A brief history overview
For the first time in history, more women than men are on the UK medical register. This fact is remarkable when we consider that the first woman to be allowed on the UK medical register was Elizabeth Blackwell in 1859. Obtaining a medical education as a woman back then was extremely difficult. Until 1869, no medical schools in the United Kingdom would train women – Elizabeth Blackwell obtained her medical degree in the US. This only changed when the Edinburgh Seven, led by Sophia Jex-Blake, enrolled at the University of Edinburgh. However, once there, they were met with hostility from their male counterparts. At the end of their studies, the Edinburgh Seven were even barred from graduating (Somerville et al., 2005).
Their experiences ignited a spark. In 1874, Sophia Jex-Blake co-founded the London School of Medicine for Women (LSMW), the first UK institution to train women as medical doctors. Then, in 1876, a new Medical Act came into force, allowing all qualified applicants to apply for the medical register – regardless of gender (Scharlieb et al, 1918).
Elizabeth Blackwell and the Edinburgh Seven were the women who started it all. Without them, we would not be here today. When looking deeper into the history of women and psychiatry in the UK, things also started slow. Back in the day, psychiatrists were members of the Royal Medical Psychological Association, and in 1920, there were only twenty-three women members. By then, women were allowed to practise and become members of medical societies. However, there were still major societal barriers, such as the fact that women doctors who married were expected to stop working – a trend that continued well into the 1950s (Ramsay et al., 2005).
From that time, Helen Boyle was a trailblazer. She trained in the London School of Medicine for Women from 1890 to 1893 and went on to achieve many ‘firsts’ in her career. She founded the Lady Chichester Hospital – the first mental health facility dedicated to treating women suffering from early signs of psychosis. Helen went on to become the first woman member of the Royal Medical Psychological Association and its first female president. She also founded the National Association for Mental Health – today known as Mind – a leading charity helping young people to access evidence-based mental health support (Ferry et al., 2020).
The challenges we face today – the need to break the glass ceiling
In the one hundred and thirty years since Helen Boyle led the way, what has changed and what still needs to change for women in psychiatry? Most doctors on the UK medical register are women, but we are still underrepresented in academic psychiatry and, notably, in child and adolescent psychiatry (Ramsay et al., 2005). While the number of women doctors and the number of women consultants is increasing, the glass ceiling still looms above us. The glass ceiling – coined by Marilyn Loden in a historic speech in 1978 about the difficulties women in the workforce face – refers to the barrier women and other minority groups encounter when seeking career advancements and leadership positions (Segovia-Saiz et al., 2020).
Out of the twenty-four existing professorships in Child and Adolescent Psychiatry in the UK, only 9 (37.5%) are held by women (Keheller et al., 2025). In overall academic psychiatry, a 2021 survey found that women occupy only 21% of professorial posts (Dhingra et al., 2021). At the professor level, only 21% are women (up from 11% in 2001).
Despite the outlook these numbers suggest, there has been progress. On a more hopeful note for the future, the same survey found that the percentage of women in academic psychiatry posts in the UK has more than doubled from 20% in 2001 to 40% in 2019 and these improvements have happened at all levels of the academic hierarchy (Dhingra et al., 2021). These numbers suggest real progress towards gender equality although things still look very unbalanced at the top of the academic ladder.
“While the number of women doctors and the number of women consultants is increasing, the glass ceiling still looms above us.”
Looking to the future – what will it take?
These statistics beg the question: Why is there continued disparity at the top of the academic ladder? Previous studies suggest several causes: few visible role models and mentors for women academics, the lack of transparency for pay and promotion procedures, gender imbalance in the decision-making processes of promotion and organisational policies and, particularly challengingly, the intangible cultural factors that seem to exclude women from the corridors of power (Howard et al., 2003).
To tackle these issues, the UK has introduced the Athena SWAN initiative: a set of principles universities must adhere to to address barriers in gender equality. To reinforce the initiative, the National Institute for Health and Care Research, one of the largest UK funding bodies, announced in 2011 that any funding would be conditional on achieving an Athena SWAN silver award (Gregory Smith et al, 2017). Despite this top-down approach, women are still not achieving parity when it comes to the highest academic grades.
Perhaps, to conquer this last milestone in academic psychiatry, we need transparency in recruitment and promotion processes and implementation of work-life balance measures to retain women who wish to have a family (Dutta et al., 2010). In this regard, UK funding bodies such as the Wellcome Trust and the Medical Research Council, have been pioneers in implementing generous maternity leave policies and should be applauded. An important area of research to better understand what is causing this issue would be to look at the metrics and academic credentials of applicants for promotion to professor by gender in psychiatry.
A personal perspective
I am a twenty-seven-year-old woman in academic psychiatry, about to start training in a Child and Adolescent Psychiatry academic post. If I do it full-time, without interruptions, it will take me six years to complete. But I also plan to do a PhD during this time – adding three more years. So, it will take at least nine years, but probably more, to complete my clinical academic training because I hope to make the most of other opportunities, such as Clinical Lectureships, during this time.
I am also a woman who aspires to have a family one day and am increasingly aware of my biological clock. Without supportive policies such as maternity leave and less-than-full-time training, my hopes and dreams of having an academic career and a family would be impossible to reconcile. Thanks to phenomenal role models, I know that it is not easy, but it is possible. As my academic mentor says, life is for living. I am really grateful for her example – being a full professor herself and having twins during her PhD. I look around and find inspiring examples among my colleagues too, like a PhD student in our group who recently took maternity leave to have her baby, and higher trainees who went less than full-time to dedicate time to their new families.
A common criticism is that women admitted to medical school do well, work well and graduate well. But then, they start to make choices to balance their family and their lifestyle (Ramsay et al., 2005), which would then hinder their careers. No doubt, maternity leave and going less-than-full-time have an impact on career progression. However, it is a false dichotomy to tell women in the medical workforce that they have a binary choice to make between their careers and their families. Women academics face unique challenges: the academic ladder is long, and thanks to biological constraints, we cannot push the maternity dream, for those of us who have it, indefinitely. The path to gender equality is to continue supporting us, with mentorship, clear criteria for promotion and supportive policies.
NB this blog has been peer-reviewed
References
References
- Dhingra, S., Killaspy, H., & Dowling, S. (2021). Gender equality in academic psychiatry in the UK in 2019. BJPsych bulletin, 45(3), 153–158. https://doi.org/10.1192/bjb.2020.116
- Dutta R, Hawkes SL, Iversen AC, Howard L. Women in academic psychiatry. The Psychiatrist. 2010;34(8):313-317. doi:10.1192/pb.bp.109.028134
- Ferry G. (2020). Helen Boyle: pioneer of early mental health treatment. Lancet (London, England), 395(10231), 1185. https://doi.org/10.1016/S0140-6736(20)30724-8
- Gregory-Smith I. Positive action towards gender equality: evidence from the Athena SWAN Charter in UK medical schools. Br J Ind Relat 2017; 56: 463–83.
- Howard L. Women in academic psychiatry. Psychiatric Bulletin. 2003;27(9):321-322. doi:10.1192/pb.27.9.321
- Ramsay R. Women in Psychiatry: ten years of a special interest group. Advances in Psychiatric Treatment. 2005;11(6):383-384. doi:10.1192/apt.11.6.383
- Scharlieb M. (1918). Sophia Jex-Blake: A Great Personality: She Opened the Medical Profession to Women. The Hospital, 64(1678), 387–388.
- Segovia-Saiz, C., Briones-Vozmediano, E., Pastells-Peiró, R., González-María, E., & Gea-Sánchez, M. (2020). Techo de cristal y desigualdades de género en la carrera profesional de las mujeres académicas e investigadoras en ciencias biomédicas [Glass ceiling and gender inequalities in the careers of women academics in biomedical sciences]. Gaceta sanitaria, 34(4), 403–410. https://doi.org/10.1016/j.gaceta.2018.10.008
- Somerville J. M. (2005). Dr Sophia Jex-Blake and the Edinburgh School of Medicine for Women, 1886-1898. The journal of the Royal College of Physicians of Edinburgh, 35(3), 261–267.
About the author
Clara is from Brazil and is a junior doctor and aspiring child and adolescent psychiatrist. She currently serves as a Young Person Ambassador for ACAMH and is interested in eating disorders and in the epidemiology of mental health disorders in young people. Clara is a MPhil candidate in the Department of Psychiatry at the University of Cambridge.
