Presentation at Minorities in Clinical Psychology Training Conference Birmingham 6th May 2014 Slide preparation was supported by Celia Smith assistant psychologist. An article written by her about this subject will be appearing in Clinical Psychology Forum in the near future.

1. Racism, Psychology and Diversity:
Progress and Prospects
Richard Pemberton
Chair, Division of Clinical Psychology
dcpukchair@gmail.com
@socratext

2. The National Picture Progress and Prospects
The mantra amongst NHS managers for 2014
2
is lets not waste a good crisis.
The current pressures and sea of changes
provide us with a real opportunity to modernise
and collectively raise our game.

3. Introduction:
The profession in
‘crisis’
• Is diversity a significant
part of the crisis?
• How much of a problem
do we have?
• What are we doing that
makes a difference?

4. Who are we talking about today?
• This talk is primarily concerned with issues of race, ethnicity and culture.
• The term ‘ethnic minority’ refers to people, when it comes to ethnic monitoring categories, would
tick a box that isn’t ‘white’. It includes dual heritage ethnic minorities but excludes white ethnic
minorities.
• Black and Minority Ethnic (BME) groups tend not have dominance in society in terms of
demography or culture (shared practices, beliefs, values).
Race, ethnicity
and culture:
what does
BME mean?
Other minority
groups &
Intersectionality
• In UK society, minority groups include people who are disabled, whose sexual orientation is
homosexual/bisexual, and people who identify as female. In Clinical Psychology, it is actually
people who identify as male who are the minority group (despite the majority role they play in
society).
• Focusing on BME groups is not to disregard intersectionality. The interplay of ethnicity, class
and gender often result in multiple dimensions of disadvantages for individuals from minority
groups.
• By focusing on the underrepresentation of ethnic minorities in clinical psychology, the intention is
not to deny the importance of other types of discrimination.

5. National context
KEY STATISTICS
• 1 in 8 people throughout England’s population are from a Black or Minority Ethnic (BME) group
(11.7%).
• 1 in 6 are from a BME group within the NHS workforce (14%).
• In London, 45% of the population and 41% of NHS staff are from BME groups.
• The number of BME appointments to NHS trust boards dropped from a high of 8.7% in 2006 to just
5.8% in 2013.
CURRENT DEBATES
• BME representation in NHS leadership (the ‘Snowy Peaks’)
• Discrimination against BME staff in the NHS workforce generally (especially regarding pay and
promotion)
• Impact of discrimination against BME individuals on staff morale & service user care
SOURCES:
• 2011 Census (27 March 2011), Population Estimates for the United Kingdom. Office for National Statistics
• NHS Institute for Innovation and Improvement. Building capability, breaking through: frequently asked questions
• 15 May 2011 Release: Population Estimates by Ethnic Group (experimental), Mid-2009. Office for National Statistics
• Kline, R (2013), Discrimination by Appointment: How black and minority ethnic applicants are disadvantaged in NHS staff recruitment. Public World.

6. 1. Data on mental health
and people from BME
groups
• 23% of service users receiving
mental health services are from
BME groups – and these are just
the individuals that are known to
services.
• Sectioning/Detention rates are 6%
lower than average among people
who are white British, and between
19% and 32% higher than
average among people who are
black Caribbean, black African,
‘other black’ or who have dual
heritage.
• Length of stay is longest for
people who have black African
or black Caribbean heritage, e.g.
a median length of stay for a man
who is black Caribbean is 345
days, versus 161 days for a man
who is white British.
2. Data on BME
qualified Clinical
Psychologists vs. other
professions
• In the medical profession,
60.6% of specialty doctors
in England are from BME
groups, as are 58% of
senior house officers and
32.9% of consultant
doctors.
• In non-medical health
professions, 22.6% of
pharmacists are from BME
groups, as are 20.5% of
orthoptics and 13.6% of
social service workers.
• As of 2013, there are
9.6% qualified clinical
psychologists in England
from BME groups (up
only 2.4% from the last
count in 2004).
3. Data on BME
applicants and
acceptances to clinical
psychology doctorate
• Whilst the BME
application rate for
clinical psychology is
the highest it has ever
been (growing
incrementally over the
last 7 years from 12%
to 17%), the
acceptance rate for
clinical psychologists
from BME backgrounds
has remained largely
low and static
(fluctuating back and
forth between 7-11%).
SOURCE: CQC Census [2010: Count Me In] SOURCE: Leeds Clearing House Equal
Opportunities Data [2005-2013, available online]
SOURCE: Health and Social Care Information Centre [2002-
2013: Hospital and Community Health Services (HCHS): Non-
Medical and Medical staff by grade and ethnic group category]

7. Literature: Barriers to entering the
profession
• Uncertain route into the profession – huge gap between completing undergraduate and
being accepted to doctorate
• (Initial) low pay
• Community’s perception that it is relatively low status compared with other professions,
e.g. Medicine
• The profession’s ‘whiteness’.
SOURCES:
• Goodbody, L (2009) A critical analysis of the personal and professional development of majority and minority group clinical psychologists: Power, difference and identities.
Canterbury Christ Church University.
• Shah, S (2010), The Experience of Being a Trainee Clinical Psychologist from a Black and Minority Ethnic Group: A Qualitative Study. University of Hertfordshire

8. Literature: Experience as a trainee
clinical psychologist
• Covert/overt racism, including:
SOURCES:
• Shah, S (2010), The Experience of Being a Trainee Clinical Psychologist from a Black and Minority Ethnic Group: A Qualitative Study. University of Hertfordshire.
• Rajan, L., & Shaw, S.K. (2008). ‘I can only speak for myself’: Some voices from black and minority ethnic clinical psychology trainees. Clinical Psychology Forum, 190, 11–16.
• Adetimole, F., Afuape, T., & Vara, V. (2005). The impact of racism on the experience of training on a clinical psychology course: Reflections from three black trainees. Clinical
Psychology Forum, 48, 11–15.
• Hird, J. S., Tao, K. W., & Gloria, A. M. (2006). Examining Supervisors' Multicultural Competence in Racially Similar and Different Supervision Dyads. The Clinical Supervisor, 23(2),
107-122.
- Occupational stereotyping (e.g. being mistaken for a nurse)
- Witnessing other professionals be prejudiced towards service user and noticing that
senior psychologists fail to advocate for the service user or BME trainee when this happens
• Supervision – supervisors avoid or resist discussions relating to ethnicity/culture
• ‘Internalised racial oppression’ – lack of external support pushes trainee’s concerns over inequality inwards,
where they are at risk of absorbing values/beliefs of dominant culture and therefore come to believe some of
stereotypes about own minority culture - can lead to low self-esteem, self-hate, and the disowning of one’s
ethnic heritage
• Eurocentric nature of course – clinical psychology doctorate assumes western cultural practices, values and
norms - trainees are consequently exposed to the double-bind of either being alienated by the institutions if they
reject these Eurocentric models, or being alienated from their own experiences and communities if they accept
them.

9. Learning from other psychological
professions
• Call for evidence: we sorely need evidence
of best practice regarding methods of
improving racial and ethnic equality in other
psychological professions.
• Learning from psychotherapy: one
example of a different psychological
professions’ practice of BME engagement is
that of the psychotherapeutic profession’s
use of ‘Thinking Spaces’:
 Started at the Tavistock and Portman NHS
Foundation Trust by psychoanalytic
psychotherapist Frank Lowe as a means of
exploring issues of race, ethnicity and culture.
 The forums constitute a ‘container for
thought’ – a ‘mental space’ in which the
participants can learn and develop.
“When such huge issues are swirling around, it can
be difficult to think in the consulting room. These are
topics that are most easily evaded than engaged with.
But in Thinking Spaces the engagement is
undertaken.”
– FRANK LOWE
SOURCE: Lowe, Franke (2013), Thinking Space: Promoting Thinking About Race, Culture and Diversity in Psychotherapy and Beyond. Karnac Books.

10. Recommendations for widening
re1.p SUrPeERVsISeIONntation
Placement supervisors should receive training
specifically on the importance of raising BME issues in
supervision. This is to ensure that supervision becomes
a space where individuals can talk openly, feeling
understood when discussing BME subject matter rather
than dismissed.
2. STRUCTURED SUPPORT FOR
UNDERGRADUATES:
Undergraduate BME psychology students should receive
greater structured advice, support and mentoring
regarding the process of becoming a clinical
psychologist.
3. ROLE MODELS FOR UNDERGRADUATES AND
POSTGRADUATES
Aspiring BME psychologists at both undergraduate and
postgraduate level should be exposed to positive role
models from current successful BME psychologists in
the NHS.
4. MINORITY PEER SUPPORT NETWORKS
Minority peer support networks, such as CPBAN (black
and Asian clinical psychology network), should receive
promotion and support from the central professional
‘container for thought’ to discuss issues of ethnicity and
culture that are considered ‘too huge’ for consulting
room.

11. Next Steps?
Richard Pemberton
Chair, Division of Clinical Psychology
dcpukchair@gmail.com
@socratex