Meet Dr Trushna Murgahayah, member of the Trainees' Advisory Council and trainee representative on the Asylum Seeker and Refugee Mental Health (ASRMH) Network Committee.

As a trainee, why are you interested in being a part of the ASRMH Network?

I have always been passionate about working with refugees and asylum seekers since I started my career in psychiatry because it was an underfunded and under resourced area. It was important for me to understand the various struggles refugees and asylum seekers experience, and the solutions that can be provided to overcome some of these adversities. I feel privileged enough to be able to receive medical care, education and justice when needed, however I could not accept that these resources were not made available to every individual. I felt it was not just a moral obligation but a desire to ensure that in some ways, refugees and asylum seekers receive equal care and treatment.

The concept of detention camps are appalling and the conditions that individuals are living in are inhumane, and should not exist in this day and age, albeit the challenges governmental organisations face.

I came across the work that various ASRMH Network members have been doing in detention camps when I joined RANZCP as a psychiatry registrar. I was inspired by the work the ASRMH Network on policy issues, promoting education and training to psychiatrists and trainees, advocating for high quality services for refugees and asylum seekers, as well as promoting the highest clinical and ethical standards in the delivery of mental health services. This was a driving factor for me to be part of a network committee that shared similar values and acknowledged the need for refugees and asylum seekers to obtain the highest level of care regardless of their background.

What’s your experience and background in asylum seeker and refugee psychiatry?  

I am currently working with the Central Adelaide Local Health Network in South Australia. I am a final year psychiatry registrar doing an advanced certificate training in consultation liaison psychiatry. I had previously worked with Rohingya Refugees together with UNHCR while working in Malaysia before moving to Australia. This sparked my interest as the challenges that often arose were unexpected, and differed from the patients I would normally see in my clinical practise.

My perspective changed when I worked with young Rohingya children who were not given the opportunity to receive basic education because there was no funding allocated. To complicate matters further, delivering psychiatric care was challenging because most of their families were opposed to it due to perceived stigma and cultural differences.

Some of the issues that arose included limitation of biological and psychological treatment options, resulting from the lack of medical insurance and government funding. The lack of advocacy for refugees and asylum seekers was disappointing and I felt it was crucial for me to work harder and be part of a network committee that could make a difference. I struggled to comprehend that in an era where we are meant to have basic necessities, people were still struggling to be granted citizenship of the country they were born in and get access to education or medical care.

I have been privileged to meet so many diverse patients and learn from them which inadvertently helped me in my day to day clinical practise with regards to having a broader understanding of culture and the legal challenges faced by refugees and asylum seekers.

I am also interested in the long term impact of complex post-traumatic stress disorder and intergenerational trauma in refugees and asylum seekers because it is not an area where a lot of research has been undertaken. Perhaps, if there were more research and longitudinal studies done, we could further reinforce the importance of abolishing detention camps.

Apart from the above, I also have an interest in working with Aboriginal mental health patients. I have been fortunate enough to work with these groups of marginalised populations in very remote parts of South Australia and have gained a completely different perspective on mental health issues that arise in rural Aboriginal communities and the intergenerational trauma they have been exposed to.

What are the challenges you experienced, and what do you feel are the greatest challenges for trainees in this area of practice?

Some of the challenges that I have experienced is the concept of refugees and asylum seekers not always getting psychiatry / medical services and treatment while in detention camps due to the legal implications involved. Perhaps even more so in psychiatry when patients who are mentally incompetent are unable to consent to treatment, but there are no formal orders in place to facilitate ongoing treatment / management. 

As trainees working in metropolitan areas, we do not often get the opportunity to work with refugees and asylum seekers. Hence, we are not familiar in dealing with some of the complex issues that arise or develop the required report writing skills. There is a lack of familiarity with regards to different medical insurances available and to what extent we are able to provide medical treatment within these policies.

Apart from that, there are limited models of care and guidelines that are available to assist us with delivering psychiatric care to asylum seekers and refugees.

I am also concerned that there are no formal, standardised medical insurance policies in place for refugees and asylum seekers in most countries. The level of medical care that is provided varies across countries and in some instances, refugees and asylum seekers are completely deprived of psychiatric care when it is an utmost priority. I would like to understand better the concept of health policies and medical insurance that are available for refugees and asylum seekers worldwide.

My wish for the future is that world leaders are able to come together to identify core challenges, abolish the concept of detention camps, and provide optimum mental health care services for refugees and asylum seekers worldwide. As part of my future career goal, I am interested in collaborating with health care policy leaders to work towards implementing a standardised model of care from a psychiatric perspective without compromising treatment options for refugee and asylum seekers worldwide.

“A refugee is someone who survived and who can create the future” - Amela Koluder

If refugees and asylum seekers are given equal opportunities and the highest level of mental health care services right from the beginning, there is no question that they will be able to have a better life for themselves, and also contribute towards a better future for all of us.