I am currently Professor of Cultural Psychiatry & Epidemiology at the Research Centre for Psychiatry at Barts (St Bartholomew’s Hospital) & The London School of Medicine. This is a school of Queen Mary College of the University of London . I also work as consultant psychiatrist for a major service provider, the East London & City Mental Health Trust.
My interests in cultural psychiatry were aroused during my early experiences as a psychiatry resident. I realized that patients from diverse cultural groups had a different story to tell from the one recorded in their clinical case notes and that the official diagnostic process captured little about their life experience, or indeed their distress. I was struck by how this difference was marked even for patients with whom I shared a culture. My Punjabi Sikh background clearly played a part in contributing a cultural dimension to my thinking about culture, conflict, colonialism and distress. The heritage of challenging social injustice and tackling prejudice was similarly inculcated in me from a very early age by parents and family, largely shaped by Sikh teachings. My parents, although of Indian origin, lived in Kenya most of their early adult lives.
I was born in Kenya , but educated in the UK . I graduated in medicine in 1988 at the United Medical & Dental Schools of Guy’s and St Thomas ’ (UMDS). At that time, in the 1980s and early 1990s, cultural psychiatry played virtually no part in the training of residents in the UK , and a cultural psychiatrist was an unheard-of specialty in psychiatry. I was advised against pursuing a career in cultural psychiatry because of the perceived political overtones of such an approach. I puzzled my colleagues and mentors by sticking with my interests, ambitions, and curiosity about a subject which seemed to me familiar and essential, but which was not part of any formal teaching I had received.
The formation of the Transcultural Special Interest Group within the Royal College of Psychiatrists, inclusion of cultural psychiatry in the curriculum and increased attention to racism in psychiatric practice were the hallmarks of maturation of cultural psychiatry in the UK . Regrettably, sometimes cultural psychiatry is still seen as strictly a minority issue, to do only with black people or people from ‘other cultures’, rather than being of wider relevance to all psychiatric practice.
I pursued a fairly conventional training in clinical psychiatry, at Guys & St Thomas’ Hospitals (1989-1992), followed by the Maudsley (1992-1995) and then a period of research training at the Institute of Psychiatry (1995-2000) supported by the Wellcome Trust. It was in this research training that I was especially challenged to try to integrate anthropological notions of culture and research methods, with epidemiological principles. My work since that time continues this process, with a special focus on health services research, psychotherapy, consultation dynamics, and training and education.
My research interests and skills flourished under the mentorship of Prof. Dinesh Bhugra and Prof. Sir David Goldberg, supported by the clinical pragmatism I had absorbed from Prof. Jim Watson and Dr Geraldine Strathdee, and some thought provoking encounters and anthropological critiques from Drs Simon Dein and Maurice Lipsedge. I became fascinated with the thinking of international experts such as Kleinman, Kirmayer, Tseng, Littlewood, Weiss, Wintrob, Prince & Minas. During my research training I also undertook training in psychoanalytic psychotherapy, another paradigm for democratic criticism of dominant ideologies.
My interests in cultural psychiatry enabled me to conduct a critical re-analysis of how mental health services were indeed discriminatory and often failed to provide culturally appropriate care. Proponents of radical service re-design at that time (1990s) were Drs Parimala Moodley & Suman Fernando and Prof. John Cox, who further supported and legitimated my interests as being of immediate and widespread relevance to psychiatry as a whole and not just to minority ethnic groups.
Since my first consultant jobs and my academic appointment at the Medical School in East London (2000), I have seen cultural psychiatry become a major force in critical thinking about service users, ethics, philosophy of psychiatry, and now, even enshrined in national policies that advocate training in cultural competency for all mental health professionals. Prof Goffredo Bartocci has almost single-handedly raised the profile of cultural psychiatry in Europe within the last five years. The formation of WACP is therefore timely, as it offers the potential for our subject matter to be understood in its richest and fullest context, as a core ‘philosophy’ in psychiatric practice and research, and to bring together different schools of cultural psychiatry.
I currently serve as Chair of the Transcultural Special Interest Group of the Royal College of
Psychiatrists (2004-2008) which has some 1650 psychiatrist members in the UK . I am also a member of the World Psychiatric Association Transcultural Psychiatry Section, and a member of the founding Board of Directors of the World Association of Cultural Psychiatry. I am also a member of the British Association of Psychotherapists and a Fellow of the Royal Society of Medicine (UK).
I am Director of MSc Transcultural Mental Healthcare at Queen Mary College , University of London . This innovative Masters program is focused on health services’ research and practice, ensuring that there is transfer of knowledge and skills to routine mental health practice. It is a multi-disciplinary course (teachers and students), and is in its fourth successful year. We are about to embark on an e-learning process for our future international students. We have 35 MSc students and 5 PhD students in our post-graduate program, as well as medical students.
My research interests include:
- South Asian’s pathways to care and recognition of mental disorder in primary care (funded by the Wellcome Trust)
- African Caribbean mentally disordered offenders in Brixton Prison and their pathways to care (DH funded)
- Somali Refugees and risk factors for mental disorders (NHS funded)
- Mixed sampling methods using qualitative and quantitative methods, specifically the interface between anthropology and epidemiology (NHS & Home Office funded)
- Cultural Capability of Services for Black and Minority Ethnic (BME) Groups (New Zealand Research Council funded)
- Policy formulation for effective services for BME groups in the UK (DH funded)
- Racism as a risk factor for mental health problems
- Adolescents’ risk of mental disorder by ethnic group and cultural identity (DH, ELCHA funded)
- Eating disorders and ethnicity
- Explanatory models of mental disorders, and use in clinical assessment and diagnosis (Barts and The London Research Board)
- Suicide & Ethnicity in the UK (DH funded, Charitable foundation of Barts & The London )
- Dual Diagnosis and Ethnicity (Mellow Campaign funded)
- Improving Pathways to Care for BME groups (DH funded)
The Centre for Psychiatry has strategic alliances with the Royal Free Hospital & UCL School of Medicine (Centre for Health Improvement & Ethnic Services: CHIMES), and with the Faculty of Health Sciences at the University of Auckland (Centre for Asian Research and Evaluation: CARE-UK and CARE-NZ). I have also worked with national DH policy leads and NIMHE (UK) to develop improved services and care for black and ethnic groups in the UK . I have published numerous peer-reviewed research and educational papers in international journals, and have authored and/or edited five books.
The main studies our research group is undertaking as part of our future strategy include:
- Adolescents’ mental health: prevalence and cultural risk factors including cultural identity.
- Studies of refugee and asylum-seeker mental health, especially Somali refugees
- Studies of mental health problems among Asian populations (Chinese and Indian-sub-continent origin) across continents
- Cultural Competency Training, and our Masters Program
- Suicide Prevention and Ethnicity
- Improving Pathways to Recovery
- Studies of Common Mental Disorders among adults: risk factors and interventions
- Religious Values and Coping with Mental Distress
October 5, 2006