South Asian History Month: Professor Dinesh Bhugra
31 July, 2020
Ever since its inception in 1971, the College has been at the forefront of many radical initiatives supporting trainees, associate specialists, and consultants of South Asian heritage. Although I start with my story, this reflects the history of psychiatry in a brief manner and also the history of the College.
The Royal Medico-Psychological Association (RMPA) had been set up in 1926 which was preceded by the Medico-Psychological Association in 1865 as part of the Royal College of Physicians. RMPA had branches in India as did the British Medical Association, with regular reports of meetings from the Indian subcontinent to the Journal of Mental Science (later to become British Journal of Psychiatry, and then BJPsych), and the Indian Medical Association had a branch in the UK.
I recall Ranjit Baruah as the first south Asian Assistant Registrar who inspired, supported, and mentored so many of us. In line with the needs of the NHS, the College set up an Overseas Doctors Committee, and as its Chair I set up induction days for newly arriving doctors - a significant proportion were from South Asia.
This led to my being elected Associate Dean for examinations and then Dean. The period as Dean was rocked by Modernising Medical Careers and the College supported an online survey which showed that 94% of trainees were under stress and complained of anxiety.
First South Asian president
As the first south Asian to be one of the first officers as Dean, there were a couple of occasions when I was challenged on my English in a discriminatory manner. Having been told to my face that my grasp of English needed to improve (and no, it was not a joke) the person then went to a senior manager in the College to say, ‘what do we have to do to get the Dean to speak proper English’?
However, as the first South Asian president and elected unopposed (first time ever in the history of the College), it was indeed a privilege and an honour to serve the profession. At that point, in the College or the rest of the medical profession in the Academy of Medical Royal Colleges there was little racist or discriminatory feeling. As Vice-Chair of the Academy I led on education and led on integrating physical and mental health across specialities.
As the first South Asian History Month organised by the Royal College of Psychiatrists to celebrate the contributions made by South Asian psychiatrists in the UK comes to an end, the time is ripe to explore its immediate short-term impact.
The idea of such celebrations emerged over a year ago when the CEO of the College, Paul Rees, had the vision to start discussions to see how celebratory events could be set up to acknowledge the massive roles South Asian psychiatrists have played in the life and working of the National Health Service, the public life of the country and the College itself. This was being discussed, and possibilities explored, way before the COVID-19 pandemic hit and, globally, the Black Lives Matter campaign started.
Representing 30% of UK doctors
Of the total 119,600 of senior doctors in the UK, about 30% are said to be of south Asian heritage.
The proportion of psychiatrists from an Asian background is around 30% of the total number of psychiatrists who are members and fellows of the Royal College of Psychiatrists. Interestingly in many medical schools about 40% of medical students are of South Asian heritage, and a majority are women.
The close relationship between South Asian countries and the UK can be seen as a reflection of colonial ties. Another reason why many trainees from the region end up in the UK is to do with a lack of training opportunities in psychiatry in the region.
For example, India produces over 60,000 doctors per year, but the number of training posts and places is around 5,000. Decades ago, South Asian psychiatrists often went into hard to fill posts and deliver services in very many unpopular places where local trainees or consultants were unwilling to go.
South Asian History Month webinars
The original plan was to launch the month with an exhibition celebrating South Asian heritage psychiatrists during the College’s annual event in Edinburgh. As the event was cancelled due to the COVID-19 pandemic, this inevitably had to be replaced by a series of webinars with key psychiatrists from the region. The first webinar on 9 July explored individual experiences of seven psychiatrists from the region.
The stories were different but similar, some of the stumbling blocks were similar but others were unique to each individual. How they overcame these was touching, humbling and inspiring.
From push factors to pull factors, the stories illustrated individual pathways into training in psychiatry and contributions to the adopted country. The second webinar a week later, followed a similar platform but the focus was on experiences of alienation as a result of racism. The speakers were of a younger generation and their experiences were often as difficult but equally moving. It was fascinating to see and hear about the potential ways forward in tackling racism within medicine and psychiatry.
What are the lessons of the South Asian History Month? It is always good to be appreciated, we know that from contacts with our patients, when a patient says thanks or gives a token of thanks, it goes a long way in making us feel joyful. In this time of pandemic, such celebrations get us together supportive of each other.
Physical distancing it may be, but social closeness is critical in these turbulent times. The celebrations confirm that indeed we are all in it together. The celebrations and joining together also offer an opportunity to share institutional memory as to how far we have come but also how far we have yet to go.
The President, Dr Adrian James deserves our congratulations and thanks as he has taken the first major step in looking at challenges related to minority status not only for the profession but also for the services. Many patients from South Asian communities continue to struggle to access services and the College can take the lead in helping deliver cultural competence in training and curriculum. It is important that we need to understand the majority of British cultures, as psychiatrists from these communities need to understand minority cultures.
The celebration of the contribution by the South Asian psychiatrists is a very welcome step forward and long may it continue so that generations to come can continue to celebrate contributions made by South Asian psychiatrists.