South Asian History Month: Registrar Trudi Seneviratne

I have never regretted becoming a psychiatrist and I am proud to be one of many South Asian British psychiatrists in the UK.

When, as medical student, I first suggested that this was my intended specialty to my father, a paediatrician, he was somewhat brusque in his response. ‘Why don’t you follow a real speciality?’, I recall him saying initially and conversations ensued encouraging me to consider alternatives.

Having trained in the Sixties in Sri Lanka, he had never considered the importance of psychiatry, which was still a small speciality when he trained. He was later very supportive of my choice. Working as a paediatrician in East London, he saw young children referred for both primary and secondary enuresis. We discussed that the majority of the children he saw had significant psychological and emotional difficulties, particularly related to bullying at school.

This included a number of young Asian children across Tower Hamlets, London. We spoke of the complex social, societal, familial, and psychological and other factors related to the children’s’ distress manifesting as enuresis. He often said that the children were referred for help very late when the problems were so entrenched, and it was difficult to find a route to start helping. The idea of intervening early to make a difference stayed with me.

My attraction to perinatal psychiatry was because the perinatal period is the earliest possible time to intervene and support the developing person’s psychological and a mental wellbeing, whilst developing in utero.

If we support the mother; we hopefully support the developing baby. Decades of research has shown us that our hypothalamic-pituitary- adrenal or HPA-axis is influenced in-utero, in part by maternal stress and mental illness.

A nudge in the right direction

I will always be grateful to Dr Martin Deahl for nudging me to speak to Professor Ramesh (Channi) Kumar at a conference in Rome, around 1995. Talking to Professor Kumar, about the importance of securing good maternal mental health, so that the mother could be the best possible ‘container‘ for the foetus, solidified what was to become a life-long passion in perinatal psychiatry for me.

As we celebrate South Asian history month at the College, it seems fitting to remember the late Professor Kumar, or Channi as he was affectionately known. He would have been thrilled at the developments in perinatal mental health in recent years.

I was fortunate to work with him for just four years as a research registrar. He was the first professor of perinatal psychiatry in Britain. He set up a new section of perinatal psychiatry at the Institute of Psychiatry, London and was the consultant at the Mother and baby unit at Bethlem Royal Hospital from 1981-2000.

His research was broad, including examining hormonal changes related to perinatal illness, to mother infant interaction difficulties linked to postnatal depression. A wonderful project to have been a part of was a multi-centre transcultural study on postnatal depression, which was set up to develop a set of instruments to facilitate research in this area.

Channi Kumar was born in India (Punjab) and came to England at the age of 13 years. As I too had emigrated at a slightly younger aged of 8, we spoke of both the opportunities and challenges of this, particularly that a diverse background offered a helpful transcultural lens in psychiatry.

We set up a project looking at different parenting styles of mothers admitted to the mother and baby unit in the context of severe mental illness, including looking at cultural differences. Understanding the socio-cultural context of both the mental illness, and also the parenting style is crucial when making recommendation to family courts regarding a parent’s capacity to parent a child in the context of suffering serious mental illness.

A truly transcultural lens

Over years, I have found that the process of family courts is not always ‘good enough’ at this and there is much more learning to do for all parties involved in holding a truly transcultural lens when making such important decisions about a parent continuing to care for their child.

As part of celebrating South Asian history month, I spoke with Dr Anusha Wijeratne, President of the Sri Lankan Psychiatrists Association (UK). SLPA UK was formed in 2001 by a small group of psychiatrists, with the aim of bringing together psychiatrists of Sri Lankan origin practising in the UK. It now has a well-established membership of Sri Lankans, South Asians, other psychiatrists, and other disciplines. As well as offering an academic programme twice a year, the organisation also raises funds for projects in Sri Lanka.

One such project was supporting the opening of a rehabilitation kitchen adjacent to the psychiatry ward of Kandy Hospital in 2019, which has facilitated the teaching of basic cooking skills for chronically ill patients. Another supported physiotherapy in a day service for people with learning disabilities and a third support a horticultural unit and occupational therapy area in Kilinochchi Mental Health Unit. Dr Wijeratne’s vision is that the association continues to grow, providing a platform for continuous learning, research projects, encourage training opportunities and mentoring psychiatrists who come to the UK, as well as continuing to support mental health projects in Sri Lanka.

I was delighted to be able to liaise with Professor Shehan Williams, President of the Sri Lanka College of Psychiatrists. He was optimistic about the status of psychiatry as a speciality. He says that ‘the discipline of psychiatry does not suffer the stigma in Sri Lanka as in many other countries (including UK) and we recruit some of the brightest and best to the field partly due to the extensive training in psychiatry imparted to medical students in all medical schools in Sri Lanka over the past few years’.

He had many suggestions for areas of collaborations with the College including, training opportunities in special interest areas such as neuropsychiatry, perinatal psychiatry, psychotherapy; opportunities for research; holding regional sessions in collaboration with the Sri Lanka College of Psychiatrists and offering attachments to consultants/ trainees from the UK to receive experience in Sri Lanka. It would be wonderful to take these and other suggestions forward and celebrate at future South Asian history month events.