Month: July 2015

Politics, mental health and the Black community: The cost of disengagement

There are some things that too many Black people would rather not talk or think about, it seems.  Perhaps because some of us have come to think they do not concern us directly.  Mental health may be one of those things. Politics may be another. While the more socially aware amongst us may know of the stark inequalities within the mental health system, many of us would stop short of looking at members of our own families as potential mental health service users. We are not quite there yet, as a community (like most others).  Though we have seen and can now even possibly recognise some of the unmistakable side effects of some psychotropic medication on some of our community members and; have also seen some of our most distressed people walk around, often aimlessly, in our streets, markets and/or shops, many of us have somehow managed to convince ourselves that ‘those people’ could not be a member of our family and could certainly not be us. Disengaging from their distress and thus distancing ourselves from the experiences that can precipitate their crises.

The truth is though, to some of us ‘those people’ are our parents, our sons, our daughters our neighbours, our friends. Or they are us. Members of the Black community who may have felt lost, wounded or alienated and who may have followed the most coercive or adverse routes into the mental health system.  People who may be going through the revolving door of psychiatric hospitalisation and community discharge or been on the criminal justice-system-to-mental-health-hospital pipeline. The reality is of course that everyone is vulnerable, under the ‘right’ conditions, to experiencing emotional distress and let’s be real; Black people are not exactly spared by trauma and adversity.  We are, thus, all concerned.  So, while I would not argue that stigma is higher in the Black community in comparison to other ethnic groups and there certainly is very little evidence of that, its impact may well be more significant.  At the risk of replaying a record that is now a few decades old, let us remind ourselves of where we are in terms of mental health services use.

Of the on-going race inequalities within the system.  Of the excessive use of involuntary detention and persistently higher rates of acute ‘mental illness’ diagnoses within African and African Caribbean communities. Of the Black lives who were taken within systems meant to care for them. Of the fact that when we access mental health services it is all too often via the criminal justice system or with police involvement.  Of the continuing invisibility of the impact of the racism we face at both institutional and individual level and its impact on our psychological functioning, amongst other race-based inequities…The message to take home is quite clear.  As Black persons in the UK, we are more likely to experience emotional distress yet less likely for this distress to be ‘treated’ psychologically or with therapy and more likely to end up detained on psychiatric wards and in prisons, if we become emotionally distressed, we are more likely to be forced to undergo psychiatric ‘treatments’.

In a nutshell, we may be more affected by the most traumatic end of mental health services. And what do we do, still too often?  We disengage from these issues. In the same way that many disengage from politics. Unsurprisingly disengagement within mental health systems likely fuels more coercion and thus the cycle continues. According to The Institute of Public Policy Research, only 20% of people from Black and minority-ethnic communities are registered to vote, almost three times less than our white-British counterparts. Here too, many of us don’t feel directly affected or represented. Or perhaps we feel that our experiences, struggles and achievements are constantly erased by a political class that often seems intent on obsessing over immigration. Yet, in the same way that mental health structures affect us arguably more violently than any other group, so do many political decisions.

And again, in the same way that disengagement from mental health issues or services contributes to inappropriate ‘treatments’ or negative experiences for too many of us, disengagement from politics and political affairs may well affect our lives more adversely than average. Cuts to mental health services for example, are bad news for everyone; they are particularly so for the most disadvantaged in society, as is the disappearance of funding streams for many third sector organisations and community groups which for many years have provided a lifeline to the most vulnerable amongst us. Those who have often been too traumatised by institutions or alienated from society to seek mental health support from statutory services. We have watched this happen before our very eyes and many have continued to feel not directly affected. It is time we ended these fallacies. It is simply not possible not to be affected by politics in the same way that it is impossible not to be affected by mental health.

Mental health and politics are intrinsically intertwined in complex ways.  For example, getting engaged in politics can enable us to challenge the social norms that do us harm, to scrutinise the allocation of opportunities and social resources which promote our wellbeing, to hold systems to account for the treatment of our most vulnerable at home and abroad.  It helps us keep power and the elite in check in relation to the decisions they make at the top of their ivory towers.  Clearly the political system often, is not effective.  All systems are fallible. However, we do not fix a faulty piece of machinery by walking away from it.  There is a strong link between voting and emotional wellbeing. Not only is political engagement a marker of social inclusion, it may well be a powerful antidote to helplessness, despair and marginalisation, experiences too common within our communities and which fuel our high rates of psychological distress. In a nutshell disengagement, irrespective of the valid reasons which may lie at its core, does nothing for the Black community but help keep intact a status quo that, too often, does us violence socially and psychologically.

Want to learn more?

Black Mental Health UK has compiled a range of reports on race inequalities within both criminal justice and mental health systems, to access them (Click here)

To access The Poverty Site – A UK site for statistics on poverty and social exclusion (click here)

Thank you for reading.

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This piece was published on Operation Black Vote (OBV) on July 12h 2015. OBV is a non-partisan political campaign aiming to empower racialised groups to vote, present politicians with the reality of what it means to be belong to a minority group in Britain and to compel them to address racial inequality.

All work published on Race Reflections is the intellectual property of its writers. Please do not reproduce, republish or repost any content from this site without express written permission from Race Reflections.  If you wish to repost this article, please see the contact section for further details.

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Blackness as a costume: Rachel Dolezal, professional ethics and racism

Imagine that you, as an overwhelmed bereaved parent, seek to the support of a therapist or of another professional to help you come to term with your loss. In time, you start to open up and to speak of your pain in the presence of this person because you have been entrusted with their personal experience of child loss. This disclosure helps you feel more human. More connected.  You eventually come to trust this person so deeply that you share with them the most intimate and shame inducing details of your history and grief, safe in the knowledge that the person hearing you has ‘been there’.

How this professional coped with distress and loss is intermittently discussed and, this gives you a sense of hope. The aloneness that pain can bring becomes more bearable. Then, imagine that long after you have invested in the relationship, you discover that not only has that professional never experienced the loss of a child; they are not even a parent. That the stories shared with you were fantasies and that the photographs you were shown were fake.  Would it make things more tolerable to know that this person was a renowned expert on grief?  Would you feel grateful that this professional had spent much of his/her career working towards a better understanding of the experience of bereaved parents?

I expect not. I expect that some might replay in their mind the conversations shared, or attempt to remember the precise words which were used perhaps looking for traces of self-evident duplicity.  Perhaps too, feelings of shame, anger and loss might resurface, with a vengeance.  For many Black people, Rachel Dolezal’s masquerade provoked a visceral sense of horror.  I can understand it.  Both as a Black woman and as a psychologist.  Yet, the breach of trust and confidence, the sense of betrayal which lay at the centre of many Black women’s experience, its social and historical context seem to have evaded many commentators.  Though Rachel Dolezal is clearly not a mental health professional, as head of the Spokane chapter of the NAACP and professor at Eastern Washington University, until just a few days ago, she did take up positions of high social power and influence.

As a community activist, not only did she occupy a position of trust; she also encouraged personal disclosures of race-related trauma and its deriving psychological distress.  She disclosed the racial indignities she had faced herself too, except much of these were manifestly fabricated.  And, sadly, as Ms Dolezal seems intent on minimising the impact and seriousness of her actions on the community she claims to want to serve and liberate, one might rightly be curious about her willingness and capacity to reflect on her white privilege as, at the very least, race related community work calls for integrity and for the ability to be socially reflexive.

There are reasons why a range of professionals in position of power from teachers, doctors to psychologists attach much importance to professional boundaries.  Boundaries encompass many ethical issues from the delineation of professionals’ role to the limitation of professional expertise as well as, the defensible bounds within which safe, effective and non-malevolent practice may be carried out. As such, boundaries protect the psychological and physical integrity of people who are unwell, in distress or in less powerful positions, socially. They help safeguard against the exploitation of those in need of support. They aim to give people who struggle to be heard, a chance to find their own voice. They help demonstrate the value and respect placed upon the experience, and perspectives of the people to be served.  Crucially, boundaries reduce the possibility that vulnerable and marginalised groups and/or those individuals with histories of violation and abuse may be re-traumatised at the hands of those whose job it is to support them.

Rachel Dolezal seems to have violated all these ethical principles. As she donned fake tan, African braids, dread locks and/or curly weaves and walked with pictures of her ‘fake’ Black dad and son in her bag, she reduced Blackness to a costume, to an act, a game. She reduced our humanity and perpetuated our painful history of cultural appropriation; gaining much status and financial pay offs in the process.  By claiming to having personally experienced anti-black racism, Rachel Dolezal misled the Black community about her expertise and made a mockery of Black women’s lived experience of oppression. She usurped her voice for ours whilst simultaneously claiming to be ‘consistently committed to empowering marginalized voices.’ Further, by putting herself at the forefront of the Black struggle, as a White woman, she disqualified herself as an ally.

For the avoidance of doubt, the work of allies in progressing any form of social justice agenda is hugely valuable and valued.  People of all ethnicities and racial backgrounds are needed to stand up and be counted when it comes to racism and race inequalities, and indeed such people abound.  People who can recognize and renounce some of the unearned privileges society affords them by virtue of the skin they were born in are required.  Though they may be few and far between, such individuals do exist.  However, allies interested in lecturing us on phenomenon and experience their privileged existence has sheltered them from, need not apply. Allies with the ambition to lead our cause on our behalf need to take a (back) seat and seriously reflect upon their personal motivation.  Allies who cannot see that having Black people as followers in their own struggle perpetuates toxic discourses, of Black dependency, inefficacy and inferiority; some of which we have internalised, are simply not allies.

There has been some speculation about Dolezal’s potential psychological  ill health. Much of it unwarranted and unnecessary. Whilst questions have been asked about Dolezal’s welfare and wellbeing, the distress and offence she has inflicted upon so many black women has fallen well under the radar. This may sadly be reflective of the invisibility of Black women. Typically perhaps, our outrage has been ridiculed and some have expected us to be grateful for the work and energy Rachel Dolezal has devoted to ‘the cause’.  Having thus been duly educated by Dolezal on our experience as Black women, we are asked to say ‘thank you’, coached into how to respond to her farce and invited to reconsider our apparently misguided sense of Blackness. One could simply not make this paternalistic and oppressive stuff up.  Forgive us please, if some of us feel as grateful to Rachel Dolezal as we feel towards colonialists.

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This piece was commissioned by the Telegraph on June 18th 2015. A slightly different version of this article is therefore available on their website.

All work published on Race Reflections is the intellectual property of its writers. Please do not reproduce, republish or repost any content from this site without express written permission from Race Reflections.  If you wish to repost this article, please see the contact section for further details.

Clinical Psychology and The Equality Act: The potential case for indirect discrimination (PART1)

Indirect discrimination and the Equality Act

Employing NHS trusts and (university based) clinical psychology courses share the legal responsibility to ensure that no unlawful discrimination occurs at any stage of the training process, this includes indirect discrimination (the present article will focus on race). Further, clinical psychology training arrangements are covered by employment and higher education jurisdictions both of which are subject to the Equality Act (2010) also referred to as ‘The Act’.  According to the Equality and Human Right Commission (EHRC, 2011), indirect discrimination exists when a provision, criteria or practice which is applied similarly across groups has the effect of putting individuals with a protected characteristic at a particular disadvantage and that criteria, provision or practice cannot be justified as a ‘proportionate means of achieving a legitimate aim’.

Although ‘disadvantage’ is not defined in law, the EHRC proposes that anything that a reasonable person would consider to be a disadvantage would be deemed disadvantageous in court/tribunal.  As examples, the commission lists the following as disadvantages: the denial of opportunities or of choices, deterrence, rejection or exclusion.  Similarly, ‘provision’, ‘criterion’ or ‘practice’ are undefined within The Act but, it is suggested that they should be interpreted widely so as to include both formal and informal arrangements and may thus cover admission onto courses, courses’ arrangements and their delivery.

Once disadvantage has been established, the provision, practice or criteria can only be deemed justified if they are not otherwise discriminatory and represent a real and objective consideration.  In the context of clinical psychology training, examples of legitimate aims might include the need to maintain academic standards or to ensure the health and safety and/or welfare of students and/or service users.  Nevertheless, even if an aim is legitimate, the means of achieving it must still remain proportionate (EHRC, 2011). Proportionate in this context means ‘appropriate and necessary’.  ‘Necessary’ however, does not mean that the provision, criterion or practice is the only possible way of achieving the legitimate aim.  In summary, the EHRC helpfully concludes that the more serious the disadvantage caused by a discriminatory provision, criterion or practice, the more convincing the justification must be for a defense to succeed.

Some potential implications for recruitment and selection

The potential for indirect discrimination on the ground of ‘race’ may become clearer by following the key steps which may need to be taken for such a claim to succeed.  The first step would be to clearly identify the provision(s), criteria/criterion or practice(s) equally applied to all relevant students/trainees or applicants.  The next, would entail establishing that the provision(s), criteria/criterion or practice(s) put students sharing a protected characteristic (e.g. applicants from specific minority ethnic groups or from the general BME population) at a particular disadvantage in comparison to those who do not share that characteristic (e.g. White British applicants or applicants from other minority ethnic groups). Naturally, in court/tribunal any claimant would also need to demonstrate that they have suffered the disadvantage in question. Crucially, the final step would be to establish that the said provision(s), criteria/criterion or practice(s) cannot be justified objectively.

There is no question that some on-going practices in terms of selection to clinical psychology training may disadvantage BME applicants as a group (or some sections of it).  For example, there are strict restrictions on the degree class applicants must achieve to be eligible to apply for training so that those with a 2.2 or low 2.1 are not generally considered. It has been argued that although distinguishing between applicants of similar aptitudes may challenge the fairness of the recruitment process at interview stage, at earlier stages of the shortlisting process the reliability of recruitment methods may be more robust. Others have attempted to justify the minimum criterion of the a 2.1 standard on the basis that clinical psychology training entails the undertaking of academically demanding studies and the completion of a doctorate degree. These arguments do appear to have face validity.

Nevertheless, as far as is known, there is currently no published empirical study or statistical information to support the predictive validity of such criteria in terms of both training and practice outcomes once qualified. Yet, there is a strong and growing body of evidence documenting real disparities in degree classification attained between different ethnic (and socio-demographic) groups with some groups of BME students considerably less likely to obtain first class and upper second class degrees, ‘the attainment gap’. Consequently, it is highly likely that the academic criteria described above would indirectly discriminate against some BME groups. Could such potential discrimination be held legitimate?

Minimum criteria may indeed need to be set to manage the vast number of applications however, in relation to the responsibilities imposed by The Act; one wonders whether this practical consideration may objectively pass the proportionality test.  Further, although there is no doubt that recruiting applicants who are able to sustain the demands of training and become competent clinical psychologists would constitute a legitimate aim, some difficulties may be encountered if we cannot objectively demonstrate that a real difference in terms of abilities to complete training and to fulfil the role of a Clinical Psychologist exists between applicants who may have achieved a 2.1 and applicants with a 2.2, and/or between those who have achieved a low 2.1 and those who achieved mid 2.1; particularly as class differences between degree attainments can depend on less than one percent difference.

For these criteria to be deemed essential and for the objectivity test to be met in court/tribunal, a real rather than a perceived difference may need to be established. Differences amongst courses in terms of academic entry requirements, (although those have reduced notably over the years), may further problematise the reported objectivity or necessity of these criteria and the defence that they help to maintain academic standards. Entry tests for all candidates who meet the “minimum” entry criteria are increasingly being used as part of the selection process.  These tests do have the potential to reduce the risk of indirectly discriminating against some groups of applicants provided that they have robust validity and reliability. Further, they may only be justified legally if they possess sound psychometric properties with scores clearly related to subsequent performance on a training programme, and indeed more problematically, once qualified, to work performance (naturally criteria used to select who is invited to sit such tests also need to be justified…)

Some research suggests that in comparison to their White counterparts; BME applicants are less likely to meet the ‘relevant experience’ criteria.  Additional evidence suggests that BME applicants may be less likely to have held Assistant Psychologist or Research Assistant posts, yet, it seems relatively common for such experience to be deemed ‘more relevant’ on the premise that it will give potential applicants more realistic views of the demands of clinical psychology training. This may be an interpretation of the competency-based assessment, which requires applicants to demonstrate developmental “readiness”. It is proposed that the same reasoning in terms of indirect discrimination could be applied to this practice/criteria whether formally or informally applied and; that it may fall foul of the Equality Act (2010), unless of course it can be objectively justified as a genuine requirement to perform the clinical psychologist role.  Again, inconsistencies across courses as to what experiences may be deemed more valuable/acceptable and the fact that there is yet no evidence suggesting that applicants who have held more ‘traditional’ roles fare better in training and in employment may also indicate that such criteria is not essential and thus that scoring those who can demonstrate it higher/or not shortlisting those who do not meet it, may be unjustified.

Conclusion

The validity and reliability of assessment methods is a serious challenge that the profession faces, not only in relation to selection, but also in terms of course assessment procedures.  Although arguably the latter may be less problematic as long as assessment tasks are properly mapped to the HCPC Standards of Proficiency, the legal framework for registering as a clinical psychologist, the influence of racial bias and indeed indirect discrimination may present real risks here too. To help establish that current practices are ‘justified’ it may be helpful for the Clearing House to systematically monitor applicants’ prior experiences in relation to ethnicity and ‘race’ (and other protected characteristics), for courses to document training outcomes in relation to degree classifications and prior experiences and, for the psychometric properties of entry tests to be established unequivocally. That there is currently limited data on which to base meaningful national analyses may well increase the risk of successful claims for indirect discrimination.

DISCLAIMER

This piece presents a lay person‘s reasoning and perspective. I am NOT legally qualified and do not intend the present article to constitute legal advice.

Acknowledgement

Simply to acknowledge the late Professor Malcolm Adams for his comments and support in writing the article which inspired this post.

Thank you for reading.

If you have found this article useful or interesting, please spread the word.

All work published on Race Reflections is the intellectual property of its writers. Please do not reproduce, republish or repost any content from this site without express written permission from Race Reflections.  If you wish to repost this article, please see the contact section for further details.