#BlackLivesMatter — A psychologically informed reflection…

05.06.2020: This week, as I write this PIE blog, as the Lead for Psychologically Informed Environments (PIE) at the UK national youth homeless charity; Centrepoint, events in the USA have been prominent in my thoughts (c.f. https://www.bbc.co.uk/news/world-us-canada-52915019). The death of an unarmed black man at the hands of the American police has sparked worldwide protests, including here in London, to highlight the injustices that Black, Asian and Minority Ethnic (BAME) individuals’ experience and that #BlackLivesMatter. At this point, I should declare to those that may be reading this but have not met me in real life that I am White British. My background is not especially privileged, having been raised by a single mother in the 1980’s, surviving on welfare benefits and low paid work. However, I have had educational opportunities to further my life chances, and I acknowledge my skin colour does confer privilege or gives me an advantage. This is something that I first really became aware of when I started travelling outside the UK and noticed that I could walk unchallenged into grand hotels that were likely restricted to others (unless they were working there). For example, whilst I have never had the money to stay in such places(!), my skin colour allowed me to enter the roof top bar of a five star hotel in New York or the famous Raffles Hotel in Singapore without challenge.

So why should I write about this issue? What right do I have to speak of the injustices that my BAME clients, colleagues or friends have experienced? Of course, I have none, and I do not pretend to speak on their behalf. However, having thought about this a lot this week, I have reflected that not to speak up and to be silent, or not to kneel alongside my BAME brothers/sisters and walk away, is to be complicit. It is to be a ‘bystander’ when I can see what is happening, rather like the other police standing and watching George Floyd as he was suffocated to death during that ‘restraint’. I have a voice, albeit only a small platform perhaps compared to those in greater positions of power, but one I have a human obligation to utilise to acknowledge the injustices, condemn the violence and press for system and social change.

Moreover, as a psychologist, my role is to consider the emotional and psychological well-being of those around me, and consequently it is entwined with the political. It cannot not be, given that social policy decisions can so dramatically affect individual mental health and well-being. Even prior to these recent events, I had observed the issue of systemic racism and injustice in the UK. Specifically, prior to coming to work for Centrepoint, I spent almost 20 years working in the UK National Health Service (NHS) and the UK Prison & Probation Service (HMPPS), during which time it was clear to see the over-representation of BAME individuals in the criminal justice and mental health system(s). My own observations are also supported by the evidence (e.g. Lammy Review, 2017; https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/643001/lammy-review-final-report.pdf; Thornton, 2020; British Medical Journal & Mental Health Foundation; https://www.mentalhealth.org.uk/a-to-z/b/black-asian-and-minority-ethnic-bame-communities).

However, during this period, I have also had the pleasure of working for and alongside many BAME staff, who have inspired and challenged me throughout my career, in both the NHS and HMPPS, and I now have the pleasure of working with many more amazing BAME staff in Centrepoint. These ‘frontlines’ of late during the COVID-19 pandemic, have been sustained not just recently, but for decades by BAME staff, working alongside their White colleagues, often in demanding and highly socially skilled roles (even if termed ‘low skilled’), with little financial reward or career recognition or progression (https://www.kingsfund.org.uk/blog/2018/03/bme-representation-nhs-leadership). And I am proud to now work for an organisation where our CEO Seyi Obakin is one noticeable exception.

Psychologists have also been studying the concepts of prejudice and racism for many years, and have noted that humans have a tendency to categorise others into ‘in-groups’ and ‘out-groups’ (e.g. Social Identity Theory; Tajfel & Turner, 1979). This ‘othering’ or disenfranchising of one group to the benefit of another has been present throughout history (e.g. slavery). Moreover, there is also plenty of psychological research that has noted the impact that racism and structural inequality has had, and continues to have upon mental health and well-being (c.f. https://synergicollaborativecentre.co.uk/wp-content/uploads/2017/11/The-impact-of-racism-on-mental-health-briefing-paper-1.pdf). As Turner (2020) notes (c.f. http://www.bmevoices.co.uk/black-steel-in-the-hour-of-chaos/), ‘much like the internalisation of homophobia, or the neurological impact of sexism and objectification, these ongoing dehumanisations into the objectified or stereotyped other, leave a definite psychological mark (Fredrickson & Harrison, 2005; Sánchez & Vilain, 2012). When it comes to racism what many … fail to recognise is these constant engagements with racism are internalised by black people all the time’.

Moreover, when an individual experiences racism, they often experience psychological distress due to its unjust, unprovoked and uncontrollable nature (Clark et al, 1999). It is, in essence, a trauma (Terr, 1991), whether that be a single event or repeated exposures. As a psychologically informed environment or PIE should be ‘trauma informed’, it is important that we are therefore aware of the impact on the psychological or emotional state of racism and the traumatic consequences of such experiences (e.g. distress, low mood, anger, hypervigilance, paranoia, shame, guilt, anxiety, avoidance etc.). Being psychologically informed therefore means that we need to acknowledge the impact of racism, power and privilege in the work that we do, and as a psychology profession ‘we speak out against all forms of minority discrimination including racism’ and we need to act in ‘ethical ways and with understanding, empathy and integrity’ (c.f. https://acpuk.org.uk/rapid_response_george_floyd_murder/).

Racism can manifest in many ways, including institutional or structural racism (e.g. in various educational opportunities or societal systems such as criminal justice) and interpersonal racism (e.g. stigmatization, avoidance or social exclusion, direct attacks or verbal/physical aggression). It is perhaps easy to look at events in the USA right now and think that the UK ‘isn’t really that bad’ or ‘that doesn’t happen here’. However, the Windrush Scandal of recent years (e.g. https://www.jcwi.org.uk/windrush-scandal-explained), as well as many high profile cases such as Stephen Lawrence’s death leading to the MacPherson inquiry into ‘institutional racism’ in the Metropolitan Police (c.f. https://www.theguardian.com/uk-news/2019/feb/22/macpherson-report-what-was-it-and-what-impact-did-it-have) have shown that the UK has its own issues of structural inequality and racism. More recently there have also been worrying trends, including a doubling of violence towards BAME groups post-Brexit (e.g. http://csi.nuff.ox.ac.uk/wp-content/uploads/2019/06/CSI34_hate-crime.pdf).

It is also true that, just as in the USA, BAME individuals in the UK are more likely to be stopped by the police or die in police custody, often having been approached in the absence of any substantial evidence of wrong doing, but rather only on the basis of ‘racial profiling’ (c.f. https://www.runnymedetrust.org/uploads/Race and Policing v5.pdf / http://www.stop-watch.org/uploads/documents/The_Colour_of_Injustice.pdf). It was of note that during our recent staff PIE training, when those present were asked the question; ‘who has ever been stopped by the police?’, every BAME male staff member raised their hand, but almost none of the white male staff had had this experience. Moreover, many of our homeless young people from a BAME background report similar experiences, which of course does nothing to help challenge their previous negative experiences of being failed by attachment figures in positions of authority.

There is also evidence that BAME individuals are disproportionately impacted when it comes to homelessness, an increasing issue that is further likely to rise post COVID-19 as unemployment rises and the financial impact of the recent pandemic starts to manifest (e.g. https://blog.shelter.org.uk/2017/10/bame-homelessness-matters-and-is-disproportionately-rising-time-for-the-government-to-act/). Our own Centrepoint 2019 data indicates that 58% of homeless young people resident in our supported accommodation services are BAME, and 21% are refugees, and thus such marginalised groups are significantly over represented (compared to the general population) and more vulnerable to experiencing homelessness.

In addition, this week the UK government published a report noting the disproportionate impact of the COVID-19 pandemic on those from BAME backgrounds (c.f. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/889195/disparities_review.pdf). The reasons for this appear complex and multifaceted but include the impact of social and health inequalities increasing rates of underlying health conditions, inadequate or high density housing issues including multiple generations cohabiting, the higher exposure risk of BAME staff who are represented in greater numbers in low paid ‘frontline’ key-worker roles (who can’t #StayAtHome to protect themselves), as well as potential biological factors such as lower levels of Vitamin D.

This issue is therefore something that is as relevant in the UK as it is in the USA, so how can we respond in a psychologically informed manner? Arguably, this is not something any of us can ignore, for the impact on our society of the systemic marginalisation and neglect of some members affects us all. When reflecting on this, and the recent protests in the USA, I am reminded of the African proverb, which I used to have printed out and stuck on my old NHS office door; ‘the child that is not embraced by the village, will burn it down to feel it’s warmth’, which notes that society is better for all, when no individuals, are left behind, persecuted or dehumanised.

So how do we start, when we might feel overwhelmed or tired of having these conversations if we are from a BAME background or we may experience shame and discomfort when acknowledging them if we are from a White background? As noted in this excellent blog (c.f. https://sojo.net/articles/our-white-friends-desiring-be-allies) and highlighted by a wise ex-NHS colleague of mine to me recently, the first step is to acknowledge that there is an issue, and to see our own privilege or power in this. For example, this video is a very simple but impactful introduction to the concept of privilege and the effect that it has on our lives (https://youtu.be/4K5fbQ1-zps). This may be uncomfortable to see this truth, but it is our responsibility to educate ourselves so that we can name these things, acknowledge them and respond more appropriately in the future with challenge, restoration and reparation. Without this, shame continues to live within this denial and defensiveness, and transforms nothing.

As Keats et al (2012) also note in their Good Practice Guide to psychologically informed environments or PIE (c.f. https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf), ‘power should be discussed openly, and should be taken into consideration when conceiving client interactions and client pathways’ (p.25) and that ‘any future changes in practice are informed by the evidence’ (p.25). The evidence, as noted above, is now overwhelming and therefore can no longer be ignored, even after the protests across the globe may cease for now. Perhaps it is time for those of us who are White (and have had the space to speak for far longer, as we have written the history books and devised the laws of the land), to listen more and talk less, so as to give space to hear other voices?

We can also educate ourselves, and our children about racism issues (e.g. see extensive resources here: https://drive.google.com/drive/folders/15oWz5mim_hYj3t89Sw8VJO8VEpS4sN_o or here: https://blacklivesmatter.com/) and be willing to walk ‘a mile in another’s shoes’ so that we can then speak up for others and act or intervene as appropriate to speak ‘truth to power’ and call out injustices whenever and wherever we see them. If we are in a position of power or privilege, perhaps we can also consider how we use this and what opportunities we give to others? For example, I am extremely grateful for those that encouraged me to go to university and study to become a psychologist, when the odds were against someone from my working class background succeeding in this career, and consequently I have always tried to encourage and support others to achieve their goals in this profession. Of course, we might not always get this right, and it is important to regularly reflect on our actions and seek feedback from others, but if we hold onto our compassion and empathy and keep trying to do what we can when we can, this is another step towards the changes in society that will benefit us all. I would also argue that embracing diversity as a positive rather than a negative, and an opportunity for learning and growth rather than a threat, is critical.

Finally, within our organisation, Centrepoint have recently begun this journey, and I am proud that the PIE Team have been working with colleagues over the past few months on our ‘People Strategy’, with a particular focus on ‘Inclusion’. We still have some way to go, for example in considering how we risk assess and respond on the ‘frontline’ to the recent BAME COVID-19 data, but I am optimistic that these conversations, and the planned formation of a specific working group for BAME staff, will lead to positive changes both at an operational and strategic level. Our Health Team, working directly with homeless young people, have also been adapting their practice to take into account recommendations from the latest research in this area (e.g. Evans, 2020), to improve access and outcomes for BAME young people. All of this is important and timely work, that we look forward to co-producing moving forward with the relevant stakeholders in the future, to ensure that both ‘Black Lives’ and ‘Black Minds’ matter…