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”