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The Royal College of Psychiatrists Improving the lives of people with mental illness

Choosing Wisely

Choosing Wisely


The Academy of Medical Royal Colleges have now published their Choosing Wisely Recommendations

This initiative aims to help mental health patients and doctors choose care that is:


·         Supported by evidence

·         Not duplicative of other tests or procedures already received

·         Free from harm

·         Truly necessary

We worked with members of the college to create a list of tests, interventions or treatments, which are not supported by best available evidence. We, as the representative body of UK psychiatrists, think they are therefore unnecessary or potentially harmful. We hope this list will generate discussion and debate. In the coming months we will be working with each of the Faculties of the Royal College to develop lists for each specialty.




RCPsych Choosing Wisely list


In the treatment of depression, if an antidepressant has been prescribed within the therapeutic range for 2 months with little or no response, it should be changed or another medication added.


When adults with schizophrenia are introduced to treatment with long-term anti-psychotic medication, the benefits and risks/disadvantages of taking oral medication compared to long-acting depot injections should be discussed with all relevant parties.


Women who are able to conceive should not be prescribed valproate for mental disorders except where there is treatment resistance and/or very high risk clinical situations. All other options should have been considered and/or tested and all the risks and contraceptive options should be discussed with all relevant parties.

* When a diagnosis of psychosis is made, CT or MRI head scans should only be used for specific indications i.e. signs or symptoms suggestive of neurological problems

If you would like to get in touch with the College about the Choosing Wisely campaign, please contact Thomas Rutherfoord at


Further information

·         UK Choosing Wisely website

·         RCPsych project brief

·         A guide to how the top 5 list was created

·         RCPsych introductory blog post

·         BMJ introductory Editorial

·         View a list of interventions produced by medical organisations in Canada



October 2016



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   Professor Sir Simon Wessely
  Professor Sir Simon Wessely, President
  Dr Adrian James
  Dr Adrian James, Registrar
  Dr Joseph Hayes, Choosiing Wisely Lead
  Dr Joseph Hayes
  Dr Daniel Maughan
  Dr Daniel Maughan, Research Fellow in Sustainability