus colleagues leave us. As soon as back in hotel we hear a loud series of mortars.

Day 9

Our work colleagues say they didn't even notice the night mortars after they left us.

Next to our training is a Polio workshop. It seems that some of the conditions of the past are recurring like polio.

The minister of health was attending this so he came to our training to deliver a speech. He talks about the conflict and the opposition being terrorists and driven on by outside interference.

Day 10

We finish off the training by discussion of how to go onto next stage of rolling out programme and supervision.

A surreal last night as after about 7 hours of preparing our work report we go to the English pub downstairs – I kid you not and play darts.

Many army people now staying in hotel.

Day 11

We head off in our armoured land cruiser to Beirut. The border takes a few hours to cross as before with a mass of people in cars and on foot making the journey out of Syria to Lebanon. A beautiful night in Beirut on the waterfront. It is so strange to have this freedom of walking and of speech.

Day 12

I head off to London and my colleague to Istanbul. It has been a surreal experience being in a dangerous city one day and back in London next.

It is hard to imagine how our programme will roll out in such an insecure environment. Yet I wish them well and more than anything else that there can be some peace as this war is truly horrible, complicated. There are no winners in Syria only losers. Fired by this experience the next thing is to think about how we can support the people of Syria both inside and out of the country.

We have identified about 6 UK Syrian Consultants Psychiatrists. We invite all those with an interest in helping Syria to contact the author of this blog.

I would like to thank the WHO for this opportunity, and also my Syrian hosts for their hospitality.

 

Written by Dr Peter Hughes

Blog Author
Dr Peter Hughes
Dr Peter Hughes

Chair, London Division

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