Breakthrough E-Book

Ahmed Hankir

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 309

Veröffentlichungsjahr: 2024

Beschreibung

"An honest, engaging and most of all, hopeful book."
—Adam Kay, BAFTA-winning, multi-million-bestselling author, TV writer and performer.

"Warm, funny and devastatingly honest. An incredibly insightful story full of hope and resilience."
—Dr Amir Khan, Sunday Times bestselling author and Resident Doctor for ITV's Lorraine and Good Morning Britain

"An inspiring rebuke to the nihilism which prevails in society about persons living with mental illness due to myths, misinformation and stigma.... Professor Hankir's personal journey bursts with courage, resilience and hope."
—Vikram Patel, Paul Farmer Professor and Chair of Global Health and Social Medicine, Harvard Medical School, USA

Explore mental health, wellness, and illness in this engaging and insightful discussion from a practicing psychiatrist who himself lives with a mental health condition

In Breakthrough: A Story of Hope, Resilience and Mental Health Recovery, World Health Organization Award Winning psychiatrist, former psychiatric patient and mental health advocate Dr. Ahmed Hankir delivers a unique and powerful insight into mental health and wellness, mental illness, mental health treatment, and the culture surrounding mental health by tracing his own personal recovery journey from impoverished and shunned psychiatric patient, to becoming an NHS Consultant psychiatrist. In the book you'll explore many of the issues currently dominating the discussion of mental health and illness, including the impacts of poverty, unemployment, the cost of living crisis, homelessness, addictions, the use of medication to treat mental illness, the widespread prevalence of stigma, discrimination and racism in mental health and much more.

You'll also find:

• Comprehensive discussions about how to overcome shame and stigma to seek help if you're suffering from a mental illness.
• Explorations of how mental health practitioners and family members of people living with mental health conditions can themselves remain healthy as they care for others.
• Examinations of why mental health related stigma remains so stubbornly common in our societies and what we can do to combat it.

Breakthrough is a resource of hope and a companion for people suffering in silence who feel isolated and disconnected from society. It will also be of interest to mental health practitioners, including psychiatrists, psychologists, social workers, counsellors, addictions specialists, carers and clients. The take home messages are clear: living with a mental health condition is nothing to be ashamed about and, with the right support, recovery is a reality for the many and not the few.

Leseprobe

Table of Contents

Cover

Table of Contents

Title Page

Copyright

Dedication

About the Author

Preface

Introduction and Mission Statement

Mission Statement

1 Seeking Sanctuary

2 Identity Formation and Fragmentation

3 Disillusionment

4 Breaking Point

5 Recovery and Discovery

Discovery…

‘Don't treat someone as a priority who only treats you as an option…’

6 Bittersweet

7 The Wounded Healer

8 Canaries in a Coal Mine

9 Dancing in the Dark

10 Reframing

11 Firefighting

12 Sorrow in the Holy Land

Acknowledgements

Index

End User License Agreement

Guide

Cover

Title Page

Copyright

Dedication

About the Author

Preface

Introduction and Mission Statement

Table of Contents

Begin Reading

Acknowledgements

Index

End User License Agreement

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“Warm, funny and devastatingly honest. An incredibly insightful story full of hope and resilience.”

—Dr Amir Khan,Sunday Times Bestselling Author and Resident Doctor for ITV's Lorraine and Good Morning Britain

“The commonly held view that the widespread stigma attached to mental illness is the result of misinformation in the population has spawned a wave of well-meaning, but largely ineffective, public-education campaigns. The fact is that stigma is largely the result of the reality of the lived experience of persons with mental illness, characterised by exclusion and violence, not least in the health care system. The battle against stigma must begin with placing the lives of humans at the heart of all conversations about mental illness and this book is an exemplar of such an endeavour. Professor Hankir offers an inspiring rebuke to the nihilism that prevails in society about mental illness through the courage, resilience and hope of his personal journey.”

—Vikram Patel, Paul Farmer Professor and Chair of Global Health and Social Medicine, Harvard Medical School, USA

“Professor Hankir's incredible story describing his extraordinary experiences is an important contribution to the mental health literature. Essential reading especially for persons living with a mental health condition, their loved ones and carers and mental health practitioners.”

—Professor Tamsin Ford, Head of the Department of Psychiatry, University of Cambridge

“An honest, engaging and most of all, hopeful book.”

—Adam Kay, BAFTA-Winning, Multi-Million-Bestselling Author, TV Writer and Performer

“A story of an extraordinary, challenged and packed life in which Ahmed bravely recounts, with every humility and grace, the life journey that has made him a unique and powerful role model for all who face adversity in their lives. This book is a toolkit for turning hopelessness into success, sadness into deep joy and stigmatisation into fuel for positively transforming others' lives. Please, please, please read Professor Hankir's inspirational book, it will change your life.”

—Professor Ged Byrne MBE, Director Global Health, Consultant Surgeon, NHS England

“Embracing a world of life challenges, and guided by his expertise, both personal and professional, Professor Ahmed Hankir has given us a gift—a true breakthrough. This timely book reminds us that mental health “flaws” can be tools: that vulnerability and shared humanity can be deployed to heal our fellow wounded travellers.”

—Professor Andrés Martin, Riva Ariella Ritvo Professor, Yale Child Study Center and Medical Director, Children's Psychiatric Inpatient Service at Yale-New Haven Children's Hospital, Connecticut USA. Editor Emeritus, Journal of the American Academy of Child and Adolescent Psychiatry

Breakthrough

A Story of Hope, Resilience and Mental Health Recovery

Dr Ahmed Hankir

This edition first published 2024© 2024 Ahmed Hankir

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The right of Ahmed Hankir to be identified as the author of this work has been asserted in accordance with law.

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Library of Congress Cataloging-in-Publication Data is Available:

ISBN 9780857089724 (Paperback)ISBN 9780857089687 (ePDF)ISBN 9780857089670 (ePub)

Cover Design: WileyCover Images: © kichigin19/Adobe Stock; © lamyai/Adobe Stock

Do not go gentle into that good night… Rage, rage against the dying of the light…

Dylan Thomas

If living with a mental health condition has taught me anything, it's that the cognitive capacity of the mind to receive and to conceive ideas is something that should never, ever be taken for granted.

There have been periods in my life during which my mind was so shattered that it was unable to comprehend and concentrate and to produce any meaningful or coherent thoughts. Reading a book let alone writing one would have been an impossible task during those trying times.

I am immeasurably grateful and extremely fortunate that I was able to recover and regain my cognitive powers. That being said, recovery, certainly for me, was a gradual, slow and painful process that took many years.

I, however, was one of the lucky ones. Far too many of us tragically continue to experience severe symptoms of a mental health condition, no matter what we do or how hard we try.

I think of people living with bipolar affective disorder, schizophrenia and schizoaffective disorder. Those held captive by paranoid and persecutory delusions or tormented by terrifying voices and visions. Persons at the behest of sudden and extreme fluctuations in mood, which can be hugely distressing to the degree that they are associated with the highest suicide rates.

Many of us perhaps take for granted the stability of our moods and/or are unaware of how immobilising and disabling psychotic symptoms (delusions and hallucinations) can be.

I also think of those with dementia and other types of neurodegenerative conditions who are unable to express themselves due to the devastating fragmentation of memory.

My heart breaks for persons living with eating disorders, which have the highest mortality rate of all psychiatric disorders. It weeps for those amongst us living with anxiety disorders such as obsessive compulsive disorder and post-traumatic stress disorder the intrusive symptoms of which can be enormously crippling and debilitating.

Not enough is being done for people living with these cruel conditions. Not enough awareness is being raised. Not enough specialist support – social care and mental healthcare – is available. The quality of that care, when it is available, has also often been described as poor and inadequate.

The human rights violations of persons living with severe mental health conditions and psychosocial disabilities and the stigma and discrimination they face is also another major issue and is a stain on our collective conscience.

The catalogue of injustices goes on and on. A government is judged based on how they treat the most vulnerable in society. If we look at how people living with severe mental illnesses are being treated, the Government has failed spectacularly.

This is unacceptable. We need to do more. We must do more. People living with severe mental health conditions have been let down for far too long and deserve better.

More attention must be given. More resources must be allocated. More high-quality and easy-to-access specialist support must be provided.

I dedicate this book to persons who cannot formulate and express their thoughts because of the severity of their symptoms and how injured their minds are. But also, to those amongst us who are able to speak out but who are stigmatised and shunned and towards whom a deaf ear is turned. This book is dedicated to the voiceless individuals who haven't been given a platform to amplify their views and share their stories and testimonies but instead are ridiculed and silenced.

Our hearts grieve for you and go out to you and to your loved ones and to all those who provide you with informal support. You are the true unsung mental health heroes, and you deserve so much more than a dedication.

I hope this book raises awareness of your plight.

But also, of your dignity and grace as you continue to fight that good fight,

And as you ‘rage, rage against the dying of the light …’.

Dr Ahmed HankirOntarioCanada October 2023

About the Author

Dr Hankir, MBChB, MRCPsych, is Consultant Psychiatrist (Canada and UK), Honorary Visiting Professor at the School of Medicine, Cardiff University (UK), Assistant Professor of Psychiatry at Western University (Canada), Professor of Academic Psychiatry at Carrick Institute for Graduate Studies (USA), Senior Research Fellow at the Centre for Mental Health Research in association with Cambridge University (UK) and Public Engagement and Education Lead at the World Health Organization Collaborating Centre for Mental Health and Human Rights, Institute of Mental Health, Nottingham University (UK).

Dr Hankir's research interests include global and Muslim mental health and pioneering and evaluating innovative interventions that reduce mental health-related stigma and Islamophobia and he has published widely in these areas. Dr Hankir has co-edited three textbooks on psychiatry and religion with Senior Members of the American Psychiatric Association. He is a public speaker and lecturer and has been invited to deliver talks at some of the most prestigious universities in the world including Harvard, Stanford, Yale, McGill, Toronto, Cambridge, Oxford, London, Padua and Coimbra. Dr Hankir has been consulted by the World Health Organization (WHO) for his expertise on mental health and human rights and has also been consulted by the New Zealand Government for advice on the psychological consequences of the Christchurch Mosque terror attacks. He is the recipient of multiple prestigious awards most notably the 2022 WHO Director General Award for Global Health.

Dr Hankir identifies as a survivor and is passionate about empowering, dignifying and humanising persons living with mental health conditions. Dr Hankir is also passionate about broadening access into medical school for persons from low-income backgrounds. He enjoys going for long walks in parks, immersing himself in nature, travelling and drinking coffee in local cafes. He also enjoys cycling, running and raising funds for charities.

Preface

In July 2005, I was 22 years old. I woke up one morning in a dilapidated and squalid terrace house in Moss Side, the roughest area in Manchester, England and I suddenly started to cry irrepressibly and inconsolably. For months I had been in denial that I was mentally unwell despite ‘the conflagration in my wake’; whilst the bridges in Lebanon were burning literally (this was during the 2006 Lebanon–Israel War, which was a factor that contributed to my ‘breaking point’), I had burnt bridges in the metaphorical sense with my very own family and people who, at the time, I considered to be my closest friends. I had been forced to interrupt medical school and I was impoverished, shunned and ostracised. The ‘insight switch’ abruptly turned on and I was completely overwhelmed with reality. What had I done? What had happened? All of my hard work to get into medical school flushed down the drain in what seemed like the blink of an eye. So, I cried, and I cried, and I continued to cry until there were no more tears left for me to shed. It was the loneliest, most isolated, and afraid I have ever felt in my entire life. If ever there was a rock bottom, this was it. Later that night, I would leave the house and walk up and down Oxford Road. The prospectus that was posted to me before I started medical school in 2003 stated that this was one of the busiest bus routes in Europe. I would look towards the oncoming traffic and thoughts of thrusting myself under one of the buses flooded my mind. ‘This pain is just too unbearable…’ I would think to myself…

May 2022:

You know that feeling when you are waiting for the President of France to finish giving his speech so that you can give yours?! World leaders and health ministers from all 194 member states of the World Health Organization (WHO) had gathered for the WHO World Health Assembly at the Palace of Nations – the headquarters for WHO – in Geneva. And there he was, the charismatic Emmanuel Macron himself, exuding panache and mesmerising the audience, me included, with his manner.

Every year, the Director General of the WHO the honourable Dr Tedros Adhanom Ghebreyesus selects individuals and groups to receive the WHO Director General Award for Global Health. In 2022, I was selected to be a recipient of the award. Words cannot begin to describe how I was feeling. I vividly remember when Dr Tedros invited me onto the world stage. I'll never forget the moment when he made eye contact with me and welcomed me with warmth, compassion, kindness and sincerity. My life flashed before my eyes as I was approaching him. All the challenges, setbacks, suffering, struggling, traumas, difficulties, discrimination, poverty, stigmatisation. All of it came flooding back. Despite my best efforts, I was unable to hold back the tears. But Dr Tedros comforted and consoled me. He fathomed the enormity of this occasion for me and I felt safe, secure and strong in his presence. We embraced each other in front of our audience and in front of the world. Following a brief exchange of words with the Director General, I felt empowered, inspired and dignified to launch into my acceptance speech. Of all the speeches that were delivered during the 2022 WHO World Health Assembly High Level Welcome, mine was the only one to have received a standing ovation. After giving my speech, I was overwhelmed with emotion again however only this time, I was not shedding tears of sorrow. These were tears of joy. This was the proudest moment in my life….

Introduction and Mission Statement

This book will trace my recovery journey from the man I was in 2005, that is, a ‘hopeless, impoverished, shunned and suicidal service user from a Black, Asian, and Minority Ethnic (BAME) background with mental illness’ to the man I am today: ‘an empowered survivor, mental health advocate, professor and consultant psychiatrist’. There are multiple versions of ourselves residing within us. These two versions of myself are not necessarily dichotomous or mutually exclusive; you can be a consultant psychiatrist living with a mental health condition and that, of course, is nothing to be ashamed about.

I identify as a Wounded Healer and this book approaches mental health from the dual perspectives of psychiatrist or ‘mental healthcare provider’ and psychiatric patient or ‘mental healthcare receiver’. Whilst there are many books about mental health from ‘Experts by Personal Experience’, for example, survivors, ‘service users’, patients, and many books from ‘Experts by Professional Experience’ (psychiatrists, professors) there are not so many books from ‘Experts by Personal and Professional Experience’(EPPEs). I was not able to find a single memoir/autobiographical narrative from a psychiatrist who recovered from a mental health condition who is from a BAME background (i.e., a ‘BAME EPPE’) despite the fact that people from BAME backgrounds are over-represented in mental healthcare services and that a substantial proportion of the psychiatric workforce in the UK (over 40%) are International Medical Graduates (IMGs) who are from BAME backgrounds. Racism is a huge problem in society and psychiatry and has been catapulted deeper into public consciousness since the murder of George Floyd in the United States and the #blacklivesmatter movement. The Royal College of Psychiatrists has appointed Presidential Leads in Racial Equality to address racism in psychiatry (both patients and psychiatrists report being victims of racism) and the American Psychiatric Association, ‘Apologised to Black, Indigenous, and People of Colour for its support of structural racism in psychiatry….’

This book also contains short stories about the people who have mental health difficulties who I have been fortunate to assess and provide care to whilst working in the frontline of the National Health Service (NHS), UK during the pandemic.

This book is aimed at people living with mental health problems, their family members, friends and caregivers. It is also targeted at health and social care workers and the general public. In other words, this book is for everyone because mental health is everyone's business and it concerns us all. The most important group, however, are people who themselves are living with mental health difficulties. It is my hope that you will be able to draw upon this book for guidance, solace and advice and that you can learn lessons from the many ‘mistakes’ that I have made. Perhaps you will be able to identify with me and relate to my experiences – both the symptoms and the stigma associated with mental health conditions. This identification can be validating and make you feel less alone and less ashamed. I hope that by sharing my story, it will give you hope that people living with mental health conditions can, with the right support and resources, recover, function again and realise their potential, even their dreams….

Mission Statement

The mission statement of this book was informed by the many, many people I have been fortunate to meet (in person or online) over the years whilst the seed of this book was in germination. It is therefore not ‘my’ mission statement but rather ‘our’ mission statement:

Dignify, empower and humanise people living with mental health conditions…

Disseminate the message that ‘there is no shame in experiencing mental health difficulties…’

Instil hope into the hearts, minds, bodies, and souls of people living with a mental health condition that recovery is a reality for the many and not the few…

Let people with mental health difficulties know that ‘they are not alone…’ and that ‘they should not suffer in silence…’

Provide people with a resource and the tools for mental health recovery, resilience and redemption…

Offer an insight into the heart, mind, body and soul of a man from a Black, Asian and Minority Ethnic Background who has recovered from a mental health condition and who has, dare I say it, done rather well for himself (not despite his condition but because of it…). In other words, a person living with a mental health condition who has not only survived, but thrived…

Demonstrate the colossal power that the performing arts and storytelling has in mental healthcare and education…

1Seeking Sanctuary

Why am I as I am? To understand that of any person, his whole life, from birth must be reviewed. All of our experiences fuse into our personality. Everything that ever happened to us is an ingredient.

Malcolm X

Malcolm's words ring true with me although I do have a point of contention with them. I would argue that events that occur even before our birth can strongly influence who we eventually become and our vulnerability to (and our resilience against) developing mental health conditions. I am also sure that the epigeneticists amongst us would say that influences that occur in-utero also play an important role.

To illustrate the above point, I will briefly trace my father's journey. Dr Zakaria Hankir was one of 13 children. It was not unusual in that time and place to have large families. Dad was born in the ancient Phoenician city of Sidon in south Lebanon, the first child amongst his siblings not to be born in Haifa, a coastal city in a territory that was named Palestine during my grandparents' generation (and in the hearts and minds of many will forever be named as such). My grandfather Ahmed Hankir (after whom I was named) worked in Haifa for many years. My father said that my grandfather's accent was strongly Palestinian, so much so that my father acquired the Palestinian accent from his father even though my father himself never lived in Palestine. Later, when my father moved back to Lebanon his accent would influence which patients would consult him, such was and remains the sectarian divide in Lebanon.

My paternal grandfather was marred by tragedy when he was rendered an orphan at a young age. He did not receive a formal education and had limited literary ability; however, he was renowned for his physical strength. My grandfather migrated to Haifa due to its economic prosperity. Whilst there, he sold ful and hummus to the local townspeople as he would walk up and down the sun scorched and unmarked streets of Haifa with his trusted business partner, his donkey! In 1948, my grandfather was forced to flee Haifa with hundreds of thousands of Palestinians during what is known as ‘the Nakba’ or ‘the catastrophe’ after the state of Israel declared sovereignty (there is so much more that can be said and that has been said about ‘the Nakba’, however, that is beyond the scope of this book. What I will say is that ‘the Nakba’ continues to have a profound impact on all those who were affected, none more so than the people of Palestine who were forcibly displaced and dispossessed. ‘The catastrophe’ is a scar that remains indelibly etched on the collective consciousness of the people of Palestine and continues to be a source of unresolved trauma). Leaving all his belongings behind, Grandad returned to his native city of Sidon setting up a ful and hummus shop over there. My grandfather had an extraordinary work ethic and the highest of standards. Word of the high quality of his food and how delicious the meals were spread throughout the city and indeed all the way to the capital, Beirut. Former Prime Ministers of Lebanon Rafic Hariri and Fouad Siniora would frequent my grandfather's establishment when they were children. It was and remains a source of great family pride. I never got to meet my Grandad, may he rest in peace, the man whose name I bear. He passed away before I was born. From time to time my gaze turns skyward where I pray his soul will ascend. I imagine him looking down on me, proud of his grandson, Dr Ahmed Hankir. It makes me emotional just thinking about it.

Although not as opulent as Haifa, Sidon was not without its charm and allure. Our teachers in Lebanon would harken to centuries gone by and proudly and patriotically say to us that the port in Sidon enabled the city to flourish and consequently the region at the time was a commercial hub. My memories of Sidon are of the crusader castle that can be seen whenever one passes by the coastline of the Old City. It is all the more stunning at night time when the lights would be turned on. I still have an affinity towards Sidon. The place and its people have shaped my character and values so profoundly. It was where I spent my formative years after all and it was just prior to the devastating fragmentation of my family. I will elaborate on the impact that living in Sidon had on my identity later in this book.

My father was from humble beginnings. It is fair to say that he grew up in poverty. During his childhood he would work long hours with his father in the restaurant. My father, however, was a genius and he excelled in his exams at school. Being from a family with limited financial means, his parents were unable to pay for the tuition fees for medical school despite my dad securing the necessary grades. He was, however, able to obtain a scholarship from the Egyptian Government to study medicine in Cairo University, one of the most prestigious universities in the region, certainly at the time. The President of Egypt was the charismatic Jamal Abdel Nasser who had a vision that there would be unity in the Arab world. Nasser had set up a foundation for brilliant Arab youth to apply for scholarships to study at prestigious universities in Egypt. My father qualified. To this day, my father's clinic in Lebanon is full of pictures of Jamal Abdel Nasser, such is the immense gratitude my father has towards the Egyptian nationalist for the pivotal role the premier played in my father's life, and indeed my life. Otherwise, my father would never have broken the intergenerational poverty cycle and my fate would have turned out to be very different.

My father qualified as a physician in the early 1980s when the Lebanon–Israel war was still raging. It was a brutal and bloody war that had devastating consequences. The conflict captured the attention of international media outlets. I think this was in part because of the presence of the Multinational Force (MNF) including the US military. The decision to deploy troops to Lebanon may perhaps be one of the US Government's deepest regrets. On 23 August 1983, early on a Sunday morning, trucks loaded with bombs were driven into buildings at the US Marine Corps barracks and were detonated. The suicide attack killed 307 people including 241 US military personnel. The 1983 Beirut barracks bombings resulted in the largest single day death toll for the US Armed Forces since the Vietnam War. I have no recollection of this as I was an infant at the time. But what I do have memories of were how the brutality of the Lebanon war seeped into popular culture. I remember, for example, the British band Human League and their single, ‘The Lebanon’ being played by radio stations in the 1980s and 1990s. The lyrics continue to haunt me to this day.

The Lebanon–Israel war and its consequences were major factors that influenced my dad's decision to migrate to Northern Ireland where another conflict was taking place, ‘The Troubles’. However, just before he left Lebanon behind, he met my mother in a village. He, a dashing doctor, my mum a beautiful belle, they did not waste any time before exchanging vows and getting married. Together they travelled to Belfast where my father worked as an obstetrician. The situation in Belfast back then was far from stable. My mother would always say to me, ‘Son, it was like jumping out of the frying pan and into the fire!’ Indeed, Belfast at the time was considered one of the most dangerous cities in the world. I remember recently being interviewed by a radio talk show host after posting a comment on social media about obtaining my Certificate of Completion of Specialist Training and becoming a Consultant Psychiatrist. He wanted to know about my background so I told him that I was born in Belfast. After goading me for more information, I proceeded to share with him what my mother had said to me in relation to the advance alerts that they would receive that a bomb would be detonated at a particular time and place. At this point, the host excitedly revealed that he himself hails from that region of Ireland. He then added, ‘Yes, what you describe were the infamous notifications that the IRA used to issue.’

I was born against this backdrop of civil strife in Belfast in 1982. The territory at the time was being disputed; was Northern Ireland (or is it the northern part of the island of Ireland?) part of the United Kingdom or was it part of a United Ireland? Irrespective of political persuasion and ideology, I received both British and Irish nationalities. This is tremendously beneficial as I remain a citizen of the European Union following Brexit and I receive all the advantages associated with this! My twin brother, for example, has been living in Germany for the past decade and he has experienced firsthand the benefits of being an Irish national in Europe following Brexit as it was a lot easier for him to work there compared to his British counterparts.

I don't remember Belfast. My parents moved to Dublin a couple of years after my father secured work in the Coombe Hospital as an obstetrician delivering babies, performing C-sections and carrying out other surgical procedures. However, that is not to say Belfast doesn't have any influence on my identity. I returned to Belfast for the first time since leaving in 2019 just before the first wave of the pandemic. I was invited by Queen's University to deliver a talk about tackling mental-health-related stigma in medical students and doctors. BBC Radio Ulster soon caught wind and the following morning I found myself in their studio. I felt a deep, sincere and authentic connection with the talk show host as I almost always do with Irish people. I can't fully explain why but my being born there and feeling accepted as Irish I think certainly plays a role. During my interview I signposted my journey but we also spoke about how Northern Ireland has the highest rates of suicide in the United Kingdom. The authors of the paper that was published in The Lancet Psychiatry report that the trauma from The Troubles was transmitted throughout the generations and it is a factor that contributed to suicide in Northern Ireland. The authors therefore urgently recommend that more trauma-informed care must be made available to help heal the psychological wounds sustained as a result of The Troubles.

My parents, like many other people who migrate, seek asylum or sanctuary, didn't relocate because they wanted to but because the devastating consequences of conflict left them with no other choice. The mental health of this population often falls under the purview of cultural psychiatry for which there is a growing body of research evidence. The data does indicate that being a migrant, asylum seeker or refugee can increase your risk of developing mental health problems. Multiple factors contribute to this such as how we are received by the host country, language barriers, employment opportunities and housing insecurity. Interestingly, second-generation immigrants are at higher risk of developing psychosis compared to first-generation immigrants. I would hypothesise that the former have more difficulties grappling with identity than the latter. We all long to belong but for second-generation immigrants it seems, certainly to me, that we struggle with knowing who we are and which tribe we are a member of. My twin brother said something to me once that I'll never forget. He said that although we are British nationals, it felt as though we were never treated or accepted as such, certainly not by the community we were immersed in when we returned to England in 2000. This despite our best efforts to integrate and the fact that we identified strongly as British. This identity crisis, certainly for me, precipitated emotional turmoil and rendered me vulnerable to developing mental health problems in the future.

It seemed to me that the prevailing culture in England was to drink alcohol. For you to be accepted and embraced as ‘one of our own’ one must subscribe to this culture. Being a Muslim, therefore, didn't stand me in good stead for social inclusion since consuming intoxicants is haram (prohibited) in Islam. I think this only served to alienate me and no doubt many other teetotallers from full social acceptance, which further increased our risk of developing mental health problems.

The rhetoric being espoused by certain politicians about immigration and seeking asylum and the policies, both those being proposed and those that are already implemented, undoubtedly has adverse effects on the mental health of those being targeted. Britain's Home Secretary Suella Braverman has come under scrutiny and criticism for the language she has been using when she is describing migrants and people who seek sanctuary. When dehumanising terms are used to describe a people it can have disastrous effects on our mental health.

One of the most striking policies against people seeking sanctuary was when Donald Trump was in office and he issued an Executive Order that resulted in the forced separation of children from their parents often for protracted periods. Such forced separation can cause irreparable damage to the mental health of both children and parents and, certainly for me, is unconscionable.

Discussions about immigration and seeking sanctuary are often in the context of the Global North. However, we know most people receive refuge and sanctuary in low- and middle-income countries like Lebanon. Indeed, up to one-in-four people in Lebanon is from Syria or Palestine. Refugees in Lebanon are often deprived of healthcare and doctors would turn them away if they did not have the resources to pay.