Are all barriers the same height?

Social inequalities are 'hidden in plain sight' within the field of clinical psychology (Delgadillo, 2018). They continue to obstruct both the development of the field's diversity and its effectiveness in both global and multi-cultural contexts (Lazaridou & Fernando, 2022; McKellar, 2020; McEvoy et al., 2021; Dzokoto et al., 2021). There are challenges around increasing diversity, including cultural insensitivity, biases or resistance to change (Schlosser, 2019). With effective management, however, diversity has wide-ranging benefits, including improved productivity and problem-solving, and employee developmental growth (Schlosser, 2019; Cletus et al., 2018).

The continued lack of diversity within the field is, therefore, to the detriment of us all. As part of NHS England's improvement strategy, Jo Lenaghan (Director of Strategy) recently stated that, "Higher education institutes will be required to take targeted action to increase the diversity of new entrants to these professions" (HEE, 2020a).

Diversity is generally defined by demographic characteristics such as age, sexuality and ethnicity (Triguero-Sánchez et al., 2018). Rather than use the common term Black and Asian Ethnic Minority (BAME), I will adopt the term People of the Global Majority (PoGM; Lim, 2020), to reflect an orientation away from UK- and White-centricity. As reflected in HEE's Action Plan (2020), the strategy's central focus is on addressing barriers experienced by PoGM (Wood & Patel, 2019). It also broadly includes applicants who have otherwise been excluded from progression. This includes those of a lower socioeconomic status (SES), or those who have been unpaid, informal carers (HEE, 2020b; Dixley et al., 2019). Within the context of social class, these barriers were discussed in the July/August 2022 special edition of The Psychologist (2022).

The broadness of the strategy does ensure that discrimination is not written into policy. However, the presence of equality hypocrisy in the UK, in which equality values are not applied consistently across minority groups (Abrams et al., 2015), suggests there is a burden on those delivering policy to ensure it is not simply another way of excluding PoGM. Diversity policy should deliver diversity outcomes.

When reflecting on the notion that not all barriers are the same height, I have felt unease with my place on the scheme.

To that end, clinical psychology has begun some promising work, with a number of positive initiatives. For those applying to the doctorate in clinical psychology (DClinPsy), this includes contextual applications. This process examines wider or systemic information about a candidate to identify barriers which may have obscured their potential or hindered their progress. Contextual applications are in development at a number of universities running DClinPsy programmes, though not all. One such university, the University of Essex (UoE; 2021) recognises that proportional representation around SES, intersectionality and gender may benefit from contextual applications (considering 85% of successful applicants identify as female), but they may not be necessary to increase ethnic diversity. For example, UoE separates academic, personal and reference sections of applications for blinded assessment, with demographic characteristics removed. Figures published by the university show that Asian, Black, Mixed and White Other groups are consistently overrepresented in successful applicants (UoE, 2021). A potential explanation for this could be found in PoGM in wider society having to do more in order to receive outcome parity with their White peers (Li, 2018a, 2018b; Khattab, 2018). An intriguing implication could be that removing prejudice and bias leaves PoGM as simply stronger candidates.

Although UoE's results and transparency should be applauded, such transparency is far from standard practice across universities (Atayero & Dodzro, 2021). Meanwhile, ideas are being posited for systemic reform (Goghari, 2022), improving cultural competence and allyship (Williams et al., 2022; Sue et al., 2017), identifying and challenging resistance to change (DiAngelo, 2018), cross-cultural interventions for reflective practice on race and racism (Kusi, 2020), and rhetorical orientation to soften attack/defence dynamics (McInnis, 2021), though these are not yet embedded. Much work still lies ahead of us if we are to adequately address the continued lack of diversity in our field.

The scheme

Another positive initiative within the NHS strategy is the Aspiring Clinical Psychologists Access Scheme (ACP; NHS, 2021), which targets recent psychology graduates. This scheme aims to provide equitable access into, and development within, a career in clinical psychology for those from underrepresented backgrounds. Funded by HEE, it offers recent graduates paid work as an assistant psychologist within the NHS, for a fixed term of six months. The targeting of people who are at the beginning of their clinical career is reflected in the eligibility criteria. Applicants must have graduated within the previous 18 months with a minimum 2:1 classification; they must not have completed a master's degree or had previous experience as a paid assistant psychologist; and they must not be on a salaried or trainee postgraduate programme. Finally, the key criterium is being excluded from entering the profession through unpaid work experience, put simply; not having the time or money to justify working for free.

There are many examples of inclusion, and I was eligible for the scheme under two of them. Firstly, I needed maintenance grants to financially survive university, having always earned minimum wage or nearby. Secondly, I have lived experience as an unpaid, informal carer. I helped to care for my father, who suffered with Parkinson's disease for over 20 years before he passed in 2017. I joined the Southwest Yorkshire Partnership NHS Foundation Trust (SWYT) as a HEE-funded assistant psychologist in October 2021, in collaboration with the University of Leeds' DClinPsy programme.

The role

The role adheres to the BPS guidelines for assistant psychologists (BPS, 2007). Initially employed on a full-time basis, on a fixed term, six-month contract, I have now moved onto a new contract, not funded within the scheme. The scheme has succeeded, therefore, in allowing me a route onto this career path.

I am part of the community psychology team in an adult learning disabilities service, and have been afforded all the opportunities of my permanently contracted colleague. Along with the raft of administrative tasks, these opportunities include diagnostic assessment of learning disabilities, behavioural assessment and intervention, 1:1 therapy, service evaluation and research. Along with the other assistant in the team, I have even published my first paper within the service (Gourley & Yates, 2022), with more in development. Furthermore, I am given the time to work on updating my undergraduate dissertation for journal submission.

This is all under clinical supervision, and I am lucky enough to have two supervisors: one for diagnostic cases (a consultant of 40 years' experience), and one for therapy cases (a newly qualified). Being my first steps in the clinical world, I cannot understate the impact of supervision. After each session, I feel perceptibly developed as a clinician. My supervisors are keenly focused on my continuous professional development, in line with the aims of HEE's improvement strategy, and ultimately towards my qualification as a clinical psychologist. On a personal note, I acknowledge the privileges this role affords me, and I feel incredibly fortunate to be in it.

 I wish to be open, curious and responsible in exploring my own 'contours of Whiteness' as I continue to develop my cultural humility, competence, and allyship.

Alongside my role, the educational and engagement element of the initiative has been managed by the University of Leeds' DClinPsy programme. There were many other assistant psychologists participating in the scheme across West Yorkshire, and we were all given access to e-learning packages and webinars. We attended a reflective session around difference, through the prism of the supervisory relationship and the 'social graces' model (Burnham, 2018), which categorises 18 socially constructed powers and privileges (e.g., appearance, ethnicity and economics), including those unseen and/or unvoiced, which impact us all on both individual and societal levels. We identified powers and privileges which united us and differentiated us, including ones which had morphed over time, or which changed within us and between us depending on the context. It was a brilliant exercise which illuminated Burnham's model in all its complexity, malleability and dynamism. This model has not only been the source of much reflection and discovery, but has also given me a framework to articulate my thoughts. It will continue to inform how I work with both colleagues and clients as I look ahead to developing my thinking and practice around intersectionality.

Reflections on social graces; Whiteness

Arguably, my most prominent social graces are being British, male and White. I was offered the role on the basis that I fit the criteria, in a blinded process. Yet when reflecting on the notion that not all barriers are the same height, I have felt unease with my place on the scheme. I have wondered if, by being the beneficiary of the strategy's broad scope, I am just another White, British man getting ahead. In other words, has my Whiteness (i.e., White dominance and/or supremacy; Ahsan, 2020) given me the power to overcome smaller, less prominent barriers? Furthermore, has the broadness of the NHS's strategy allowed my dominant Whiteness to prevail?

This is the social graces model in action as my power and privilege warps across contexts. Within the wider context of racism and Whiteness within our field (Ahsan, 2022; Wood & Patel, 2019), this is a crucial and serious reflection to undertake. I want to accept the unease which can accompany this discussion and commit to repudiating 'White fragility' (DiAngelo, 2018) by being neither defensive nor silent on this topic. Rather, I wish to be open, curious and responsible in exploring my own 'contours of Whiteness' (Smith et al., 2021) as I continue to develop my cultural humility, competence, and allyship.

Much work ahead

To conclude, the ACP is a positive scheme within a wider NHS strategy. It has successfully propelled myself and others into careers within clinical psychology, when otherwise we may have struggled to do so. As such, both the strategy and scheme should be considered as largely progressive and successful and I would gladly recommend the scheme to anyone who has faced barriers in developing a career. Furthermore, I hope to see its significant expansion over the coming years, and look forward to enjoying the positive impacts which will accompany increased diversity in our field.

The strategy's broadness, however, may paradoxically be both its strength and its limitation, by promoting a wide range of diversities whilst potentially perpetuating Whiteness within clinical psychology. Worthwhile reflections are required, which could include more focused schemes for different career stages, to develop consistent diversity. For example, protected places for PoGM on DClinPsy programmes (for precedent, see Anglican bishops in the House of Lords; Electoral Reform Society, 2018).

Although the ACP scheme should be applauded, and considered a step in the right direction, such positive initiatives are yet to be universally embraced, whilst others exist only as ideas. It bears repeating that there remains much work ahead of us if we are to actively dismantle the barriers which continue to obstruct and restrict good candidates, to the ultimate detriment of clinical psychology.

Acknowledgments

Thank you to Professor Nigel Beail, Anita Ghosh and Luke Yates for their thoughts, perspectives and editorial amendments.

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