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field in the UK. These include a lack of informationabout the
process of qualifying, registration andaccessing further training,
and difficulty in achieving thehigh levels of academic English
necessary and readjustingto the basic level of medical knowledge
needed to passProfessional and Linguistic Assessment Board
(PLAB)examinations. Their documentation may have been lostor
destroyed, and they may have difficulties in securingreferences, to
say nothing of having to cope with anypsychological problems linked
to their forced migration.
MRCF is currently working with over 400 of these
overseas-qualified doctors, 197 of whom came to the UKas
refugees. While they wait for employment, most areseeking training
opportunities, but many are preventedfrom training because of
financial hardship and benefitsregulations. Refugee doctors
represent an enormousuntapped resource. Not only are they highly
skilledprofessionals, but they are also able to draw on theirown
experiences of migration. Refugee doctors alsooften speak more than
two languages, and have a goodunderstanding of the cultural needs
of their fellowmigrants and refugees, and of the wider social,
culturaland health needs of migrant and refugee communities.The
mentoring scheme aims to provide much-neededopportunities for
career development and accreditedtraining. The MRCF previously ran
a programme withthe Central School of Speech and Drama in which
36migrant doctors attended a six-week course oncommunication
skills. Following the training, 12 doctors
Research into the mental health needs of migrantcommunities
shows that most statutory mentalhealth services have a poor
understanding oftheir needs.1 Many forced migrants havecomplex
mental health issues as a result of their
migration experiences. Stigma around mental health mayprevent
them accessing support from their communitiesand any help available
from statutory and voluntarysector mental health services. In
addition, they will facea wide array of practical and social
difficulties, startingwith the bureaucracy of the migration
process, and
encompassing housing, language, employment, andsocial isolation.
Understanding the complex issues facedby forced migrants is crucial
to planning and offeringappropriate and culturally specific
services.
The Migrant and Refugee Communities Forum(MRCF) is a west
London-based strategic alliance of 40community groups representing
and providing services to12 different ethnic communities. Since
2001, MRCF hasbeen running a project for overseas qualified
healthcareprofessionals, offering career advice and
guidance,structured study groups, clinical training and job
searchsupport. In October 2006 the MRCF received 18-monthsfunding
from Capital Volunteering for a pan-Londonmentoring project for
forced migrants with mental healthproblems. The aim of the Face to
Face scheme is to train20 migrant doctors to provide this
mentoring.
Refugee doctors themselves face a number of barriersthat prevent
them from returning to work in the medical
David Palmer reports early successes from aunique mentoring
project for forced migrants
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mainphoto:clarita@
morguefile.com
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mentalhealth today April 2007 17
gained full-time medical employment and two securedclinical
attachments (40% of the total number). Ourhope is that the
mentoring project will have similarbenefits for the mentors job
prospects.
There are few models of mentoring services for forcedmigrant
communities suffering from mental ill health. Thisis the only one
using doctors to work outside the medicalmodel. The mentors are
recruited through MRCFsrefugee healthcare professionals programme.
They workon a purely voluntary basis, and offer emotional
supportand help with social and practical needs, includingaccessing
social networks and community and voluntarysector services. They
also provide language andinterpreting support. In the words of one
doctor: Becauseof my experience here as a refugee, I am able to
help mymentee because of what Ive gone through and because ofmy
experience gained in other life skills, which I will beable to pass
on. It will also help me to see the mentee andhealth problems from
the social viewpoint rather than a
medical view. This [project] will be an opportunity to learnand
I can benefit from the learning opportunities thatwould be provided
by this venture.
This is not a medical project, and training, supportand
supervision is provided so that the doctors are fullyaware and
reminded that their role is non-medical, andthat the mentee is not
their patient. The training coversa full range of helping skills,
including befriending,coaching, networking and tutoring. Listening
plays acentral role in the mentoring relationship, as this
mentorobserves: We will try to work on the solutions. We willset
objectives. Write down some problems and look atpossible
solutions.
Clients are referred by the Refugee Support Service,the Medical
Foundation, the Helen Bamber Foundation,community mental health
teams, and other healthproviders. Referrers are asked to ensure
that the
identified mentees are at a stage of recovery to engageand
participate fully in such a programme. This projectis based on a
social model of health, working alongsidethe conventional medical
model. The focus is on aholistic approach, using knowledge about
the wholeperson and their life experiences, rather than solely
orpredominantly the medical diagnosis, when planningtreatment and
recovery. The solving of mental healthproblems becomes an issue
beyond that of the individual,encompassing isolation, community
support, culturalbereavement, housing deprivation, employment,
legalstatus, and education and training issues.
The mentors also work to combat stigma. Byproviding positive
role models to service users anddemonstrating the possibility of
positive outcomes, theyaim to counter negative beliefs within the
community andinstitutions that stigmatise those suffering from
mental illhealth, and to challenge perceptions of mental ill
health.
The project has so far recruited and trained 11 refugeedoctors
as mentors. Seven of the mentors have beensuccessfully matched with
forced migrants.Relationships are matched on the basis of
language,ethnicity, gender and location, and are expected to
lastbetween six and nine months, with mentor and menteemeeting
weekly for two to three hours.
The project has a steering group of 20, which includesmentors,
mentees, mental health commissioners, serviceproviders and
academics. The steering group helps toguide and advises on various
aspects of the project,including training, supervision and
evaluation methods.To measure its outcomes, Face to Face is being
evaluatedover time through workshop feedback, focus
groups,one-to-one interviews and questionnaires. Theinformation is
intended to provide a resource for localservice providers, who lack
the in-depth knowledge thatis essential to effective delivery of
accessible andacceptable services, as required by the Department
of
Healths Delivery Race Equality action plan.Early feedback and
evaluation suggest that the project
is achieving its aims and objectives for its current cohortof
participants. One mentor said of a client: Shegenuinely could talk
about herself. As far as I could see,it has had a positive effect
on her mood cheering herup. A mentee told us, after just four
meetings with hermentor: I have gained confidence. I want to
continue onthe programme. Another highlighted the value oftalking
with someone from their own culture: I feelpositive about this. I
am touched by the fact that mymentor is giving up time to help us.
Its so good that mymentor is from Kosovo and speaks my language.
Sheunderstands what I went through, which really helps.
The project has also resulted in some of the doctorswanting to
explore the possibility of specialising inmental health work.
Because they are trusted by the people they work with,the
mentors are able to find out why forced migrants donot access or
use statutory mental health services, and howthey might be helped
to do so. It is hoped that thedissemination of the outcomes of the
evaluation will assistcommissioners and providers to plan and
deliver moreappropriate and accessible services, which in turn
mayreduce the need for secondary service involvement, andresult in
better long-term outcomes for mentees.
David Palmer is deputy director of the Migrant andRefugee
Communities Forum (MRCF). For furtherinformation on the project,
t0208 962 3041e [email protected]
1 Palmer D, Ward K. Hearing voices: listening to refugees
andasylum seekers in the planning and delivery of mental
healthservice provision in London. London: Commission for
PublicPatient Involvement in Health, 2006.
I
Mentor doctorsat a recent MRCFtraining session
