A recent survey by the Royal College of Psychiatrists found that almost six in ten of Black, Asian and minority ethnic respondents had experienced racism in the workplace, affecting either themselves, their colleagues, or patients. Although the sample size was select (689 responses of which 233 were from ethnic minority psychiatrists), the findings are shocking, and align with other research and personal stories that we’ve both heard of in our time working in the health service.
Psychiatrists outlined a range of different personal responses to their experiences of racism in the workplace, including feeling embarrassed and humiliated, intimidated and bullied, and isolated. These incidents had affected their health (over a quarter of ethnic minority respondents said their own health has been impacted), and caused some to even consider leaving their jobs altogether. Those who had seen abuse directed at colleagues found it deeply concerning, and understandably, painful to watch.
However, reporting rates appeared to be low. Of the minority ethnic psychiatrists who had experienced or witnessed racism—only 29% could confirm the case had been reported. This raises questions around people’s confidence in coming forward, as well as whether current reporting mechanisms are effective enough.
These results are uncomfortable, but how can we change things?
As much recent research has found, the drivers of this kind of discrimination in the workplace are complex and deep-rooted. As the body that represents psychiatrists in the UK, and with 39% of members from ethnic minorities, the Royal College of Psychiatrists has a critical role to play in addressing these issues. The RCPsych Equality Action Plan sets out the College’s strategy to address the structural and institutional discrimination that affects the delivery of mental healthcare and career progression and wellbeing of staff.
The Action Plan includes work on an improvement collaborative to support use of the Advancing Mental Health Equalities Resource, developed by the National Collaborating Centre for Mental Health and NHS England and Improvement. The resource provides guidance to improve care for all those with protected characteristics, including people from minority ethnic groups. The Action Plan also supports the use of organisational competency frameworks such as the Patient and Carer Race Equality Framework which drives transformation, with equity in services as the primary goal.
Looking at the results of this survey, for us, three areas of importance spring to mind. Leadership, training and support.
Leaders who take a strong position on discrimination and set up efficient and supportive reporting processes are key to fostering a positive culture within their workplace. They must also ensure they’re gathering and making the best use of related data to be able to understand where issues are and whether solutions are having any real impact.
Training is also incredibly important. Employers in the NHS already run training on equality for their staff, but what is key is ensuring that this training is meaningful, that it focuses on the understanding of discrimination and the prejudice it stems from; how unconscious bias affects decision-making; structural inequality, and the importance of developing practical strategies to avoid the abuse of the power differential in mental health.
Supporting staff is paramount for the NHS, and covid-19 has really brought this to light. To perform at their best, staff must be supported so they feel welcomed and able to talk to their employers and taken seriously. Essentially, healthcare staff must feel valued.
The College is also expanding its work in these three areas, through strengthening its leadership and accountability on equality issues, reviewing the core and higher training curricula, and prioritising workforce wellbeing.
Minority ethnic doctors give much to the NHS. We will be working hard to support them and contribute to fostering a positive and welcoming culture and enhancing staff wellbeing and performance. This work will not only lead to improvements for staff, but ultimately to better outcomes for patients.
Shubulade Smith is Clinical Director of Forensic Services at the South London and Maudsley NHS Foundation Trust and one of the two Presidential Leads for Race and Equality at the Royal College of Psychiatrists. Twitter @DrLadeSmith
Rajesh Mohan is a consultant Rehabilitation Psychiatrist at the South London and Maudsley NHS Foundation Trust, and one of the two Presidential leads for Race and Equality at the Royal College of Psychiatrists. Twitter @raj_psyc
Competing interests: none declared.