mht feature
face
to face
David Palmer reports early successes from a
unique mentoring project for forced migrants
R
esearch into the mental health needs of migrant
communities shows that most statutory mental
health services have a poor understanding of
their needs. 1 Many forced migrants have
complex mental health issues as a result of their
migration experiences. Stigma around mental health may
prevent them accessing support from their communities
and any help available from statutory and voluntary
sector mental health services. In addition, they will face
a wide array of practical and social difficulties, starting
with the bureaucracy of the migration process, and
encompassing housing, language, employment, and
social isolation. Understanding the complex issues faced
by forced migrants is crucial to planning and offering
appropriate and culturally specific services.
The Migrant and Refugee Communities Forum
(MRCF) is a west London-based strategic alliance of 40
community groups representing and providing services to
12 different ethnic communities. Since 2001, MRCF has
been running a project for overseas qualified healthcare
professionals, offering career advice and guidance,
main photo: clarita@ morguefile.com
structured study groups, clinical training and job search
support. In October 2006 the MRCF received 18-months
funding from Capital Volunteering for a pan-London
mentoring project for forced migrants with mental health
problems. The aim of the Face to Face scheme is to train
20 migrant doctors to provide this mentoring.
Refugee doctors themselves face a number of barriers
that prevent them from returning to work in the medical
16 April 2007 mentalhealth today
field in the UK. These include a lack of information
about the process of qualifying, registration and
accessing further training, and difficulty in achieving the
high levels of academic English necessary and readjusting
to the basic level of medical knowledge needed to pass
Professional and Linguistic Assessment Board (PLAB)
examinations. Their documentation may have been lost
or destroyed, and they may have difficulties in securing
references, to say nothing of having to cope with any
psychological problems linked to their forced migration.
MRCF is currently working with over 400 of these
overseas-qualified doctors, 197 of whom came to the UK
as refugees. While they wait for employment, most are
seeking training opportunities, but many are prevented
from training because of financial hardship and benefits
regulations. Refugee doctors represent an enormous
untapped resource. Not only are they highly skilled
professionals, but they are also able to draw on their
own experiences of migration. Refugee doctors also
often speak more than two languages, and have a good
understanding of the cultural needs of their fellow
migrants and refugees, and of the wider social, cultural
and health needs of migrant and refugee communities.
The mentoring scheme aims to provide much-needed
opportunities for career development and accredited
training. The MRCF previously ran a programme with
the Central School of Speech and Drama in which 36
migrant doctors attended a six-week course on
communication skills. Following the training, 12 doctors
gained full-time medical employment and two secured
clinical attachments (40% of the total number). Our
hope is that the mentoring project will have similar
benefits for the mentors’ job prospects.
There are few models of mentoring services for forced
migrant communities suffering from mental ill health. This
is the only one using doctors to work outside the medical
model. The mentors are recruited through MRCF’s
refugee healthcare professionals programme. They work
on a purely voluntary basis, and offer emotional support
and help with social and practical needs, including
accessing social networks and community and voluntary
sector services. They also provide language and
interpreting support. In the words of one doctor: ‘Because
of my experience here as a refugee, I am able to help my
mentee because of what I’ve gone through and because of
my experience gained in other life skills, which I will be
able to pass on. It will also help me to see the mentee and
health problems from the social viewpoint rather than a
medical view. This [project] will be an opportunity to learn
and I can benefit from the learning opportunities that
would be provided by this venture.’
This is not a medical project, and training, support
and supervision is provided so that the doctors are fully
aware and reminded that their role is non-medical, and
that the mentee is not their patient. The training covers
a full range of helping skills, including befriending,
coaching, networking and tutoring. Listening plays a
central role in the mentoring relationship, as this mentor
observes: ‘We will try to work on the solutions. We will
set objectives. Write down some problems and look at
possible solutions.’
Clients are referred by the Refugee Support Service,
the Medical Foundation, the Helen Bamber Foundation,
community mental health teams, and other health
providers. Referrers are asked to ensure that the
identified mentees are at a stage of recovery to engage
and participate fully in such a programme. This project
is based on a social model of health, working alongside
the conventional medical model. The focus is on a
‘holistic’ approach, using knowledge about the whole
person and their life experiences, rather than solely or
predominantly the medical diagnosis, when planning
treatment and recovery. The solving of mental health
problems becomes an issue beyond that of the individual,
encompassing isolation, community support, cultural
bereavement, housing deprivation, employment, legal
status, and education and training issues.
The mentors also work to combat stigma. By
providing positive role models to service users and
demonstrating the possibility of positive outcomes, they
aim to counter negative beliefs within the community and
institutions that stigmatise those suffering from mental ill
health, and to challenge perceptions of mental ill health.
The project has so far recruited and trained 11 refugee
doctors as mentors. Seven of the mentors have been
successfully matched with forced migrants.
Relationships are matched on the basis of language,
ethnicity, gender and location, and are expected to last
between six and nine months, with mentor and mentee
meeting weekly for two to three hours.
The project has a steering group of 20, which includes
mentors, mentees, mental health commissioners, service
providers and academics. The steering group helps to
guide and advises on various aspects of the project,
including training, supervision and evaluation methods.
To measure its outcomes, Face to Face is being evaluated
over time through workshop feedback, focus groups,
one-to-one interviews and questionnaires. The
information is intended to provide a resource for local
service providers, who lack the in-depth knowledge that
is essential to effective delivery of accessible and
acceptable services, as required by the Department of
Health’s Delivery Race Equality action plan.
Early feedback and evaluation suggest that the project
is achieving its aims and objectives for its current cohort
of participants. One mentor said of a client: ‘She
genuinely could talk about herself. As far as I could see,
it has had a positive effect on her mood – cheering her
up.’ A mentee told us, after just four meetings with her
mentor: ‘I have gained confidence. I want to continue on
the programme.’ Another highlighted the value of
talking with someone from their own culture: ‘I feel
positive about this. I am touched by the fact that my
mentor is giving up time to help us. It’s so good that my
mentor is from Kosovo and speaks my language. She
understands what I went through, which really helps.’
The project has also resulted in some of the doctors
Mentor doctors
wanting to explore the possibility of specialising in at a recent MRCF
mental health work. training session
Because they are trusted by the people they work with,
the mentors are able to find out why forced migrants do
not access or use statutory mental health services, and how
they might be helped to do so. It is hoped that the
dissemination of the outcomes of the evaluation will assist
commissioners and providers to plan and deliver more
appropriate and accessible services, which in turn may
reduce the need for secondary service involvement, and
result in better long-term outcomes for mentees. I
David Palmer is deputy director of the Migrant and
Refugee Communities Forum (MRCF). For further
information on the project, t 0208 962 3041
e david@mrcf.org.uk
1 Palmer D, Ward K. Hearing voices: listening to refugees and
asylum seekers in the planning and delivery of mental health
service provision in London. London: Commission for Public
Patient Involvement in Health, 2006.
mentalhealth today April 2007 17