‘Working abroad had shaped me into a different person’

At the age of 14, I knew I wanted a career to do with the brain. But growing up in India, a bachelor's degree outside of engineering or medicine was seen as a failure. Thankfully, my parents supported my decision to seek a better education abroad, and after entrance exams and clearing high school, I packed my bags to move to America by myself in order to study pre-medicine. 

I didn't enjoy the first few semesters. I had to study science courses like physics, chemistry and biology. It was not until I started my placement at a lab conducting various neuropsychological and neuroimaging assessments that my career path changed. I thought studying psychology would give me wider scope to interact with people in a meaningful way.

Initially, I thought it would be all about sitting in a chair and listening to a client talking through their problems. The more I explored, the more depth I built in terms of professional and clinical experiences. Over the years, I worked with different populations in the US including providing mental health support to a substance misuse unit, cancer ward, homeless shelter, and non-profit organisation for human trafficking. I thought these opportunities were taking me closer to my ultimate career as a neuropsychologist, but they translated into different things as I started to travel and move around the world. 

A few years ago, I decided to move to London for my postgraduate studies. My decision to was based on how the UK attracted the immigrant population, and the cutting edge research in neuropsychology. For my master's dissertation, I studied whether higher mortality was avoidable for those with epilepsy, in both rural and urban parts of the world. 

The US education system had given me a lot of freedom to explore; in the UK it felt somehow more concise. It was not until I started interviewing for jobs in the UK that I felt my foreign experiences were not valued. Employers gave feedback reminding me, often indirectly, that I was not from here… apparently I couldn't be taught how things are done within the UK system. My classroom experiences in the university sometimes felt unwelcoming. During discussions, I would bring my experiences regarding mental health in both traditional and western worlds, and students and staff would actually ask why I didn't go back to my country of origin. Most of the students and staff seemed unaware how to interact with a foreign student. 

Ultimately, this led me to leave the UK about two years ago. I decided to travel and work in the USA and India. I interned with a clinical psychologist in California and learned about biofeedback mechanisms in reducing seizure frequency for those with epilepsy. When I moved to India, my qualifications and experiences enabled me to work as a clinical psychologist in a private practice. I administered neuropsychological tests and rehabilitation work with the geriatric population. Because of the traditional culture, a lot of the work was family centred. 

I was back in my home country, but I didn't feel I belonged. Living and working abroad had shaped me into a different person. I realised it was time for me to move back to the UK and finish training to become a clinical neuropsychologist. 

In the summer of 2020, finding a job as an assistant psychologist became a nine-to-five job in itself. Finally, four months and 17 NHS interviews later, I landed my first assistant psychologist post within the NHS.

As a foreign applicant, I have found the onboarding process to a new job in the UK could be a long and tedious process. There are constant changes to immigration and the right to work requirements. Be patient, and ready to educate your future employers on how to issue immigration documents. Even after starting in post, there can be a barrier between you and your work. There are stereotypes around how psychology is practised in traditional countries. People often think that because I was brought up in a traditional country, I might not be aware of how psychology is practised in western countries. What people tend to forget is that these countries have progressed a lot – high quality treatment is possible anywhere in the world. 

It can be exhausting for a foreign mental health expat to establish a career in the UK, but once you find that niche it can be the most rewarding career. The UK has integrated best practice from around the world – for example, trauma-informed care, CBT, and DBT, originally developed in the US, are very effectively practised here. As a result, I have found that working in the NHS gave me the platform to attend training that is well recognised around the world. London, like any big city, can make you feel lonely as an outsider; you are constantly having to adapt, culturally. But it's an ideal place to live and work if you want to reach a large and diverse population. With my multilingual skills, I discovered an opportunity to connect with service users in a more meaningful way. The psychological workforce would be weaker if we were to ignore the diverse experiences of international mental health professionals. Let's build rapport, between colleagues and to service users, to make sure everyone's wellbeing needs are met. 

Ankita Guchait

Moving to the UK as a mental health practitioner was both the easiest and most difficult thing to do. I was coming into one of the best healthcare systems in the world, where I knew I could gain invaluable experience in an establishment that understood mental health. But I found myself navigating a new system.  

I'm from Karachi, Pakistan, one of the biggest cities in the world. In a city that holds millions of residents, mental health is still a majorly ignored issue. Depression and schizophrenia are largely confused with supernatural possession. Lack of public mental healthcare means people go without mental health support. They don't have the finances to receive help. Due to a general lack of mental health awareness, we don't even know how many are going without support. 

A decade ago, my mother was the only person I knew who was confident in discussing mental health. My mother is a medically trained professional with an interest in neuroscience. She would often talk about neuroscience – it ignited my lifelong passion for psychology and the human mind. Yet I was often discouraged from becoming a mental health professional, and I was told I will never have a successful career in my country. Why would I want to spend my day with people who were so unwell, I was asked, as if a career to support these people was not a worthy one. Nearly everyone I knew asked me to give up on the field of mental health… except for my Mom. She understood where my passion came from. 

Due to the lack of psychology courses in my home country at that time, I went to Middlesex University to pursue a degree in Psychology. I did a placement in Mauritius, a small island off the coast of Africa. Mauritius is a large French and Creole speaking country where it was rare to work with service users that spoke English. It was during that experience that I was able to connect with service users without being able to verbally communicate with each other. I was assisting in art therapy sessions, where the service user and I used art as a way of conversing. The language barrier allowed us to build rapport and communication nonverbally. This experience instilled a skill in me that I was later able to use when working with nonverbal autistic young people.

Shortly after, I moved to Pakistan for the summer before my postgraduate studies began. I briefly worked as a counsellor. I was new to the field and not aware I should be receiving supervision. I carried on, mostly getting terribly burnt out, wondering if this is what my career would look like. Actually, this lack of clear guidelines and support built my resilience. I was determined to pursue the career.  

After this, I joined a non-profit school for autistic young people as a special education coordinator and as a provisional school psychologist. This experience transformed my view of my skills and allowed me to flourish. It was the first workplace in Pakistan to provide me with extensive training, supervision and CPD opportunities. Working in Pakistan in an evolving mental healthcare system allowed me to contribute. I was able to participate in Pakistan's first ever art display of art by neurodivergent young people, called Aut.Art, as a curator displaying the art of the young people I worked with. I was also able to introduce dance therapy for the young people and contribute to the launch of the life skills program for the teenagers. It was the most innovative I have ever felt – as if any idea that I had to help young people was a future possibility. That's a very hopeful view to have on a career.

After nearly three years of working with young people with complex and challenging needs, I felt I was ready for my move to the UK. It was a daunting task to learn about a whole new healthcare system. I was lucky to get my first NHS position only 12 days after I moved. I was unable to take that particular job due to recruitment taking months as an international candidate. Eventually I was told the position was no longer available. I joined another instead. There is a lack of clear guidelines for international candidates, but supportive recruiters have been a help to me. 

You may have wealth of experience, but coming into a new country with its own healthcare system makes you feel like a fresh graduate again. You find yourself learning new job titles, pathways, procedures and terms. You may have worked as a mental health professional for the past four years but people explain CBT to you as if they expect you not to know. In the UK education system, people have been shocked that I know how to make visuals, having not worked in UK schools before. Experiences from abroad remain valid, and the skills should be acknowledged. Mental health expats bring may have worked in very varied cultures and countries, including working with lesser resources. Being multilingual is an asset, for connecting with service users. And it takes resilience and determination to leave your home country to learn the system in a brand new country. 

My colleagues have always offered a helping hand as I navigate my way through a new healthcare system. They have encouraged me to progress, and I am grateful for that. If the world of mental health as a new expat professional is daunting, it is the support of the colleagues that can make the experience enjoyable. 

Eman Raheel