2017

WPA – EFPT Position Statement on the Mental Health of Psychiatric Trainees who Migrate: Supporting Adjustment and Growth

Introduction
Migration is increasingly a fact of the world that we live in and is more common from certaincountries to other specific countries. Psychiatrists are not exempt from this, including manypsychiatric trainees. The reasons for migrating are highly varied and span the gamut fromforced migration following conflicts and for political reasons, to moves to take advantage ofnew professional opportunities, personal development and for economic reasons. Regardlessof the reasons for migration, it can be a stressful and disorientating experience. Somemigrants are at increased risk for certain types of mental health problems, due to theadditional stresses and disadvantages to which migration exposes them. On the other handmigration may bring many benefits to both the migrants as well as the countries they moveto, allowing knowledge and different perspectives to be shared across cultures.

Psychiatric trainees who migrate will be exposed to a range of experiences and undergochange at varying rates. They are likely to find themselves in an unfamiliar environment, awayfrom many pre-existing support structures, which may leave them isolated. Challenges inadjusting to the new environment, understanding the complexity of the local system,language difficulties, cultural disparities and other adverse experiences may all contribute todistress in those who have migrated. Such difficulties may well discourage a psychiatrictrainee from getting actively involved in relevant professional associations, societies andevents, as a way of avoiding anxiety and distress. There is an increased risk of this occurringimmediately following migration and it may leave them unsupported.

The European Federation of Psychiatric Trainees’ Research Working Group showed that onein three immigrant trainees across Europe who responded to their survey reported perceiveddiscrimination. This is especially relevant for the academic and working environment. Oftenpsychiatric trainees who migrate may end up working in unpopular specialties and in placesthat are less attractive to local trainees. Therefore, they may need additional support toadjust to and grow within the new system in which they find themselves.

Acculturation to the new environment may prove to be difficult for many individuals.Contained within this process of acculturation are factors like language, diet, dress andbehaviours. Language is a highly complex component of adaptation to a new environmentand is of great importance in psychiatry, where crucial meanings can be conveyed throughsubtle variations of linguistic usage. Independent of language abilities, trainees who migratemay struggle in and can do worse at assessments. The cause for this discrepancy ismultifactorial and is believed to involve aspects such as differences in training approaches atundergraduate and postgraduate levels, varied expectations in the patient-clinicianinteraction between countries and other aspects of non-verbal communication. It isimportant to recognise that even those trainees with a very high level of functioning in therelevant language may need additional support to appreciate the nuances of local use of thelanguage and regional dialects. Efforts are needed to reduce this burden and provide apositive environment that helps safeguard against such problems.

Socio-political conditions are also very important for the maintenance of good mental health. Some trainees who have migrated may require support in meeting obtaining the basic necessities of living, such as suitable accommodation, help in identifying schools for their children, as well as access to the resources to meet their cultural needs. The aim of such support is to ensure seamless transition. Support must be focused on ensuring that the trainee can practise and learn safely and effectively within the new context, while simultaneously safeguarding their own welfare.

Feeling accepted within their new workplace is of critical importance for the effective adjustment of psychiatric trainees who migrate. The diversity that doctors who migrate bring could help them and their teams perform better. Yet, to realise these benefits, the needs of psychiatric trainees who migrate, such as orientation to the new society and support for a healthy acculturation process, should not be underestimated.

Recommendations:

WPA and EFPT acknowledge the importance of support and mentoring for psychiatric trainees who migrate to ensure their healthy adjustment. They make the following recommendations:

  1. Careful attention must be paid to all psychiatric trainees who migrate to consider what support they need. This is important to ensure that the trainee can respond to the needs of their patients, fulfil their training requirement and maintain their own mental health.
  2. A period of induction should be provided to the new environment, with special emphasis on cultural differences. This should extend beyond a simple description of the immediate job, to include the broader community, health system, workplace culture, traditions, norms, ways of living and wider cultural expectations.
  3. Each psychiatric trainee who migrates should be assigned a supervisor who is familiar with the needs of such trainees and ideally has received training in supporting them.
  4. A tailored plan should be agreed with the trainee that provide holistic support to help them acclimatize and grow.
  5. Trainees should be supported, if necessary, with overcoming language barriers, including understanding idiomatic phrases, idioms of distress in the new culture and other cultural nuances.
  6. To achieve this, employers should be encouraged to form collaborative partnerships with local NGOs and cultural organizations who can help teams familiarize with the needs of trainees and populations.
  7. Discrimination against migrant trainees should not be tolerated and active efforts in and out of workplace should be made to identify and eliminate such behaviour.
  8. Professional bodies responsible for training assessments should strive to identify the root causes of any discrepancy in the performance of migrant trainees and attempt to redress this as soon as possible.
  9. Regulatory and professional bodies need to create systems of support and are well positioned to influence policy in this area.
  10.  Further research may be required to understand the experiences of migration and adjustment by psychiatric trainees.