“No Algorithm Can Replace Trust and Empathy in Mental Health Care”

Dr Tiagarajen Sawmynaden, Psychiatrist in Austria 

• “If the process of registering as a specialist with the Medical Council had been more straightforward, I would already be working in Mauritius.”
• “Psychotherapy is widely accepted in Austria… In Mauritius, therapy is still less normalized, and seeking help is often delayed due to cultural barriers and misconceptions.”
• “While psychiatric care has traditionally focused on treatment, there is a growing recognition of the importance of prevention and early intervention.” 

“The plan has always been to return. Mauritius is home.” For Dr Tiagarajen Sawmynaden, a Mauritian psychiatrist based in Austria, the path from public health centres in Bel Air to consultant level in a leading psychiatric hospital has been shaped by linguistic adaptability, professional resilience, and a clear sense of purpose. While willing to return and contribute to the local health system, he warns that “the process of registering as a specialist is excessively long and disheartening.” A situation he believes is preventing skilled Mauritian professionals abroad from coming back.

Can you walk us through your journey from Mauritius to Austria? What led you to pursue psychiatry and ultimately join Kardinal Schwarzenberg Klinik? 

I left Mauritius in February 2016 with the goal of pursuing my medical specialization in Germany, a popular path at the time for many doctors seeking international opportunities. My first step was to learn the German language – an essential requirement before I could begin practicing medicine. To qualify for clinical work, I also had to pass the medical language exam.

After a few weeks of preparation and applications, I secured my first job interview with a Swiss hospital group operating several facilities across Germany, Switzerland, and Austria. They urgently needed doctors for their Austrian branch, and I saw this as a perfect opportunity. Keen to begin my medical career in Europe without delay, I seized it wholeheartedly.

In 2017, I began working as a Resident Doctor in Psychiatry and Psychotherapeutic Medicine at Ameos Klinik in Bad Aussee, Austria. The clinic is centrally located and affiliated with the Medical University of Graz, offering an excellent environment for both professional and academic growth.

After a couple of enriching years there, I sought new challenges and joined the Kardinal Schwarzenberg Clinic. Upon completing my medical specialisation, I was offered a position as a specialist at the same institution. Last year, I was honoured to be promoted to Consultant in Psychiatry – a role I embrace with pride and dedication.

Was working in Europe always part of your plan, or did the opportunity arise later in your career?

After completing my medical studies in Romania and my pre-registration training in Mauritius, my initial goal was to work in one of our local hospitals. At the time, if I recall correctly, there were around 250 to 300 doctors applying and waiting for placements in the public healthcare system. Despite the competitive landscape, I eventually began working as a General Practitioner in the community health centres of Bel Air Rivière Sèche and Brisée Verdière.

Although I was grateful for the experience, I had always hoped to contribute within a hospital setting. As time passed and opportunities remained limited, I made the difficult decision to seek new horizons. After a year, I left Mauritius to pursue my medical career abroad.

What were some of the biggest challenges you faced transitioning from Mauritius to Europe?

At first, it was a real cultural shock, made even more challenging by the language barrier. But once I became fluent in German, daily life in Europe gradually became much easier to navigate. That said, adapting wasn’t just about language or culture. I’m not exactly the best cook, so I found myself missing our Mauritian cuisine deeply.

I’m also very much a family-oriented person, and living alone in the quiet, mountainous region of Austria was particularly tough in the beginning. Things became a lot better when my wife was finally able to join me.

Interestingly, working in the hospital turned out to be one of the smoother parts of my journey. I was fortunate to be surrounded by kind and supportive colleagues, which made the integration process at work much more comfortable and welcoming.

What does a typical day look like for you at work? Can you describe the kind of cases you usually handle?

A typical day at the hospital begins with a handover from the night staff, providing important updates on patient conditions. Following this, we begin our daily rounds, which usually last until midday. Afterwards, there’s a brief meeting to discuss patient discharges and new admissions.

We’re given a half-hour lunch break, which is often a welcome pause, before diving into the afternoon tasks: reviewing discharged patients, completing discharge summaries, and assessing new cases. This is, of course, the ideal scenario.

The hospital where I work serves a large catchment area, and due to a shortage of doctors and limited bed capacity, we often face significant challenges in managing patient flow. Currently, I oversee a ward primarily focused on patients dealing with addiction issues. However, because of the ongoing shortage and the lack of available beds, we also admit patients suffering from a wide range of other psychiatric conditions.

On top of this, I sometimes assist my colleagues by covering other areas, including the Day Clinic, our geriatric ward, and the outpatient department. Working in a psychiatric hospital can be quite hectic at times, requiring a great deal of adaptability and teamwork.

How would you compare the perception of mental health in Austria with that in Mauritius?

It’s unfair to make a direct comparison. Mental health care in Austria is part of a well-established system, constantly evolving with ongoing improvements. In contrast, Mauritius has a developing mental health system, with a central psychiatric facility at the heart of it.

In Mauritius, there remains a significant lack of understanding surrounding mental health. Stigma is deeply ingrained in the culture, often linking mental health issues with shame and social isolation. Psychotherapy is widely accepted in Austria, and medication is commonly prescribed, both of which are integrated into mainstream care. In Mauritius, however, therapy is still less normalized, and seeking help is often delayed due to cultural barriers and misconceptions.

That said, positive change is slowly taking root. There are emerging efforts focused on youth mental health, and gradually, more awareness is being raised around the importance of early intervention and mental health support. This shift is encouraging, but there’s still much progress to be made.

In Mauritius, we have an aging population, and it’s heartening to see how family members often come together to support elderly relatives, particularly those suffering from dementia. This strong sense of familial responsibility stands in contrast to what I’ve observed in Austria, where such support structures can be less prevalent. I truly hope this tradition of close-knit family care continues to thrive in Mauritius, as it provides invaluable comfort and security to our aging loved ones.

What are some of the key mental health issues you’ve observed?

Substance abuse – particularly the use of synthetic drugs – is a growing concern, especially among young adults. The videos circulating on social media are deeply worrying, and reflect a disturbing trend.

Additionally, anxiety and stress-related issues are becoming increasingly prevalent, often linked to financial pressures, job insecurity, and the weight of family expectations.

Depression is also widespread, but it remains significantly underdiagnosed, often overlooked or dismissed until it reaches a more critical stage. These challenges are affecting both the youth and professionals alike, highlighting a pressing need for greater awareness, early intervention, and better access to mental health resources.

How important is cultural sensitivity in psychiatric practice?

Cultural sensitivity in psychiatric practice is absolutely crucial. Different cultures have unique perspectives on mental health, including its causes and treatments. For example, some cultures may attribute mental health issues to spiritual or supernatural forces, while others may approach them from a strictly medical or psychological standpoint. By understanding these cultural contexts, mental health professionals can more accurately assess, diagnose, and treat their patients.

When patients feel understood and respected, particularly in relation to their cultural identity, they are far more likely to engage in treatment and adhere to prescribed care. Cultural sensitivity also enables mental health professionals to tailor treatment plans that are not only more relevant, but also more likely to be embraced by the patient, increasing the likelihood of positive outcomes.

Moreover, cultural sensitivity is vital for addressing the stigma surrounding mental health, which can vary across different cultures. By acknowledging and incorporating cultural nuances, healthcare providers can create a more inclusive environment, ensuring that care is accessible to all populations, particularly those from marginalized or underserved communities.

In your opinion, what are the most pressing challenges facing psychiatry today – both in Europe and globally?

The challenges facing psychiatry today are multifaceted, with the most pressing issue being the shortage of psychiatrists, psychologists, and other mental health professionals. Many countries are struggling to meet the growing demand for mental health services, resulting in increased workloads, burnout, and difficulties in providing timely and adequate care.

While psychiatric care has traditionally focused on treatment, there is a growing recognition of the importance of prevention and early intervention. Mental health issues, when detected early, can often be managed more effectively, reducing the risk of long-term disability. However, programs aimed at mental health promotion and early intervention remain underfunded and often undervalued in comparison to treatment-focused approaches.

Although awareness of mental health has increased in recent years, stigma continues to persist, particularly in certain regions or among older generations. This is especially true for more severe mental health conditions, such as schizophrenia, where societal perceptions are often negative and clouded by misconceptions.

Have you encountered an increase in mental health disorders post-COVID, and if so, in what forms?

The COVID-19 pandemic has had a profound impact on mental health globally, leading to a significant rise in anxiety, depression, post-traumatic stress disorder (PTSD), and substance abuse. The long-term psychological effects of the pandemic are still unfolding, placing immense pressure on mental health systems that are already struggling to meet the increasing demand for services.

Furthermore, the pandemic has highlighted the vulnerabilities within these systems, particularly the heavy reliance on in-person care, which became challenging during lockdowns. This situation has underscored the need for more innovative approaches, such as telepsychiatry. However, access to technology and digital health services remains a significant barrier in many regions, limiting the effectiveness of these solutions.

“The COVID-19 pandemic has had a profound impact on mental health globally… leading to a significant rise in anxiety, depression, PTSD, and substance abuse.”

 

How has the mental health field evolved since you first started practicing?

Worldwide, the field of psychiatry has undergone a remarkable transformation, propelled by technological advancements, a greater emphasis on early intervention, increased mental health awareness, and a growing understanding of the interconnectedness between mental and physical health. At the hospital where I am currently employed, we are constantly adapting to these evolving demands by implementing a patient-centred approach. The results to date have been very positive, reflecting the effectiveness of this tailored method.

You’re working abroad with your wife, who is also Mauritian. How has that shared experience shaped your life in Austria?

Initially, I was alone in the Austrian mountains, adjusting to a new life far from home. About a year later, my wife joined me, and together, we began to recreate a sense of Mauritius in our everyday lives.

Through our language, food, traditions, and shared routines, it felt as though we had built a little piece of home there – a comforting presence that grounded us even in a foreign land.

Experiencing a new culture side by side has helped us grow, both as individuals and as a couple. Today, we are blessed with a son who is almost two years old. He is truly our ray of light in the cold, snowy winters of Austria – a beautiful reminder of how far we’ve come.

What aspects of your Mauritian identity have you carried with you into your professional and personal life in Europe?

Growing up in Mauritius, I became fluent in several languages, greatly enhancing my ability to communicate across cultures. This linguistic versatility supports effective communication and helps me build meaningful relationships and feel at ease in diverse communities.

Life on a small island, often with limited resources, nurtured a mindset of resilience and creativity. It taught me to adapt quickly to new environments, customs, and expectations.

In Mauritian schools, every student is encouraged and supported to strive for excellence, which over time instilled a strong work ethic and unwavering dedication.
Additionally, our warm and open-hearted nature has been a great asset in my professional life, helping me build trust and connect easily with colleagues and patients alike.

What has living and working in Austria taught you about yourself, both as a professional and as a person?

Living and working in Austria has taught me the value of structure, discipline, and high professional standards, which are actually core elements of Austrian work culture. I’ve become more detail-oriented, efficient, and assertive, all while remaining true to the collaborative and warm-hearted approach that I bring from Mauritius.

Adapting to a new language, climate, and lifestyle has strengthened my resilience and self-confidence. It has shown me how much I’m capable of overcoming, even in unfamiliar or challenging circumstances. Most importantly, it has reaffirmed the importance of staying rooted in my culture, while remaining open-minded and curious about the world around me.

If you could give one piece of advice to young Mauritian doctors aspiring to work abroad, what would it be?

Working abroad will challenge you culturally, professionally, and personally, but it will also expand your horizons in ways that are deeply rewarding. Be brave enough to take that first step, even if it feels uncertain. Embrace the learning curve, the unfamiliarity, and the growth that comes with it. But never forget your roots!

What are some personal or cultural values from Mauritius that you think give Mauritian professionals an edge internationally?

The fact that most Mauritians are multilingual is a significant advantage. This linguistic adaptability greatly enhances our ability to communicate and connect in diverse global settings. Additionally, our resilience and “never-say-die” attitude enable us to adapt quickly and find creative solutions, even in challenging situations. Equally important is our strong work ethic, which is widely recognized. Mauritians are known for being disciplined, respectful, and diligent. These qualities are deeply rooted in our family upbringing and educational values.

How do you see your role and contribution evolving?

I have a deep interest in addictology, as I find the complexity of addiction – and its far-reaching impact on individuals, families, and communities – both intellectually stimulating and profoundly meaningful to address. I am committed to further specializing in this field, along with other key areas such as dementia and community mental health. These domains not only challenge me professionally, but also align closely with my aspiration to make a real, lasting difference in people’s lives. I remain highly motivated to continue growing in my career and to embrace greater responsibilities as I progress.

For nearly two years, I have also been teaching part-time at our Academy. While I was initially uncertain about taking on an academic role, it quickly proved to be a deeply rewarding experience. Teaching has given me the opportunity to share my knowledge, contribute to the development of future professionals, and enhance my own understanding of psychiatry through ongoing reflection and engagement. It has become an integral and enriching part of my professional journey.

Do you have any aspirations to return to Mauritius one day – perhaps to contribute to the development of mental health services there?

The easiest of all questions so far!

Of course, the plan has always been to return. Mauritius is home, and contributing to its healthcare system has always been part of my long-term vision.

Unfortunately, the process of registering as a specialist with the Medical Council is proving to be quite challenging. The procedure is not only complex, but the waiting time is excessively long and, at times, disheartening. If the process had been more straightforward, I would have already resumed working in Mauritius.

I recently watched a video in which our Prime Minister encouraged Mauritians living abroad to return and contribute to the country. I fully support this vision and sincerely hope that meaningful changes will be made to simplify and streamline the registration process. Making it more accessible and efficient would not only benefit returning professionals, but also strengthen the country’s healthcare system.

How do you see the future of psychiatry, especially with the growing integration of digital tools and AI?

This is a topic that continues to surface with increasing relevance. While technological advancements hold great promise for the field of psychiatry, I firmly believe that technology should serve as a complement – not a replacement – for human interaction. As we integrate digital tools into mental health care, it is crucial that we approach them with caution and responsibility, particularly when it comes to ethical concerns such as data privacy and patient confidentiality.

Despite these innovations, I am convinced that the human connection will remain at the heart of psychiatric care. The therapeutic relationship, built on trust, empathy, and understanding, is something no algorithm can replicate.