News & Reflections

Reflections on the ISPS 2018 Annual Conference: Psychosis and Institutional Racism



Reflections on the ISPS 2018 Annual Conference: Psychosis and Institutional Racism

by Cassie Addai

Whether your relationship to psychosis is professional or personal, it is likely that the over-representation of people from Black, Asian and Minority Ethnicity communities is something that you will have noticed. It may be something you have observed in psychiatric wards or in psychology services or you may be a Black, Asian or Minority Ethnicity service-user who has unfortunately experienced racist discrimination through your journey of accessing mental health services. Despite both empirical and experiential evidence to highlight how institutional racism occurs and affects both service-users and professionals in psychosis services, it is something we often struggle to discuss openly. Therefore the topic of psychosis and institutional racism has, perhaps quite rightly, earned the label of ‘the elephant in the room’ as an area that many are hesitant to acknowledge, despite its existence being so apparent. That the ISPS chose to explore this topic in 2018 is quite apt, given that just six months prior to the conference, the Interim Report on the Independent Review of the Mental Health Act (MHA) was released, sparking much debate. One of the major critiques of the MHA has been its failure to account for the variation in its use between different ethnic groups, leading to disproportionate negative effects for people from Black, Asian, Minority Ethnicity communities, and the failure to acknowledge institutional racism within mental health services.

This silence around the systematic discrimination towards Black, Asian and Minority Ethnicity individuals who experience psychosis is something that ISPS was keen to explore. When I first began planning the organisation of the conference along with Jessica Pons, Kawthar Ali and Akiko Hart, our aim was to provide a space for service-users, carers and professionals to start tackling the ‘elephant in the room’ together and open up discussion in a safe and productive way. Those hopes of safety and productivity were crucial given that lived experiences of racism and psychosis, and simply talking about them can elicit, very valid and understandable, emotional responses. As organisers, we also recognised that it would be easy to spend the whole conference ‘complaining’ about the issues, without exploring possible ideas towards resolution. A key aim was to attend to the emotion of the topic, whilst enabling potentially challenging conversations and respecting the views of all attendees.

In order to achieve these aims we arranged a schedule of speakers who we felt would share thought-provoking ideas and engage the conference attendees. First to speak was Suman Fernando, a retired psychiatrist with an extensive career of writing and speaking about institutional racism in psychiatry and psychology services. Suman’s session began with an example from his clinical practice of the power of stereotypes in shaping our preconceptions, particularly problematic is the stereotyping of Black men as “big, black and dangerous”. Suman argued that this stereotyping affects both Black and white psychiatrists and combined with a long history of “othering” individuals, who are perceived as different, this contributes to institutional racism within mental health services. Drawing on empirical evidence, Suman highlighted patterns of inequality negatively affecting Black communities including stop-and-searches, psychiatric sectioning, diagnosis of psychosis, imprisonment, school exclusion and estimation of dangerousness. The stimulating first session ended with a call to address the issue of institutional racism through changing the Eurocentric curriculums of psychiatry and psychology and improving legal safeguards, such as the MHA. Hearing Suman speak, I was personally struck by his ability to provide such a comprehensive history of racism within the psy-disciplines in just 25 minutes, whilst also exploring ideas as to how the professions might move forward.

Another hope in organising the presentation was that it would not be a line-up of only Black, Asian and Minority Ethnicity speakers addressing an audience of mainly white attendees, feeding into the assumption that institutional racism is a problem to which Black, Asian and Minority Ethnicity people must find the solutions. Alison Faulkner, a mental health survivor researcher, began her presentation by acknowledging the awkwardness of being a white woman sharing her reflections on racism. This theme of reflection ran throughout her session as she described how her early research with Black service-users, whilst well-meaning had not always been well-executed. Alison described her learning journey since then and a subsequent shift towards not just including Black service-users in research, but truly valuing their perspectives in producing knowledge. Central to this journey have been her relationships with Colin King and Jayasree Kalathil who critiqued the homogeneity of survivor research and its tendency to exclude service-users from diverse backgrounds. Alison acknowledged the privilege associated with whiteness and how attempts to decentre this can lead to discomfort, avoidance and silence. She implored others to join her on a journey of utilising their white privilege in order to overtly challenge racism, rather than leaving Black individuals to shoulder this responsibility alone.

Next to speak was Colin King whose session was in equal parts engaging and informative. What struck me most was that Colin shared with the audience insights from his varied experiences as a mental health service-user, through to training and working as social worker, then his involvement in activism. I was particularly interested in his reflections regarding working in mental health as a Black practitioner and questioning whether this is a form of necessary survival or a means of selling out to the institutions whose very practices disproportionately affect Black communities. This is a question that I myself often ponder as a Black woman training to becoming a clinical psychologist and thus I was grateful to Colin for openly exploring his experiences on both sides of the system.

Following Colin’s presentation, there was an opportunity to reflect on our tables, in small groups with the people sat around us. This provided much-needed time to begin processing the morning’s proceedings, which my table had found to be both powerful and challenging at times. This idea of small round-table discussions was something that we, as organisers, were keen to include in the conference schedule as we could each relate to experiences of attending conferences where so much rich material is shared, which can become overwhelming without time and space to try and engage with it.

The lunch break provided time to explore the book stall, which was filled with ISPS titles and publications written by the speakers. Following lunch, Jessica and I joined Sonya Chee, Anam Elahi, Unwana Etteh, Paulette Villiers and Jennifer Nicholas, to form a panel of early-career speakers. The panel was expertly chaired by Rai Waddingham and we each delivered a five minute pitch. When Akiko first mentioned the idea of speaking as a panellist, I was uncertain that I would have anything valuable to offer but after reflecting on my experiences within mental health services as a Black professional, I soon realised I did have insights to share. Whilst I have attended many conferences to further my professional development, this panel formed exclusively of women of colour sharing their professional and personal experiences in research, psychiatry, psychology, social work and nursing, was unique. Although a nerve-wracking experience at the time, I am grateful to have been involved in the panel.

Hari Sewell ended the conference with an enlightening session, which summarised ideas from earlier speakers as well as providing new thoughts. He began by recognising how the continued presence of institutional racism in mental health services can lead to a sense of feeling stuck. Hari detailed fundamental flaws in psychiatry and psychology, including unconscious bias and implicit associations, which form the basis of institutional racism. One of solutions often cited in response to these flaws is to promote a more racially diverse workforce, to which Hari responded “a Black carpenter using a blunt saw will still splinter the wood”.  He went on to argue that Black professionals using the models and frameworks of existing mental health services can perpetuate problematic and racist practices. Again, this point had particular poignancy for me, given my professional role. The day ended with Hari’s call to action, which encouraged attendees to think about what we will do differently in the quest for anti-racist practice and how we can move towards activism, rather than complicity in institutionally racist services.

If I had to describe how I felt at the end of the conference, I would say enriched (and somewhat exhausted!). It was enriching to see months of organisation come into fruition on the day, to share the stage with six inspirational women as part of the panel and also to benefit from the wisdom of the speakers. It was also enriching that this complex and challenging topic was met with so much interest from attendees, such that all the tickets sold out and attendees appeared engaged in the presentations and discussion throughout the day. Following the conference, I have had the opportunity to reflect on feedback from attendees, which has been overwhelming positive. Some anonymous quotes are shared below –

People reported that they were motivated to attend the conference because of the following –

  • “An interest in the ways in which institutional racism impacts peoples lives in mental health services”
  • “Concerns from what I was seeing happening on psychiatric units and over-medicated black friends”
  • “Knowledge and to gain a new perspective from a factual stand point.”
  • “Interest in how ISPS would tackle this important set of issues”
  • “Interest in learning and understanding more about white privilege and racism. To take this back to the conversations I have daily at work and home and every where.”
  • “Although we’ve been aware of institutional racism within MH systems, we’ve never really spoken about it “out loud” or ever had a safe space where we felt able to do so without fear of being gaslighted. I thought this was a great opportunity to open up such a discussion and to bring together our vast experiences and I wanted to be a part of that.”
  • “I wanted to have the opportunity to think about how to work within the NHS to combat institutional racism for those working in the system and the BAME clients who try to access services.”

In terms of things that worked well, people said –

  • “The delivery and approach were excellent, the non judgemental atmosphere from both speakers and listeners! The combination of such taboo topics we’re perfectly blended!”
  • “Range and quality of speakers; atmosphere of honesty trust and openness; critical and reflective voices”
  • “The presentations were great an speakers were all very moving, I really liked the smaller group conversations to give everyone space to think about the issues being raised.”
  • “The round tables. The panel. The mix of youth and experience. The blend of different approaches/people from different areas/experiences.”
  • “The panel of young people and the finale by Hari at the end stood out to inspire attendees at a crucial time when there are attempt being made in ‘official’ circles (e.g. at discussions on Review of MHAct) to play down ‘race’ issues and yet again hide them behind ‘culture’ and ‘diversity’.”
  • “It was a fantastic event and the structure of the day was well-thought out. I thought it was such a great idea to sell books during the course of the day too which is something I’ve never really come across at a conference before. I really enjoyed the panel discussion too! It felt particularly validating to hear other people say they have been through the same things I have without someone trying to dismiss the experience.”

Attendees also shared ideas on how the day could have been improved –

  • “Possibly had more male speakers as it was a dominated female panel! Which would blind the perspective of racism injustices. More male perspective would of been eye opening too.”
  • “More time for discussion. More to take away, eg further reading, lists of organisations etc”
  • “It was interesting that my recollection of the day is that there was very little discussion about psychosis. Much more about staffs experience of institutional racism. I don’t necessarily think this was a bad thing but it is interesting that this happened. I wonder if more alternatives and best practice could be explored. My other reflection was that if the system is racist and psychosis is a social construct, why are people still wanting to join or remain in such a system?”
  • “It was quite intimidating to speak out to the large group and if there were some icebreaking exercises/getting to know you type intros, this might have been easier for most people.”
  • “Maybe bringing examples of how people have worked in services to attempt to address this issue. If there have been successful projects and how they addressed any barriers they were faced with.”

People shared that attending the conference left them with –

  • “The event was incredibly inspiring. There are times when it feels like there’s no point in continuing down the career path I have chosen as it doesn’t feel like the system will change soon but I realise now that each of us is the change. Coming together and hearing other professionals speak about successful careers despite the abuse they’ve faced was particularly inspiring as it not only validated my own experiences but also gave me hope. I’ll definitely go away and continue to be a voice for PoC, particularly marginalised groups, in academia whose experiences are rarely captured by research.”
  • “More awareness and hope”
  • “A responsibility to have sometimes difficult conversations about racism and rather than worry too much about ‘saying the right thing’ to be honest about my own experiences and listen with curiosity to the experience of others.”
  • “Better consciousness of white privilege; hope for the future from the amazing young all women panel”
  • “Personally I took away that I feel less alone with the challenges of being a woman of colour. It felt validating to hear other who have shared experiences.  Professionally I got a lot from the presentations in relations to my clinical work and learning.”
  • “Overall an energy and confidence to challenge more and to ask more questions. To focus on people as individuals and get to know them, day to day. Whilst not forgetting and discussing the social and political factors that lead to people being discriminated against.”
  • “A real sense of needing to think about the privileges of whiteness and the different ways in which groups who lack privilege and power may be disadvantaged”

Alison Summers- an appreciation

Alison Summers and Alf Gillham stepped down from the ISPS UK Committee at the November AGM. We would like to thank both of them for their work, dedication and passion over the years. Whilst they have left the Committee, we very much hope they will stay on within the broader ISPS UK ‘family’.

Here, Bill McGowan, ISPS UK Committee member, shares some thoughts about Alison:

‘I first met Alison when I joined the ISPS UK Committee in 2008. She was then acting chair as the group were in a transition period recovering from a series of set backs. This proved to be a prolonged and difficult period for the group and there was a palpable air of demoralisation around.

Alison kept the helm, contained the group and ensured that the business was done and a good standard of service provided to its members was maintained. When a further crisis hit the group, we looked to her and she graciously agreed to formally become chairperson. From that point on Alison worked progressively to encourage and strengthen the resolve of the group to move on and she worked assiduously to consult and find a way of harnessing the varied talents of the group members. Her intuitive and humanitarian impulses played a large part in enabling her to get the best out of the group particularly during the difficult periods.

Alison recruited new members to supplement the then existing expertise pool within the committee and facilitated the development of an appropriate organisational structure underpinned by a values framework, with aims and goals and work streams to match. These developments proved to be transformative and engendered a sense of optimism and a renewed sense of direction for the group. It moved us from the historical position of running a charity to being responsible for delivering a service dedicated to bringing about change in the field of psychosis.

When I was asked to write a few paragraphs about Alison’s contribution to the ISPS UK Committee, I baulked at the thought of trying to squeeze someone like Alison into such a tight space. If you are left feeling that there must be something more to be said, you are right, in which case, go to the Autumn  Edition of the ISPS International Newsletter 2018 and read Brian Martindale’s erudite account of his experience of working with Alison and Alf Gillham’s more personal account.

We are grateful to Alison for her steadfast commitment during her period with the ISPS UK Committee and for the legacy which she has left for Akiko to build upon. On behalf of the committee I wish to thank her most sincerely for her almost effortless inspirational leadership. We will miss you but wish you well with your next set of challenges!’

Bill McGowan

ISPS UK Committee Member

Free resource on healing psychological trauma

A new, free-to-use guide to the healing of psychological trauma is available to download. It comprises information, approaches to healing and resources together with links to selected clinicians, organisations, projects and support groups. It is designed to make a useful contribution within the developing field of trauma-informed services to the training and support of staff across a range of institutions whose work can be impacted by trauma, and via self-help material, to trauma sufferers themselves.

It is the outcome of a collaborative research project coordinated by Ann Jordan (educator, social justice campaigner and researcher) which aims to address some of the failings of current treatments of psychological trauma. Various members of ISPS have offered advice and guidance, and the resource is very much seen as one of the ways in which the 2017 Liverpool conference can be taken forward.

“It offers some viable alternatives to the predominantly biomedical model,” explains Ann. “The focus is on actual healing v. treatment. This compilation is not prescriptive or exhaustive; there is plenty of scope for development and further research findings will be incorporated.”

You can download the pdf here: Healing Psychological Trauma.

Advanced Studies Seminar: ‘Surviving student life as a voice-hearer’

The Educational Voice-hearing Network’s next Advanced Studies Seminar will take place on Wednesday 28th November (10 am – 4 pm) at St Catherine’s College, Oxford University. The title of this seminar is ‘Surviving student life as a voice-hearer’. You can book your free place here.

Psychosis & Institutional Racism- ISPS UK Conference and AGM

Institutional racism is sometimes viewed as the elephant in the room in mental health and psychosis. We know that people from racialised minorities are more likely to be diagnosed with schizophrenia, more likely to be subject to the Mental Health Act, and more likely to be restrained or be under a Community Treatment Order. And yet- it seems to many working or campaigning in the field that we have failed to address these issues, and that too little has changed over the past few decades.

How do start talking about and addressing institutional racism, when so often it can feel invisible or taboo? How does institutional racism affect people who use services, but also family members and carers, and professionals (psychiatrists, psychologists, nurses, OTs, HCAs etc) who deliver services? What are the barriers which stop us talking about it – and how do we address what we struggle to recognise?

This day will encourage discussion & reflection on how institutional racism plays out in the field of psychosis, from multiple perspectives. We will reflect on how we can name it, and how, together, we can start to find ways of addressing it.

Book your ticket here


Dr Suman Fernando, Honorary Professor, Faculty of Social Sciences and Humanities, London Metropolitan University and former (retired) consultant psychiatris

Dr Philip Thomas and Dr Alison Faulkner on the Privilege, Partiality and Power of Whiteness

Sara Haq on Complex Subjectivities and Survival Strategies for Collective/Cultural Psychosis

Dr Colin King

Other speakers tbc

Followed by ISPS UK AGM, 17.00-17.30

All are welcome to attend

Details of the day:

Coffee and lunch will be provided. Please contact us if you have any questions about the day or access.

£10 for ISPS UK members, £30 full price, £10 concessions.

Book your ticket here.


NEW ISPS book: CBT for Psychosis, Process-orientated Therapies and the Third Wave

A new ISPS book has been published: CBT for Psychosis, Process-orientated Therapies and the Third Wave, edited by Caroline Cupitt.

Cognitive Behaviour Therapy (CBT) for psychosis is constantly changing and evolving. Recently, in what is sometimes called the ‘third wave’, therapy has become more concerned with the individual’s relationship to their experience, rather than with the content of it. This more process–orientated approach appears to tap into universal psychological processes. The aim is to reduce distress by changing the function of the experience, rather than necessarily the experience itself. Written by some of the leading figures from around the world, CBT for Psychosis: Process-Orientated Therapies and the Third Wave brings the reader the latest developments in the field.

Presented in three parts, CBT for Psychosis first explores theoretical perspectives on recent developments in cognitive behavioural therapies. Part two examines specific therapeutic approaches, including metacognitive training, mindfulness, acceptance and commitment therapy, compassion focused therapy and the method of levels. Finally, part three presents two critical perspectives: the first offering a reflection on the experience of receiving CBT, and the second looking ahead to possible future developments.

Offering a cutting-edge collection of theoretical, therapeutic and critical perspectives, CBT for Psychosis: Process-Orientated Therapies and the Third Wave will be of great interest to clinical and counselling psychologists, both practising and in training, as well as psychiatrists, nurse therapists, occupational therapists and other healthcare professionals working with people experiencing psychosis.

You can buy it at a discounted price here. If you are interested in reviewing it, please contact us.

ISPS Book Series: Series Editor Vacancy

We are looking for a new honorary co-editor for the ISPS book series, published with Routledge, to help continue to expand and develop this important strand of ISPS’s work. There are now over twenty books published in the series, further books commissioned, and a number of proposals under consideration.
The opportunity has arisen as one of our two co-editors, Alison Summers, will soon retire. The person appointed now will work in partnership with the second current co-editor, Anna Lavis. The book series co-editors work alongside a separate editorial advisor for the academic monograph series, currently Andrew Moskowitz. We also have the invaluable support of an editorial board, with members drawn from a variety of disciplines and perspectives.
We are seeking someone with a good understanding of the ethos of ISPS, whose interest in psychological and social aspects of psychosis is relatively broad and who has experience of writing on these topics. The co-editor needs to be able to respond to submitted manuscripts within a short time frame, and to deal with email communications promptly.
For further information, or to express interest in the role, please contact Anna Lavis and Alison Summers. To express an interest, please send a letter outlining why you would be interested in the role and the strengths that you would bring to it, alongside a curriculum vitae, by 31st August 2018.
Person Spec:
  • A commitment to ISPS’s aims and willingness to become a member of ISPS;
  • Knowledge of recent developments in the treatment of, and/or academic research into, psychosis;
  • The ability to write clearly and lucidly on mental health topics;
  • Written and spoken English to the standard of a native speaker;
  • Excellent communication skills;
  • Previous experience of publishing, editing or peer reviewing.
Role Outline:
Series editing tasks shared with co-editor include:
  • Identifying topics for new books; approaching potential editors/authors; responding to unsolicited suggestions
  • Giving feedback on draft proposals, book chapters and manuscripts.
  • Liaising with authors over the progress of work and answering author queries promptly
  • Liaising with Routledge re proposals, sales, finances, contracts
  • Liaising with co-editor, and with the ISPS International Organiser Antonia Svensson, who provides a few hours’ support per month to the series editors. In addition to email, currently we are meeting by Skype, approximately quarterly
  • Reporting to the ISPS International Executive Committee
  • Liaising with the editorial board
Time Commitment:
Variable; average commitment perhaps two days per month.
None. Series editors receive up to £300 per annum expenses, and three copies of each book that comes out during their editorship. They have recently also been offered a free place at the ISPS international conference.

Update on the Young Voices Study at Manchester Metropolitan University

Manchester Metropolitan University Young Voices Study is just coming to the end of the pilot phase, during which the researchers wanted to gain a better understanding from young people about their experiences of hearing voices, as well as hearing from parents/carers. Through interviews and an online survey, they heard from over 100 young people and parents about varied experiences of voice hearing, additional sensory experiences that accompany voices, difficulties accessing tailored help for young people under 14 years old and many accounts of creative avenues that help young people cope (e.g. music, running, writing). They have a new PhD student joining the study in September to explore multiple sensory experiences with young people and are currently seeking funding to establish some support groups in the Northwest.

For more information on the study, including links on how to take part, please click here.


‘Compassion & Compulsion’: ISPS UK event in Preston on 31st July

‘Compassion & Compulsion: exploring the tensions faced by service users & clinicians when people experience psychosis.’

Come and join us at an ISPS UK event in Preston, Lancashire, on the 31st July, from 18.00 to 20.00. FREE for ISPS members, tickets £6 or £4 (low waged). You can book your ticket here.

Professor David Pilgrim from Liverpool University will do a presentation about the issues faced by mental health services when using coercion. Jen Kilyon and Neil Caton, both ISPS UK Committee Members, will then give a response to the paper after which we will open up to questions and comments from the audience.

David Pilgrim is Honorary Professor of Health and Social Care, University of Liverpool and Visiting Professor of Clinical Psychology, University of Southampton. He has published extensively in the field of mental health policy.

Jen Kilyon campaigns for genuine informed choice in mental health care where those who need it can be in a safe place that is right for them. She promotes respectful non-judgemental and family/network inclusive approaches to psychosis such as Open Dialogue. Jen is an ISPS UK and Soteria Network Trustee and helped to set up the first Soteria House in the UK.

Neil Caton has lived experience of psychosis and has several experiences of being admitted to psychiatric unit, one of which was compulsory. He will explore his experience of these admissions. Neil has worked as an involvement worker for the early intervention service. He has been an ISPS UK trustee for 5 years and runs a hearing voices and paranoia group in Chorley.

Book Review of ‘A Kind of Mirraculas Paradise: a True Story of Schizophrenia’ by Sandra Allen

Review by Jessica Pons, ISPS UK member

Her family cast Uncle Bob as a drug abusing, ‘crazy’ misfit. After reading his life story (after he hounds her to try and get it published), Sandra questions this stereotype she’s learnt to accept and begins a journey of getting to know her uncle for herself.

Through reading his diaries and talking to him about his memories, it becomes apparent his stories are not the ‘delusions’ they initially appeared. At times Bob questions the validity of his diagnosis. I particularly like the way he talks about his medication: sometimes he wants to take it, whereas other times he’s not keen. Sandra allows Bob’s story to flow without neatly fitting into one model of thought around what it means to be diagnosed with schizophrenia.

Sandra shows a burgeoning critical mental health gaze. She begins to see past the lens of his diagnosis and through putting together his story, her beliefs regarding schizophrenia are challenged. She becomes more comfortable with having more questions than answers, more grey than black and white. This uncertainty is representative, I think, of where we’re up to when thinking about sensory experiences and strong beliefs.

A book that shows the vagaries of time and truth, I think Sandra Allen does her Uncle Bob justice in this version of his autobiography. Sandra tries to stay as close as possible to her uncle’s narrative. I think she gets the balance right between allowing the book to tie together, and allowing her uncle’s creativity and voice to come through.