Through my literature review, I became increasingly aware of the scale of legislation that directly promotes race equality that is applicable
internationally and nationally. However, there is little sense of the weight of these legal instruments in everyday practice and I am in agreement with what Palmer (2018, p.129) concludes is ‘an absence of strategic direction’.
This is particularly true of the child and adolescent context and recent governmental strategy not including initiatives relating specifically to ethnic inequality (see Section 1.2.5.). Without a strategic direction or effective monitoring by services, action to redress these inequalities is made more difficult. Mental health trusts must expect clinical psychology to engage in promoting greater access and should form an explicit part of the expectations in the role, rather than the responsibility of the impassioned clinical
psychologist.
There was a great awareness of the impact of reduced funding and resources on the capacity of clinical psychologists to engage in equality practice. Alongside improved strategic direction, an acknowledgement of the consequences of austerity and the underfunding of child and adolescent services is needed, which recognises the harmful impact on clinical
psychologists’ priorities in these contexts. Such contexts are less conducive to practices that redress issues of inequitable access, as there is an
increased push for greater therapeutic contact hours and the
discouragement of structural changes that are needed to change rates of access. This process must be seen as an act of institutional racism, with greater value placed on practices of equality that go beyond an analysis of throughput and therapeutic hours. Funding should be provided to manage the potential ‘increase’ in referrals as a result of providing fairer access, rather than current (under)funding which may stifle structural change due to claims of an inability to cope with increased demand; a justification for the maintenance of the status quo and an act of institutional racism.
4.5.1.2. Community partnership
This kind of work need not start from scratch, and despite my
recommendation that services do more to initiate equity initiatives, this need not be siloed and disconnected from the many resources already extant in the community. Strategic models that recognise and utilise existing
community knowledge through greater collaboration with non-governmental organisations and charities can provide a mutually supportive environment to achieving greater equity. Innovative approaches to addressing underserved groups have often been associated with the voluntary sector, and Chandra (1996) highlights some of the features available to these organisations that lend to their success: the provision of services that are language and culture specific; knowledge about local communities and their unique circumstances;
user-friendliness and accessibility, and; a vital link with alternative voluntary and statutory services.
Research with local BME communities is an important part of assessing needs, with evidence suggesting this kind of knowledge is not up-to-date, is not regularly reviewed, and is not used systematically in the planning of service provision by commissioners (Malek & Joughin, 2004). In addition, BME communities are under-represented in assessments of need and processes of decision-making in their localities (Bhui et al., 1995; Rawaf &
Bahl, 1998). A commitment to greater local research and strategy could draw on the principles of action research (Kagan, Burton, & Siddiquee, 2008) and encourage a mutual exchange of learning, co-production and joint working.
Importantly, action research promotes practical change through participative processes. These approaches have been successfully implemented in adult services (Griffiths, Byrne, & Nolas, 2010) and services for children and young people (Dwivedi, 2002), and is characterised by meaningful local research that considers the unique contexts of the communities they serve, alongside a willingness to adapt to better meet these needs (e.g. 42nd Street, 2017).
Specific campaigns of awareness can be delivered that follow from what is already indicated in the literature, for instance Messent and Murrell (2003)
conducted a piece of action research in relation to the local Bangladeshi community that led to the suggestions of improved signposting to increase visibility through information at health centres and mosques; CAMHS staff attending open days at local schools and mosques, and; advertisements in local media. Similar findings with African Caribbean parents found a similar lack of awareness campaigns from local psychology services (Fatimilehin &
Coleman, 1999). Further local-level research would need to be conducted to meet the needs of each community that are up-to-date and not based on different times and contexts (Ramchandani, 2004).
4.5.1.3. Improving access to psychological therapies
Children and young people’s improving access to psychological therapies (CYP-IAPT) aims to improve the availability and effectiveness of mental health services for children and young people through the transformation of existing service provision (CAMHS Press, 2014). To achieve this, one of its aims is to increase training available to staff that follows a ‘standardised curriculum of NICE approved and best evidence-based therapies’ (CAMHS Press, 2014, p.3). This key tenet brings the potential for opportunities and costs to greater equity in services. The costs are already apparent from the findings of this research, with the risks of standardisation and an
over-adherence to the ‘evidence base’ contributing to services that provide for the particular needs and evidence as it relates to WME young people, potentially excluding BME young people. Such a direction has the potential to further constrain clinical psychologists in their current contexts; limiting possibilities for the development of creative approaches to improving access.
There are also opportunities that come with a nationally recognised and funded training programme such as CYP-IAPT. Commitments could be made to acknowledge the enaction of Whiteness and embed anti-racist practice, model culturally appropriate services, use systems of outcome monitoring that disaggregate based on ethnic identity, actively pursue local research with under-represented groups, decolonise therapeutic practices and promote cultural humility, to name but a few. These are not small tasks,
and would require concerted efforts, but in CYP-IAPT there exists a ready-formed network for the dissemination and development of these ideas. The CYP-IAPT initiative also holds the principle of participation and strategic collaboration in service planning and delivery, which could be further utilised to improve access to services through recruitment and culturally relevant training (CAMHS Press, 2014).