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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?
      • Help support our campaign
      • Choose Psychiatry – Guidance for Medical Schools
      • 'Make this a better world'
      • Continue to choose psychiatry
    • Sixth formers and school students
    • Medical students

      Medical students

      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries for medical students
      • 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
      • Careers in mental health research
    • 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
    • Choose Psychiatry
      • What is psychiatry?
      • How to become a psychiatrist
      • Why choose psychiatry?
      • What next?
      • On a break from training?
      • Help support our campaign
      • Choose Psychiatry – Guidance for Medical Schools
      • 'Make this a better world'
      • Continue to choose psychiatry
    • Sixth formers and school students
    • Medical students
      • Becoming a student associate
      • Psychiatry attachments
      • Awards, prizes and bursaries for medical students
      • 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
      • Careers in mental health research
    • 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
  • 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
      • Exams Reading List
      • FAQs about our exam centre in Doha
    • Curricula and guidance

      Curricula and guidance

      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty training guides
      • Dual training
      • Assessment Strategy Review
    • Portfolio Online
    • Your training

      Your training

      • Psychiatric Resident Doctors' Committee: supporting you
      • Routes to Registration
      • Applying for training
      • Run-through training
      • Training less than full time
      • Time out of training
      • Academic Training
      • Understanding Career Choices in Psychiatry
      • Leadership and Management Fellow Scheme
      • Prizes and bursaries for trainees
      • Cost of Training
      • Industrial action FAQs
      • Distribution of medical training posts
      • Presenting evidence at mental health tribunals
    • Medical training initiative (MTI)
    • International Medical Graduates
    • Employer Hub
    • Undergraduate education forum
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Dean's Quarterly Updates

      Dean's Quarterly Updates

      • Dean's Quarterly Update - April 2025
      • Dean's Quarterly Update - January 2025
      • Dean's Quarterly Update - September 2024
      • Dean's Quarterly Update - June 2024
      • Dean's Quarterly Update - February 2024
      • Dean's Quarterly Update - October 2023
      • Dean's Quarterly Update - June 2023
      • Dean's Quarterly Update - March 2023
      • Dean's update - 2022
    • Building Capacity in Perinatal Psychiatry

      Building Capacity in Perinatal Psychiatry

      • Perinatal Psychiatry Masterclass Series
      • About the Building Capacity Project
    • RCPsych Learn
    • 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
      • Exams Reading List
      • FAQs about our exam centre in Doha
    • Curricula and guidance
      • 2022 Curricula Implementation Hub
      • 2014 GMC approved curricula (ending July 2024)
      • Specialty training guides
      • Dual training
      • Assessment Strategy Review
    • Portfolio Online
    • Your training
      • Psychiatric Resident Doctors' Committee: supporting you
      • Routes to Registration
      • Applying for training
      • Run-through training
      • Training less than full time
      • Time out of training
      • Academic Training
      • Understanding Career Choices in Psychiatry
      • Leadership and Management Fellow Scheme
      • Prizes and bursaries for trainees
      • Cost of Training
      • Industrial action FAQs
      • Distribution of medical training posts
      • Presenting evidence at mental health tribunals
    • Medical training initiative (MTI)
    • International Medical Graduates
    • Employer Hub
    • Undergraduate education forum
    • Quality Assurance in Training
    • Credentialing
    • CPD eLearning
    • Dean's Quarterly Updates
      • Dean's Quarterly Update - April 2025
      • Dean's Quarterly Update - January 2025
      • Dean's Quarterly Update - September 2024
      • Dean's Quarterly Update - June 2024
      • Dean's Quarterly Update - February 2024
      • Dean's Quarterly Update - October 2023
      • Dean's Quarterly Update - June 2023
      • Dean's Quarterly Update - March 2023
      • Dean's update - 2022
    • Building Capacity in Perinatal Psychiatry
      • Perinatal Psychiatry Masterclass Series
      • About the Building Capacity Project
    • RCPsych Learn
  • 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 (PSS)
      • 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
      • Support for Refugee Psychiatrists
    • 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

      • Faculty of Academic Psychiatry
      • Faculty of Addictions Psychiatry
      • Faculty of Child and Adolescent Psychiatry
      • Faculty of Eating Disorders Psychiatry
      • Faculty of Forensic Psychiatry
      • Faculty of General Adult Psychiatry
      • Faculty of the Psychiatry of Intellectual Disability
      • Faculty of Liaison Psychiatry
      • Faculty of Medical Psychotherapy
      • Faculty of Neuropsychiatry
      • Faculty of Old Age Psychiatry
      • Faculty of Perinatal Psychiatry
      • Faculty of 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
      • CBSeic Cymru
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions

      English Divisions

      • Eastern Division
      • London Division
      • Northern and Yorkshire Division
      • North West Division
      • South Eastern Division
      • South West Division
      • Trent Division
      • West Midlands Division
      • Executive Committee job descriptions
      • All Division events
    • International members
    • Special Interest Groups

      Special Interest Groups

      • How to join a Special Interest Group (SIG)
      • Adolescent Forensic Psychiatry Special Interest Group (AFPSIG)
      • Arts Psychiatry Special Interest Group (ArtSIG)
      • Digital Psychiatry Special Interest Group (DPSIG)
      • Evolutionary Psychiatry Special Interest Group (EPSIG)
      • History of Psychiatry Special Interest Group (HoPSIG)
      • Neurodevelopmental Psychiatry Special Interest Group (NDPSIG)
      • Occupational Psychiatry Special Interest Group (OPSIG)
      • Philosophy Special Interest Group 
      • Private and Independent Practice Special Interest Group (PIPSIG)
      • Rainbow Special Interest Group
      • Spirituality and Psychiatry Special Interest Group (SPSIG)
      • Sport and Exercise Psychiatry Special Interest Group (SEPSIG)
      • Transcultural psychiatry Special Interest Group (TSIG)
      • Volunteering and International Psychiatry Special Interest Group (VIPSIG)
      • Women and Mental Health Special Interest Group (WMHSIG)
      • 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
    • Mindmasters quiz

      Mindmasters quiz

      • Attend Mindmasters 2025
      • Who won in 2024?
      • The rules of the quiz
      • Sample quiz questions 
    • RCPsych ceremonies

      RCPsych ceremonies

      • New Members Ceremonies
      • Fellowship ceremonies
      • Specialist Registration Ceremonies
    • Question Time with the Officers
    • 2024 membership feedback
    • Speciality and Sub-Speciality (SAC/SSAC) Advisory Committees
    • 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 (PSS)
      • 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
      • Support for Refugee Psychiatrists
    • 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
      • Faculty of Academic Psychiatry
      • Faculty of Addictions Psychiatry
      • Faculty of Child and Adolescent Psychiatry
      • Faculty of Eating Disorders Psychiatry
      • Faculty of Forensic Psychiatry
      • Faculty of General Adult Psychiatry
      • Faculty of the Psychiatry of Intellectual Disability
      • Faculty of Liaison Psychiatry
      • Faculty of Medical Psychotherapy
      • Faculty of Neuropsychiatry
      • Faculty of Old Age Psychiatry
      • Faculty of Perinatal Psychiatry
      • Faculty of 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
      • CBSeic Cymru
      • RCPsych in Northern Ireland
      • Executive Committee job descriptions
    • English Divisions
      • Eastern Division
      • London Division
      • Northern and Yorkshire Division
      • North West Division
      • South Eastern Division
      • South West Division
      • Trent Division
      • West Midlands Division
      • Executive Committee job descriptions
      • All Division events
    • International members
    • Special Interest Groups
      • How to join a Special Interest Group (SIG)
      • Adolescent Forensic Psychiatry Special Interest Group (AFPSIG)
      • Arts Psychiatry Special Interest Group (ArtSIG)
      • Digital Psychiatry Special Interest Group (DPSIG)
      • Evolutionary Psychiatry Special Interest Group (EPSIG)
      • History of Psychiatry Special Interest Group (HoPSIG)
      • Neurodevelopmental Psychiatry Special Interest Group (NDPSIG)
      • Occupational Psychiatry Special Interest Group (OPSIG)
      • Philosophy Special Interest Group 
      • Private and Independent Practice Special Interest Group (PIPSIG)
      • Rainbow Special Interest Group
      • Spirituality and Psychiatry Special Interest Group (SPSIG)
      • Sport and Exercise Psychiatry Special Interest Group (SEPSIG)
      • Transcultural psychiatry Special Interest Group (TSIG)
      • Volunteering and International Psychiatry Special Interest Group (VIPSIG)
      • Women and Mental Health Special Interest Group (WMHSIG)
      • 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
    • Mindmasters quiz
      • Attend Mindmasters 2025
      • Who won in 2024?
      • The rules of the quiz
      • Sample quiz questions 
    • RCPsych ceremonies
      • New Members Ceremonies
      • Fellowship ceremonies
      • Specialist Registration Ceremonies
    • Question Time with the Officers
    • 2024 membership feedback
    • Speciality and Sub-Speciality (SAC/SSAC) Advisory Committees
  • 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
      • Old Age Faculty Trainees
    • International Congress 2025

      International Congress 2025

      • Exhibiting organisations
      • Poster Presentations 2025
      • Your guide to Congress
      • Registration
      • Programme
    • In-house training

      In-house training

      • Competing interests
    • Free webinars
    • Claiming expenses

      Claiming expenses

      • What can I claim
    • Terms and conditions for event booking
    • Speaker guidance for online events
    • EventsAir FAQs
    • Speaker guidance for in-person 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
      • Old Age Faculty Trainees
    • International Congress 2025
      • Exhibiting organisations
      • Poster Presentations 2025
      • Your guide to Congress
      • Registration
      • Programme
    • In-house training
      • Competing interests
    • Free webinars
    • Claiming expenses
      • What can I claim
    • Terms and conditions for event booking
    • Speaker guidance for online events
    • EventsAir FAQs
    • Speaker guidance for in-person 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
      • CCQI research and evaluation
      • Health of Nation Outcome Scales (HoNOS)
    • Influencing and campaigning for better mental health policy

      Influencing and campaigning for better mental health policy

      • College Reports
      • Position Statements
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Processes for producing College publications, consultations, surveys and endorsements
      • Other policy areas
      • Mental Health Watch
      • Reforming The Mental Health Act
      • The Mental Health Policy Group (MHPG)
      • Preventing mental illness: Our manifesto for the next UK general election
      • The 2024 General Election and our manifesto
      • Assisted dying/assisted suicide
    • Planning the psychiatric workforce

      Planning the psychiatric workforce

      • About our workforce unit
      • 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
      • PMHIC Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
      • PMHIC Commercial Determinants of Mental Health (CDoMH) Symposium 
      • PMHIC Parliamentary Roundtable 
      • Smoking and Mental Health in Wales 
      • Public Mental Health Learning Community 
      • Weight management and mental health: A framework for action in Wales
      • Health inequalities briefing pack
    • National Collaborating Centre for Mental Health (NCCMH)

      National Collaborating Centre for Mental Health (NCCMH)

      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reviews, evaluations and reports
      • Service design and development
      • Work with us
      • Culture of Care Programme
      • A–Z of NCCMH publications
      • Compassionate and Relational Care Learning Programme
    • 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?
      • Sustainability in your community
      • Sustainability in your practice
      • Sustainability in your trust
      • Sustainability at RCPsych
      • Nature matters
      • Sustainability scholars
      • Sustainability resources
      • College position on sustainability
      • RCPsych at COP26
    • Public Health and its role in mental heath
    • Using quality improvement
    • Net Zero Mental Health Care Guidance and Education

      Net Zero Mental Health Care Guidance and Education

      • Net Zero Mental Health Care Report Launch Event
    • Mental Health Awareness Week
    • Invited Review Service
    • Physician Associate Review

      Physician Associate Review

      • Physician Associate Review Meeting Summaries
    • 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
      • CCQI research and evaluation
      • Health of Nation Outcome Scales (HoNOS)
    • Influencing and campaigning for better mental health policy
      • College Reports
      • Position Statements
      • Integrated care and mental health
      • Children and young people's mental health Green Paper
      • Cross-government mental health and wellbeing plan 
      • RCPsych in Parliament
      • Processes for producing College publications, consultations, surveys and endorsements
      • Other policy areas
      • Mental Health Watch
      • Reforming The Mental Health Act
      • The Mental Health Policy Group (MHPG)
      • Preventing mental illness: Our manifesto for the next UK general election
      • The 2024 General Election and our manifesto
      • Assisted dying/assisted suicide
    • Planning the psychiatric workforce
      • About our workforce unit
      • 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
      • PMHIC Aims and objectives
      • Reports
      • About public mental health
      • PMHIC Parliamentary Launch 
      • PMHIC Commercial Determinants of Mental Health (CDoMH) Symposium 
      • PMHIC Parliamentary Roundtable 
      • Smoking and Mental Health in Wales 
      • Public Mental Health Learning Community 
      • Weight management and mental health: A framework for action in Wales
      • Health inequalities briefing pack
    • National Collaborating Centre for Mental Health (NCCMH)
      • About NCCMH and our work
      • Clinical guideline development
      • Competence frameworks
      • Quality improvement programmes
      • Reviews, evaluations and reports
      • Service design and development
      • Work with us
      • Culture of Care Programme
      • A–Z of NCCMH publications
      • Compassionate and Relational Care Learning Programme
    • 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?
      • Sustainability in your community
      • Sustainability in your practice
      • Sustainability in your trust
      • Sustainability at RCPsych
      • Nature matters
      • Sustainability scholars
      • Sustainability resources
      • College position on sustainability
      • RCPsych at COP26
    • Public Health and its role in mental heath
    • Using quality improvement
    • Net Zero Mental Health Care Guidance and Education
      • Net Zero Mental Health Care Report Launch Event
    • Mental Health Awareness Week
    • Invited Review Service
    • Physician Associate Review
      • Physician Associate Review Meeting Summaries
  • Mental health

    Mental health

    • Mental illnesses and mental health problems

      Mental illnesses and mental health problems

      • ADHD in adults
      • Alcohol, mental health and the brain
      • Anorexia and bulimia
      • Anxiety and generalised anxiety disorder (GAD)
      • Autism and mental health
      • Avoidant/restrictive food intake disorder (ARFID)
      • Bereavement
      • Bipolar disorder
      • Cannabis and mental health
      • Catatonia
      • Cocaine dependence
      • Coping after a traumatic event
      • Debt and mental health
      • Delirium
      • Depression
      • Depression in older adults
      • Feeling overwhelmed
      • Gambling disorder
      • Heroin dependence
      • Hoarding
      • Intellectual 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 for carers
      • Postpartum psychosis
      • Postpartum psychosis for 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 (in England and Wales)
      • 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
      • Long-acting injectable (depot) antipsychotics
      • 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
      • What are perinatal mental health services?
      • Planning a pregnancy
      • Psychotherapies and psychological treatments
      • Social prescribing
      • Spirituality and mental health
      • Stopping antidepressants
      • 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 for young people
      • 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 for young people
      • Schizophrenia for young people
      • When a parent has a mental illness
      • When bad things happen for young people
      • Who is who in CAMHS?
      • Anxiety for young people
      • Weight, exercise and eating disorders for young people
      • Preparing for a blood test or vaccine for young people
      • Use of digital media for young people
    • Translations of our mental health information

      Translations of our mental health information

      • Arabic عربى
      • Bengali বাঙালি
      • Chinese 中文
      • French Français
      • German Deutsch
      • Greek Ελληνική
      • Gujarati ગુજરાતી
      • Hindi हिंदीहिंदी
      • Italian Italiano
      • Japanese 日本語
      • Marathi मराठी
      • Persian (Farsi) فارسی
      • Polish Polski
      • Portuguese (Brazil) Português (Brasil)
      • Punjabi (Pakistan) پنجابی
      • Romanian Română
      • Russian Pусский
      • Sindhi سنڌي
      • Spanish Español
      • Swahili Kiswahili
      • Tamil தமிழ்
      • Telugu తెలుగు
      • 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
      • Travmatik bir olayla başa çıkma Coping after a traumatic event in Turkish
      • စိတ်ထိခိုက်ဖွယ် ဖြစ်ရပ်တစ်ခုကို ရင်ဆိုင်ဖြေရှင်းခြင်း Coping after a traumatic event in Burmese
    • Order mental health leaflets and resources

      Order mental health leaflets and resources

      • Order mental health packs for schools
    • About our mental health information
    • Mental health information disclaimer
    • Mental health and psychiatry FAQs
    • Mental illnesses and mental health problems
      • ADHD in adults
      • Alcohol, mental health and the brain
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Development in Afghanistan: A Personal Reflection on Progress, Challenges and Lessons Learned

The RCPsych blog

17 April, 2023

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A blog post by Dr Peter Hughes based on work with Action Against Hunger (Action contre la faim) and the Dutch Mental Health Surge Support and Psychosocial Support Programme (DSS MHPSS).

October 2022

This was to be my third trip to Afghanistan. 

Background Afghanistan 

Afghanistan is a low-income country afflicted by conflict over many decades. 

The population is 38 million people. There is a high under 18 population with 46% under 15 years.  Life expectancy is low, at approximately 65 years.  Illiteracy rate is high. Literacy is 37% with more female illiteracy than male.  

The Taliban took control of Afghanistan on 15th August 2021 - one consequence of this has been a loss of international support for health and social care. 

45% of previous gross domestic product (GDP) was international in origin. 

There are reported to be 129 psychiatrists in the country, but it is unclear how many have left in the past year. Most are in Kabul, Central Region with an estimated 0.34 per 100,000. There are reported to be 2 psychiatrists working with children. 1 in Herat and 1 in Kabul. 

There are a handful of psychiatric units throughout the country. 

Afghanistan has often been cited as an example of good practice in mental health with its psychosocial workers and tireless commitment over the years to mental health. 

What is clear is that health service needs are dominated by women and children. Women will not see male health workers meaning that having sufficient female health workers is crucial. Even if a woman agreed to see a male health worker, it is unlikely her husband would allow this. In fact, the culture and customs of Afghanistan appeared to be close to the tribal areas of Pakistan that I had visited in the past. It’s clear that gender issues are so fundamental to the future of Afghanistan and its people’s health. 

Like many other countries, people attending health services have a strong expectation of a medication-based treatment for their problems, even if not indicated with x-rays or scans. 

Problems with stress and stress-related psychosomatic problems are extremely common.  Conversion disorder is very common. Mental illness is highly stigmatised and seen as a spiritual problem by many. 

1990s

My first trip was as a young man. Looking back now, I realise the risks I took were rather unwise; this was crossing the border into Russian occupied Afghanistan, which included the daily reality of no water, electricity and daily Russian aerial bombings. 

I had been spending time in Khyber Pakhtunkhwa, or Northwest Frontier province as it was called then, in Peshawar, Pakistan. I met so many Afghan refugees fleeing the war at that time. I saw depressed people without hope and manifesting somatic symptoms. This experience really helped me during my two trips in 2022 in understanding the context in Afghanistan and the culture. The situation remains similar to this day with people desperate to flee Afghanistan. Many Afghan people I met in 2022 had actually spent time themselves living in Pakistan. There is a close bond between eastern Afghanistan and Pakistan. 

Although somewhat dangerous to visit at that time, what I recall was the beautiful mountains, the hospitality and kindness of the local people. What was most striking was the sense of hope in the future which is now sadly lacking.  

June 2022

I was delighted to be invited to return to Afghanistan. 

In June 2022, I was asked to deliver training in mental health in primary care, namely the mhGAP (Mental Health Gap Action Programme). This was a relatively brief trip of a few weeks. 

Arriving in Kabul Airport brings up all the memories of the horror of the August 2021 evacuations that we saw on television. There was no sign of this on arrival - just a busy, somewhat chaotic airport, and my first face to face with the Taliban. What I wasn’t expecting was having to leave my passport with the airport authorities and not see it for a week. 

Thankfully, I got picked up by a car and was transported to the heavily fortified United Nations compound. From then on, and at all stages henceforth, I was prohibited from standing or walking on a public street. 

The compound had a subculture of UN humanitarian workers. All were friendly. There was everything you needed, such as shops, restaurants. There was a heavily fortified checkpoint which was comparable to getting in and out of the checkpoints at Gaza. I stayed in a converted shipping container which was fine I would say, but I was glad I wasn’t staying for too long this time.  

We then embarked on an intensive course in integrated mental health in primary care which was held in Central Kabul. Travel was escorted with an armoured vehicle to and from the compound. The hotel was heavily fortified, but we had views of the mountains that surround Kabul. 

We trained a number of psychiatrists and doctors including a mixed gender participant list and a female co facilitator. With training, you wonder at the beginning if the participants will engage and talk or be quiet and perhaps shy away from active learning such as role play. I shouldn’t have been concerned, the Afghans were a very active group and eager to share their knowledge and learn. 

Some of my experiences of Afghanistan were heart-breaking, especially when talking to some of the female doctors who lost their jobs with the arrival of the new Government. They were asked not to return to work. They feared for their daughters and how they would get an education. Many in Afghanistan spend much time thinking how they can leave. This is especially so for anyone with daughters.  Girls no longer can have secondary level education. Women need a male relative to move around in public. Hope seems to have gone.

Many spoke to me of the difficulties of life in Afghanistan since the takeover in August 2021, with the loss of international funding for the new Government contributing to these difficulties. However, the truth is, life has been difficult long before the invasion. Problems of poverty and social injustice predates the new government. The view of the Taliban are shared by many in Afghanistan, particularly in rural areas, but a bit less in cities like Kabul. Many have left and started new lives in other countries but would love to return to their homeland when the situation improves.

It is unclear what the future holds for women in Afghanistan. Themes that were pervasive in our training were protection or safeguarding as we would term it in UK.  Women have a high risk of being victims of abuse with reports of forced marriages and child marriages and drug use is a big issue for males. Education for girls in the country in secondary and tertiary level has been banned so lessons are now conducted in secrecy.

Depression seems to be very common. Somatisation is a common manifestation and conversion disorder is much more apparent, unlike my experience in the UK and other countries. Family conflicts are common and cause immense distress. 

The rate of suicide is reported to be relatively low in Afghanistan. This is due to socio-cultural factors. However, we heard of many stories of self-harm and suicide in both genders including overdosing, hanging and self-immolation. Suicide is illegal in Afghanistan, but the law is not enforced generally. It is a very sensitive area culturally and a taboo topic carrying other repercussions. For example, the whole family may be stigmatised by a family member's suicide. Anecdotally the reports match what we know of suicide, i.e., higher rate of successful suicides by men and self-harm by women. There is a real dilemma of sending someone home who has tried to take their life when the reason for this may be back at this same home. 

Children’s problems are common especially food insecurity and malnutrition. Children often go to traditional healers for their problems. Epilepsy in children can be stigmatised and seen as a demonic possession.   

Many psychiatrists might think that psychosis is a core part of mental health in primary care. This is not the case. The amount of psychosis varies but is still relatively uncommon in the community. However, effective treatment can transform the person affected and see a change in the family and community. 

There is abuse of human rights of people suffering from psychosis. A common belief is possession by Jinn or spirit where people may be tied up at home with supernatural causes being a common attribution. First line care are traditional healers and generally the care there is benign with religious healing principles. Outside of specialist settings, which are rare themselves, there is a lack of capacity to treat psychosis in the community settings. 

Dementia is seen as a rare condition due to low life expectancy in Afghanistan. There are no nursing home facilities, so all support is from the family.  However, there were anecdotes we heard of people suffering from dementia amongst the training groups to indicate that it is relatively well known but limited treatment and support is available. 

Substance use is a significant problem in Afghanistan. Opium grows throughout the country, especially in areas such as Helmand in the South. There are problems with methamphetamine and abuse of tramadol and benzodiazepines, the latter of which can be bought at local pharmacies without prescription. On the contrary, alcohol use is extremely rare. 

The participants provided some sample cases that are representative of what they see in community settings:

  • 25-year-old married women. She has 2 children. She has been feeling depressed [for a] long time because of poor economic problems. She is [always going to the] clinic and after [some time she explains the] above. She is jobless and her husband is jobless also.
  • A woman with paralysis came to [the] hospital. She can’t talk and had this condition after her father’s death.

Themes were poor economy and family stress. 

The training in Kabul has since been the impetus to a cascade of trainings around Afghanistan, especially in the East. This did give me hope as there are many people working tirelessly to make a difference even in the setting of frequent hardship. 

I left Afghanistan with a plan to provide ongoing online supervision to doctors and psychiatrists. 

22 June 2022

Shortly after my departure, an earthquake occurred on 22 June 2022, which was 6.2 on Richter scale and 2.5 miles deep and killed over 1,500 people. This diverted the programme to focus on the emergency earthquake response. 

Some of the people I trained were deployed to the earthquake area. They used basic principles of Psychological First Aid (PFA) which is a way of meeting people’s basic and emotional needs when in distress. Colleagues told me of their stay in tents and hearing harrowing stories of whole families being wiped out. This was an area with very poor electricity supply, limited internet and deprivation even before the earthquake. 

October 2022

This current mission of October 2022 arose out of a request from a French non-governmental organisation, ACF (Action Against Hunger), for support with coordination of mental health work in Afghanistan. My role was funded by the Dutch Surge Support programme on MHPSS and hosted by ACF.

The visa was the next hurdle which took longer this time. I therefore had to work from home in the UK before being able to travel. 

My visa eventually came through and I travelled almost immediately to Kabul. There are currently two Afghan airlines that fly to the country, both of which are reliable. This flight was from Dubai to Kabul. In Dubai, you must travel to the very extreme end of the airport and then a bus takes you to a further remote section from where the flight departs. 

You know that you are going to Afghanistan as soon as you arrive at the gate. There is a separate waiting area for women, people are dressed in shalwar and chemise, turbans, burqas etc. and usually there are a few expatriates like myself. Generally, expatriates in humanitarian work for a few weeks (5 to 8) in Afghanistan before compulsory rest and recreation leave. The R and R becomes so important as life is very restricted for them in Afghanistan. 

Even though it wasn’t my first time in Kabul, the airport remained chaotic for me. At least this time, I knew I would get my passport back after a week or so. I was then waiting in the wrong place for my transport before eventually heading out the front gate and soon picked up by a vehicle. Then, a car to my new home. 

This time I was staying in a guesthouse of ACF. This was a secure place where there was a safe room in each building of the compound in case of attack. Fortunately, I never had to use this. I then battled the mosquitoes and an incredibly uncomfortable mattress. This was soon sorted by my very hospitable ACF hosts. The compound had a gym, many kitchens and a cook. We were comfortable. The weather at this stage was warm, although Kabul can have 1 metre snow and go down to minus 20 in the depths of winter. 

My life was pretty comfortable here. I would have a car with a guard to drive me morning and night to the office and back – a journey that lasted less than 5 minutes. We were never allowed to walk on the streets freely. My life was office, guest house, training venue. We had electricity gaps at night and day, but we always had internet. Internet had an emergency battery supply as seen as an essential need in case of security problems. 

We were allowed to visit one or two shops and restaurants. This was a lifeline but always escorted and in high security. The streets would appear like any other South Asian Muslim city apart from the relative lack of women and the lack of all music which is not permitted. Sometimes we could see the homeless opium addicts lying on the ground around the city. We had a curfew so always needed to be home early. 

Weekends were restricted but we could go to one restaurant at certain times. I learned that a friend of mine with whom I worked with in Haiti was now based in Kabul. So, a weekly restaurant visit to catch up was a highlight. Also, there was the socialisation at the guest house and catching up with others. I have to confess to having watched so much on Netflix which was available and a lifeline for the lonely weekends and evenings stuck indoors.

Life for the average Afghan is not easy. Electricity supply is poor, with maybe less than five hours per day, and when this is available is never known. Winter cold is dreadful for Afghans with no electricity. My colleagues would have three to four different transports to get to and from work through traffic.  

Life for women is another story. More and more restrictions came in as time goes on. Girls can’t go to high school. I visited Kabul Education University one day and met the female Vice Chancellor. We toured the campus and met the teaching staff. There were so many female students around even in off term time. It was devastating then to hear that women were banned from tertiary education. Tertiary education was permitted until December then stopped. 

I spoke to women who told me that they were in tears on hearing the news of banning of women at tertiary educations and any little hope they had in Afghanistan was stripped away. 

Women are now compelled to cover their faces. Sometimes one sees the traditional Afghan Burqa, but this was less than I remember than in North Pakistan. Women tend to wear a Covid mask which I heard is a way of fulfilling the law but making a symbolic gesture to the government. 

In early November 2022, the government banned women from going to parks and gyms. I found the lack of women in parks ghostly and particularly chilling. 

Another vulnerable group identified are the adolescent males who get caught up in drug use. Indeed, the amount of drug users in Afghanistan, like its neighbour Iran, is staggering and likely reflects the misery of day-to-day life.

Afghanistan is a very religious country, even apart from the Taliban. At village level there is a deep religious conviction, very similar to North Pakistan. During training, I saw how precious religion is for people and what strength it gives them.  Along with the strong families and community, religion is a factor that provides resilience to the Afghan people in general. All training and other programmes must consider religious sensitivities and focus on family. 

Afghanistan has many different diverse regions each with their own culture and character. With my restricted visa, I was unable to leave Kabul although I met some people of the Hazara community. These people face stigma due to their faith and ethnicity. In the past there have been Sikhs, Hindus and others but it seems that everyone has just about left now. 

The Taliban presence is everywhere. From my office, I could look out and see what must be one of the largest, if not the largest, flagpoles with the white Taliban flag, on the top of the mountain facing us. The white flag of the Taliban is everywhere. 

On the streets one can see the young Taliban with their guns and characteristic shoulder length hair. What is jarring is men that look like they are teenagers carrying rifles. Sometimes the Taliban soldiers have their faces covered. There are checkpoints and many trucks fitted with guns that are part of the cityscape of traffic. 

Professionally, we would meet people from the Ministries. I never had any problem and was always treated with great politeness and respect. The Taliban represent a popular move in Afghanistan that would echo with many people throughout the country, particularly in the villages. For me, I needed to respect that this was a view in Afghanistan even when I struggled to agree with some of their viewpoints.

Night by night, we would hear what sounded like fireworks. However, I needed to remind myself that this was indeed Afghanistan. This was gunfire. The trick was to see how far away the shots were and if the next round was closer then it would be time to worry. Another bad sign would be if the gunfire was on each side. It was never a problem for me. I would just remember that this was most likely a wedding or cricket match. People celebrate here by firing their guns in the air and guns are ubiquitous. 

The only security risk I encountered was an Islamic State – Khorasan Province (ISK) attack in Kabul one day. I was doing a training session in Central Kabul in a hotel and a colleague came in at the end of the day to say there were reports of a complex blast and street fighting outside our hotel. Next, I could hear the blasts and shooting. I felt quite safe in our secure hotel, that was fortress-like from a security point of view. I waited a few hours until our organisation security came to bring me out safely. Several fighters and members of the public were killed. Security levels were higher after this. We travelled in convoy, and it was only with great trepidation that we resumed training in this venue. 

My work was to support coordination of mental health work in Afghanistan amongst state and international organisations. What helped me greatly here was my time and experience of formerly being the Chair of the London Division of the Royal College of Psychiatrists. It was about advocacy, reaching out and engaging with government and other organisations - national and international. We conducted a number of training activities and workshops which were relatively easy to set up and well attended. I did not do any clinical work directly. The role of the international psychiatrist can be often a somewhat pedestrian one being in an office stuck at a laptop. However, the trainings were a joy to deliver. 

There were a number of phases in this type of work. There is an initial period of trying to pick up information on background followed by a frantic period of getting everything covered in time and finally a feeling that one is leaving too early. In fact, there was no possibility of extending my time as my visa was not extended. My visa also prevented me leaving Kabul. 

My work was in MHPSS (Mental Health & Psychosocial Support) which was trans-professional. I did not need to be a doctor, psychiatrist, nurse or psychologist but needed to have mental health skills that covered mental illness and psychosocial support. A lot of my time was spent on non-medication approaches to health with stress management etc. 

My office was next to a phone line service for people in distress to connect with counsellors. This was staffed by women and men however I am unsure if the government still allows women to continue this work due to further restrictions imposed since I left. The stories were depressing. Women could ring only if their husbands allowed them to. Sometimes women would ring secretly. The calls were from people in distress, depression and social adversity. We heard about forced marriage, child marriage, domestic violence and economic struggling. One call, I remember, was from a woman who tried to self-harm using a Kalashnikov rifle but survived. 

End of November 2022

We had our first workshop on supervision and teaching skills. 

Our plan was to have a succession of such workshops to reinforce the message of supervision and ensure sustainability. We knew that training is not sufficient without adequate supervision afterwards to power any intervention. It was also an opportunity to introduce the new WHO-UNICEF electronic tool of supervision called EQUIP (Ensuring Quality in Psychological Support). 

Our next workshop was on emergencies which was important as Afghanistan can be seen as in a state of protected emergency, prone to natural disasters and climate adversity. We heard harrowing stories of the earthquake with multiple casualties and the adversity faced by first responders. This earthquake exposed hardships such as difficult access and living situations for first responders. 

Psychological First Aid was the key MHPSS intervention which is a model of helping people in distress. There were other stories of bomb blasts, road accidents, floods as well as emergencies increasingly arising out of climate change. This allowed reflection, learning from each other and development of an emergency plan. 

Early December 2022

We had a six-day workshop on problem solving called PM+ (Problem Management Plus). This was based on a World Health Organisation (WHO) manual. 

The intervention consists of two assessment sessions then five intervention sessions. The intervention sessions were individual and took place once a week for five weeks. and involved stress management, problem solving, relaxation, behavioural activation and social mobilisation. The training was great, and I could really see this intervention working in Afghanistan. They were not about making a diagnosis but generally for people with distress, depression or safeguarding issues. So often the cause of people’s distress are social factors and problem solving was absolutely the right approach. 

During these sessions, I began to hear some of the big social problems in Afghanistan - forced marriages, selling babies due to poverty, conflicts with in-laws. I heard stories of 12-year-old girls married to men in their 30s and 40s, and even older, with no autonomy. I saw the pressure on these girls to have babies and, most important of all, to produce sons. On the other hand, I heard the protective force of religion and family. 

Below are some of the sample cases from these sessions (exact texts from participants used):

  • One of [the] biggest case[s] I saw [was] of [an] 18 [year old girl]. She can’t go to school because of [the] current situation and has mental health problems.
  • Symptoms [caused by] fear after change [in] government [included] blood pressure going up and [having a] heart attack. 
  • After collapse of [the] government, people face[d] many problems. [I] lost my job and was depressed for months, this affected [my] family and my son [and I am] still not successful. 
  • 42-year-old during bombing lost his arm and [is no longer] working. He thinks he is useless and is not the man he was before. He gets headaches, [is] angry all the time and [shouts] at his child.

There were other cases of secret romances and broken romances. This was surprising in such a restricted society on genders mixing. There is a huge stigma around LGBTQ+ issues. This is not discussed but they do have what is called transgender or third gender. 

All these situations can be managed by PM+. Here, I was not a psychiatrist but a general health worker. Problem solving can be so fascinating as is the need to be creative with the solutions. Often the solutions generated by the group were religious in nature and family centred.

We next held a training on Psychological First Aid. This was a 2-day training session following requests from some of the national MHPSS organisations. This again brought up harrowing stories, some including children. We heard many first-hand accounts of dealing with emergency situations such as the recent earthquake, blasts and the chaos of August 2021 when the Taliban came to Kabul.  

Mid December 2022

The last phase of my mission was a training session based on “THINKING HEALTHY”. This was, in some ways, the most challenging area for me. It was a psychosocial intervention based on cognitive therapy, behavioural activation and problem solving. This intervention is used for women before and after birth and must be implemented by women, due to cultural factors. 

With the governments restrictions on women working in organisations, I fear for this programme. Part of the programme involves a woman looking at a series of pictures that guide cognitive reframing. We were told that the pictures would need to be adapted to Afghanistan. A picture of a whole person would not be acceptable, even if a cartoon. The picture must be, at the very least, a partial view of the person e.g., leaving out an arm or a leg to be acceptable. 

We had a midwife present who was able to really contextualise the intervention for Afghanistan and particularly how religion would interplay helpfully here. To further contextualise this training, we asked people what the issues might be for mothers or pregnant women in Afghanistan. It is a disaster for a woman to have a daughter. This was truly chilling and such a strong message. 

We managed to get a more positive religious perspective - such as the daughter being “God’s will”. We even talked about the ‘daddy’s girl’ phenomena and that the husband and in-laws could grow to love “even” a daughter. We talked of the grandparent effect and overcoming their unhappiness with a daughter after they grew to know and love the child. The other pervasive theme was that of the conflicts with in-laws. This was soul destroying to hear stories of maltreatment by including threats of divorce if the child is a girl. I was impressed with this intervention and could see it working in Afghanistan as it doesn’t require literacy skills. 

I remarked to my colleague one day that one of the women had not attended. I said that it was likely her husband stopped her coming here. My colleague said, “you are indeed Afghani now”. This was a depressing realisation of what the day-to-day struggles are of women in Afghanistan. Although it must be said that there are many who don’t share these views and bravely advocate for women’s rights.

End of December 2022

The weather is beginning to get cold. For those with limited electricity, the next few months would be tough. People use a type of “bukhāri” heater which causes a significant amount of pollution. You could see a cloud of smog across Kabul at this time. 

I began to get very concerned about the risk of travelling out of Kabul. The airport is always a risky place and with the number of foreigners leaving during holiday season the risk increased. It is especially dangerous at the point of leaving the car at the street and going through the first of multiple security cordons. But fortunately, there were no problems and I got out successfully. 

Late December 2022 I returned safely to UK. 

January 2023

Back in the UK, I was reeling from the Taliban pronouncement that women are prohibited from working in non-governmental organisations. Without trained women working in the health force there is no health access for half the population. I hope that this gets sorted as it is an existential crush to life in Afghanistan. 

Being back in the UK, I enjoyed walking on the street, not having a curfew, going out at the weekends but strangely I began to miss my time and work in Afghanistan. 

Blog Author
Dr Peter Hughes
Dr Peter Hughes

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