I have come into contact with many remarkable clinical teams. Teams whithin which levels of commitment and clinical expertise were outstanding and from which I have learnt immensely. Yet, even amongst these, when it came to increasing equality of access to the service for traditionally marginalised groups; feelings of powerlessness and anxiety appeared to dominate discussions. The task seemed too vast, too impregnable (these sentiments were not aided by the length and/or complexity of some of the relevant documents available on the issue) or; beyond’s one’s remit and/or expertise. The activities below may be a helpful starting point for those who may not have engaged with the matter.
1. Improving Equality data collection/monitoring
Addressing inequality has to start with the systematic collection and analysis of demographic data across all nine protected characteristics within all services. Collecting such demographic information at several points may help increase response and recording rates (which are notoriously low). It may also be helpful to include agreed definitions as part of any data collection exercise e.g. people vary in their understanding of what may be a disability, so including the Equality Act (2010) ‘s definition and asking in relation to it ‘Do you consider that you have a disability’ may be more productive than simply asking ‘do you have a disability?’ This may help ensure a shared understanding. Similarly, in terms of ethnicity, meaningful comparisons between service use data and local demographic information can only take place if similar categories are in use.
2. Carrying out of Equality Analyses and Equality Impact Assessments at micro level?
NHS Trusts are required to publish evidence of the analysis they have undertaken to establish whether their policies or practices would further or would have furthered the aims of their Public Equality duty*; to provide details of the information considered and describe the engagement(s) they have undertaken when doing the analysis. Thus, Equality Analyses have become a standard part of policy and decision making processes at Trust level. Many Trusts have developed Equality Impact Assessment (EqIA) tools to assist staff in assessing and addressing potential unintended adverse consequences. Access to Clinical Psychology Services could be vastly improved by the completion of such analyses at micro level. This may support the regular consideration of the effects of team practices on different groups by clinicians.
3. Establishing stronger links with community organisations
Partnership work with organisations that represent and/or work with diverse communities may be a means to ensure more equitable and inclusive services. Perhaps undertaking mapping exercises to locate such community resources/groups in the locality may be helpful for some services. There is no doubt that Clinical Psychologists have much expertise and knowledge to offer community groups but similarly; community groups and culture/identity specific services could impart valuable skills and experience in terms of working with minority groups and marginalised communities.
4. Supporting staff learning and development needs around Equality
Increasing staff knowledge of the Equality Act (2010), their responsibilities and that of the service under the same may be similarly important. All NHS staff have to attend Equality and Diversity training. In my experience however, such mandatory training is often relatively basic and can be somewhat removed from service level/delivery issues. The workings of unintentional, institutional and structural discrimination, key issues in terms of inequality of access; tend not to feature much, if at all. It is difficult to see how services may start to tackle inequalities without having a firm grasp on such dynamics. In practice, service specific training on Equality and Diversity could be much more helpful in terms of facilitating a dialogue on the issue and ideally, staff at all level of the service should be involved. Given the standard distribution of power within the services, it may be that those at the ‘bottom’ of the hierarchy and service users have particularly useful contributions to make.
Evidently, not all services have issues with equality of access and many may well have become experts in managing it. Nevertheless, such inequities (in addition to inequalities of outcome and experience) remain national concerns. The above list is not exhaustive and many services and clinicians will have undertaken different actions (I would be grateful for the sharing of such examples of practice). It must be borne in mind that increasing access to Psychology Services is only one part of fostering better psychological wellbeing for marginalised groups. Getting engaged in helping reduce inequalities at societal level and diversifying the models and interventions available within services may also encourage the inclusion of Service Users from marginalised groups and support their engagement once they access Psychology Services. Naturally services’ capacity to manage any potential increase in demand and thus in workload, are added complicating factors that would need careful planning.
*Under the Public Sector Equality Duty, NHS Trusts must have due regard to the need to:
• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Equality Act 2010;
• Advance equality of opportunity between people who share a protected characteristic and those who do not; and
• Foster good relations between people who share a protected characteristic and those who do not
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