Journal of Health Policy & Opinions
Medics, Migration and Mental Illness
JS Bamrah MBBS FRCPsch1 and Kailash Chand MBBS FRCGP2
1 Professor & Consultant Psychiatrist, Manchester Mental Health Trust, Manchester, UK
National Chairman, BAPIO
2 GP (rtd), Hon Vice President, British Medical Association
Migration, mental illness
Cite as; Bamrah JS, Chand K. Medics Migration and Mental Illness. Sushruta 2020 (Mar)
vol13;1: 19-20 epub 16.12.2019
It is a well-known factor that migrants to
1960’s nearly half the junior doctor and
another country have a higher
non-consultant posts were filled by
preponderance of developing mental
overseas graduates2. Today, almost 36% of
illness when they arrive to settle in their
registered medical practitioners have their
adopted country. The reasons for these are
primary medical qualification from a non-
many fold. It is possible that some of these
UK country and for the first time, between
individuals will already have pre-existing
2018-2019 more new registrants are
metal illness which is triggered off in a
trained overseas than in the UK. The
foreign land, but there are other factors
commonest registered surnames on the
which are known to be causative, such as
GMC register are, in order of popularity,
stress of migration, isolation, job issues,
Khan, Patel and Smith giving us an idea on
etc. The article examines the effects that
the workforce configuration of doctors in
migration has specifically on the mental
the UK. The UK’s response to its own crisis
health of doctors, as well as the
in recruitment and retention continued to
consequences of developing mental
rely on international recruitment to fill its
vacancies despite the fact that the
numbers of medical school places have
Migration and the NHS
increased by 50% since the 2000’s3.
The fact of the matter is that the National
With migration come a number of
Health Service has been a key benefactor
challenges for doctors. Most doctors leave
of medical migration over many decades.
their native countries to seek better
Indeed, during times of staff shortages, the
opportunities for themselves and/or their
NHS has relied on countries such as India,
families, or in some instances to escape
Pakistan, Sri Lanka and Bangladesh to fill
unsafe conditions. There are three stages
posts in hospital and general practice1.
to the migratory process4. At the pre-
European Union doctors have also made
migration stage individuals decide to
very significant contributions. By the
migrate and plan the move. Stage two
Journal of Health Policy & Opinions
involves the necessary psychological and
requirements such as visas, health
social steps in the process of migration
surcharge, subscription fees for medical
itself and the physical transition from one
defence, trade union and royal college
place to another, and the third stage is the
organisations, professional courses and
post-migratory stage when the individuals
examinations, add to the stresses they are
deal with the social and cultural
likely to experience.
integration in the new society, requiring
them to adopt new values and adapt to
Racism and migrants
their new environment. Their next
generation will have some similar
The recent high profile cases of a Scottish
experiences in terms of cultural identity
doctor5 and a senior surgeon6 in the North
and stress, even though they are
West have thrown sharply into focus how
technically not migrants.
discrimination by patients can undermine
the NHS, and also affect those doctors who
Migrant diaries, letters and articles in
are the subjects of such behaviours. In
medical journals have often captured
both those instances, involving in a first
recollections of traumatic transitions of
generation Indian GP and a second
migrant doctors from old to new worlds:
generation Indian hospital surgeon, two
the tribulations of bureaucracy, the pain of
white patients had demanded that they
parting, and the discrimination many of
see a white doctor.
them feel in their adopted new
homeland. In most cases the difficulties
These doctors are brave to speak out.
were short-lived or manageable, but
However, this is a common occurrence for
occasionally they were catalysts for mental
many BME health staff, underreported for
breakdown. Those lucky enough to secure
various reasons - ranging from not feeling
high achieving jobs might escape the
confident to do so, feeling that no one
ravages of these stresses, while for those
would listen or act, while many feel
who are less fortunate, qualitative
recrimination from being branded racists.
research demonstrates that they will end
Although we would be regarded as having
up in what are regarded as ‘second rate
been successful in our respective careers
jobs where there are fewer learning
that span almost eight decades between
opportunities and advancements in
us, it hasn’t always been plain sailing for us.
careers and more of an element of service
We have each experienced discrimination,
delivery which shatters their dreams and
whether that is in exams, interviews or
expectations. Most migrants who arrive at
selection to jobs. And there have been
trainee doctor level are ill prepared for
seemingly well meaning colleagues who
making that transition; whilst they are
have made remarks that would be
likely to be well equipped in the practice of
considered to discriminatory today. The
medicine, the adaptation to a different
stress of this, on top of everything else, is
culture, preparedness for postgraduate
examinations and a culture of tighter
regulation are matters that many of them
Imperatives for tackling mental illness in
struggle to grapple with. Medical migrants
might also come with no more than a few
pounds in their pockets so they may have
The emotional burden of migration to a
underestimated the cost of living,
foreign country is the main contributor to
expenses on regulatory and essential
health problems in some of these
Journal of Health Policy & Opinions
individuals. Unlike migrants from the
acknowledged. However, if these doctors
general population, medical migrants are
are to feel valued than employing
unlikely to have pre-existing mental illness
authorities and regulators must do more in
and so there are ethical and economical
order to support them and so that they can
imperatives to ensure that these factors
continue to work efficiently and
are understood and remedied at the
earliest opportunity. Research has shown
that availability of career and training
opportunities, adequacy of supervision,
contract type, salary, satisfaction with life
in the host country, and acquiring
citizenship are associated with a positive
experience for these doctors. It is well
within the gift of employing authorities
and statutory organisations to make a
better effort in ensuring that these factors
are earnestly tackled. Not doing so comes
at a considerable cost not just to the NHS
but to the individual doctor and their
families as the consequences of stress and
depression are substantial, from loss of
income, re-employment issues, visas
restrictions, stigma of mental health, and
at its worst, suicide of the affected doctor.
The contributions of migrant doctors to the
NHS are well known and widely