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Guest Blog: Structural Racism: A call to action in the NHS

Saiqa Naz: CBT Therapist, Sheffield Specialist Psychotherapy Service, Co-author IAPT BAME Positive Practice Guide, & Chair, BABCP Equality and Culture Special Interest Group)

Foreword by Clare Baguley: Programme Manager North West PPN

The NHS Constitution for England states that it the responsibility of all of us working in the NHS to “…contribute towards providing fair and equitable services for all and play your part, wherever possible, in helping to reduce inequalities in experience, access or outcomes between differing groups or sections of society requiring health care.”

In the autumn of 2019, the North West Psychological Professions Network (NWPPN) in collaboration with the British Association for Behavioural & Cognitive Psychotherapies (BABCP) supported the Launch of the BABCP IAPT Positive Practice Guide at the British Muslim Heritage Centre in Manchester.  Led by co-author and CBT Therapist Saiqa Naz, the workshop bought together a rich combination of clinical and lived experience for an immensely positive and energising learning experience.

Since this time COVID-19 has turned the world upside down. Public Health England (PHE) has  thrown a shocking spot light on how our Black, Asian and Minority Ethnic (BAME) colleagues and patients have been disproportionately affected during the pandemic and the parallel emergence of #Blacklivesmatter movement has given fresh impetus to us having an important discussion about structural racism. 

On the 30th May 2020 NHS England and the NHS Confederation confirmed the creation of the NHS Race and Health Observatory, a new centre to investigate the impact of race and ethnicity on people’s health and in her regular COVID-19 bulletin last week, Claire Murdoch (NHS England National Mental Health Director), stated that “the NHS needs to be at the forefront of the fight against inequalities, a commitment embedded by all members of the senior leadership team… that the NHS is part of the problem and of the solution and we stand united to improve our organisation for the benefit of both staff and patients. Now is the time to increase our efforts and work closely with partners to advance health equalities in our sector and across the country”.

This important call to action from NHS Leaders to support our colleagues is one that we must all act on, but if racism or discrimination is not within your own experience it can be difficult to know how to play a constructive part in the movement for change.

We asked Saiqa Naz who is co-author of the IAPT Positive Practice Guide and recently presented a National IAPT webinar on working with BAME communities https://www.babcp.com/Therapists/IAPT-Webinars.aspx to share her thoughts with us in her guest blog below:

 

I hope everyone reading this blog is in the best of health during these challenging times. Things are difficult for so many of us for so many different reasons. Following the launch of the IAPT Positive Practice Guide many people have contacted me to seek advice on how best to respond to issues about racism and structural racism in their work places.

I think it’s fair to say that there is now compelling evidence we all live and operate in systems that are structurally racist which have been disadvantaging communities for years. I’m of the opinion if a system is structurally racist, it will also be disadvantaging all those people who fall under the other protected characteristic of the Equalities Act. So, if we can get it right with racism we can get it right for everyone. When we speak about being complicit in structural racism, it doesn’t mean the people in the system as a whole or as individuals are racist. It refers rather to how a particular action/ inaction contributes to structural racism.We need to get better at differentiating between the two. Either way, racism is a disease and as we are seeing during COVID-19, it can kill people like any other disease.

Whilst we are talking about deaths, unfortunately, we still don’t have any clear data on ethnicity and suicide (https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/suicideratesbyethnicity). I wonder if BAME people are also disproportionately affected by suicide?”

 

If we are serious about addressing racism, we need the following two conditions:

  • Psychological safety- When people come to their therapy sessions, we create an environment to enable them to feel safe to speak about their personal lives. That’s part of our roles, not theirs to do. Similarly, People need to be provided with psychologically safe places to explore and have difficult conversations about racism in general and structural racism. I recently asked my team to hold a reflective space to explore racism and how it affects us. I slept better that night. The culture of the team I work in enables me to bring the whole of me to work. If something is bothering me, I know I can share it and I know I will be supported. I wish all services were like this.
  • White Allies- I think people underestimate how empowering it is to have white allies. Your BAME colleagues and communities are tired from carrying this additional load of structural racism with them everyday alongside the demands of work and life in general. When my manager asked how I felt about my experiences of structural racism, I responded, “Wounded.” It’s hard to carry on and challenge racism or indeed any other forms of discrimination when you’re feeling like this. Having allies means that load is shared between us all and it is easier to manage. It also means BAME people can have some respite, even if it’s just in work.

Access Imperial College London's video "5 tips for being an ally" here.

Being a white ally does not mean you need to understand everything about each community (I certainly don’t). It means you’re recognising that people are wrongly being disadvantaged in society and in our mental health services. Despite feeling anxious about “getting things wrong,” you still take steps to challenge this. If we do make mistakes, it’s okay to apologise and learn from it. We must manage our vulnerabilities as otherwise they can lead to inaction.

Once we have decided to create safe spaces to explore racism and commit to becoming an ally, what can we do?

  • Commit to self-study. Racism feeds off ignorance, so we must educate ourselves as there have been gaps in our training. There is some excellent coverage on Channel 4 News and Sky News at the moment highlighting issues affecting our BAME communities. The Guardian has also printed some insightful articles. Many resources are being shared on Twitter- Webinars, books, TED Talks. People are sharing their experiences of racism also. If anything, you shouldn’t struggle to get access to information. This is also a perfect opportunity to get to know your local communities and learn about them. Be curious and take your time learning.

I understand not all services will support you to hold psychologically safe conversations. This should not deter you from being an ally. If enough of you in the team pull together, your managers will realise lack of inaction is no longer acceptable and the culture of the team needs to change.

  • Reflective meetings- An opportunity for you to hear about colleagues experiences of racism and structural racism. “I’m sorry you’ve had these difficult experiences. It’s not just your responsibility to address these issues. I’m thinking about how I may be able to help. I can speak to… I can do…. I think as a service we should do…Is there anything else you think we could be doing? What would be the best way to support you? How can we make coming to work easier for you?” These are some of the comments that I have recently found helpful. Please don’t wait for others to tell you that you need to do something or what to do. I find reminding people we are all responsible tiring. Take some initiative here and take the lead. We have a lot of work to do together.
  • Support and encourage your BAME colleagues to join your BAME Staff Network Groups in your organisation. Most trusts should have these.
  • Does your trust have a BAME mentoring scheme? If not, please speak to your Directors and ask them to consider setting one up to support your BAME colleagues. I would encourage you to familiarise yourself with the work of the Workforce Race Equalities Standards (WRES) team. https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/.Speak to your organisations Freedom to Speak up Guardian confidentially to raise concerns about racism and other forms of discrimination. I think it’s important to support the development and retention of the BAME workforce. For some people their career development will have been hindered by structural racism. Others may have chosen to leave the psychological therapies profession and the NHS altogether. Having a diverse workforce enables us to have diverse views to be represented. We can’t afford to lose these voices.
  • Join Psychologists for Social Change and encourage your BAME colleagues to also. You can find your nearest group here: http://www.psychchange.org/
  • See what support and information what your trade union offers. They can provide you with support and guidance. Again, encourage your BAME colleagues to also.
  • If you’re a BABCP member, you can join the Equality and Culture Special Interest Group by emailing This email address is being protected from spambots. You need JavaScript enabled to view it.
  • Develop action plans for your services. You can use the toolkit at the back of the IAPT BAME Positive Practice guide. The guide can be found on https://www.babcp.com/Default.aspx
  • You can also find information here from the launch event of the IAPT BAME Positive Practice guide: https://www.nwppn.nhs.uk/index.php/our-work/nw-positive-practice-into-action-launch-event

Sooner or later all eyes will be on mental health services and what they have been doing. We don’t want to be hanging our heads in shame knowing we could have done far more than we are doing now. We must not lose this opportunity to turn around mental health care for BAME communities.

I recently presented a webinar on working with BAME communities for the national IAPT team, which can be accessed here.

You have plenty of information here to get you going and keep you going. You must have confidence in yourselves. Often when people contact me, they’re seeking reassurance. We all know what we do in therapy with reassurance seeking safety behaviours right? That’s what we need to do here. Good luck!

My best wishes to you all,

Saiqa (CBT Therapist, Sheffield Specialist Psychotherapy Service, Co-author IAPT BAME Positive Practice guide, Chair, BABCP Equality and Culture Special Interest Group)

 

More Information about Freedom to Speak up Guardians & Helpline

 

Ensuring and promoting a culture of openness and transparency during the COVID 19 pandemic and beyond

 

"In an organisation that has a strong culture of openness and transparency, leaders are comfortable to listen to staff concerns. High quality care providers understand that staff should feel able to engage through fora for discussion that have been created, and that the concerns shared during these discussions will be understood - this sharing of experience will improve care delivered and create a better working environment for colleagues" - Prerana Issar, NHS Chief People Officer

If I want to speak up about something, what should I do?

Usually your line manager will be your first point of call, but if you don’t feel you can speak up to them, use the other routes set out in your organisation’s Raising Concerns Policy, then you should refer to your local Freedom to Speak Up Guardian who will be able to offer impartial guidance and support to any member of staff.

How do I contact a Freedom to Speak Up Guardian?

Freedom to Speak Up Guardians will make an effort to promote their contact details within their organisation, so you may find details on your intranet page or staff noticeboard but you can also find details of guardians through the Guardian Directory.

Other places that you can find support include: 


‘Speak Up’ helpline:
This is a free, independent and confidential helpline for people working in NHS and Social Care organisations in England, operated by Social Enterprise Direct Limited on behalf of the Department of Health and Social Care.  You can contact them on 08000 724 725 or by completing their contact form.


You can also share information about patient safety concerns and your experiences working in the NHS with the Freedom to Speak Up Team at NHS England and NHS Improvement.  You can email them at This email address is being protected from spambots. You need JavaScript enabled to view it..  Information you share will be treated in confidence


Trust boards in England can use the NHS England and Improvement self review tool to identify areas for development and improve the effectiveness of their leadership and governance arrangements in relation to Freedom to Speak Up. Guidance, additional information, and the tool itself are available here.

 

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