'Be the grit in the oyster'

There was a hint of revolution in the air among the pre-qualified psychologists who joined together to hear more about community psychology, with the conference set around the theme 'thinking more, speaking more, doing more'.

Lisa Cameron MP, a former clinical psychologist and chair of the all-party group on disability [see https://thepsychologist.bps.org.uk/volume-28/july-2015/5-minutes], delivered a message of hope and suggested psychologists were 'pushing at an open door' in terms of their ability to get involved with the workings of government and have impact on policy. She described psychologists as 'true public servants' and emphasised the importance of mental health being given parity of esteem with physical health.

During her next four years in parliament, Cameron added, she planned to work closely with the British Psychological Society. She hoped that psychologists and their research would be involved in policy in the future, and she encouraged the audience to get involved in parliament through internships or visits. She told the gathered psychologists, trainees and undergraduates that they had excellent skills which could be used in areas of service to the public.

When asked how psychologists can become more involved in policy decisions, Cameron suggested they use social media to their advantage, and make note of areas of importance, even on a local level, and contact their MPs. She added that working from the ground up could eventually help to feeding into policy making. Psychologists' evidence-based practice was fundamental and should also be central to government policy. Cameron concluded that psychologists should be placing themselves at the forefront of policy decisions through involvement in policy groups, through links to parliament or by holding more events in parliament.

President of the BPS Jamie Hacker Hughes encouraged the audience to find their voices – whether this be through social or traditional media. He said if they had something they wanted to say or a cause they wished to tackle there were ways of doing it. Speaking of some of his recent work as President, including setting up a task force for asylum seekers and refugees as well as launching a campaign regarding work capability assessments, he said: 'As psychologists I'd say it's our professional duty to speak more and to do more. There are many ways community psychology can communicate – by participating in social action, speaking the truth to power, speaking out against injustice.'

Nina Browne a third-year clinical psychology trainee, and Senior Clinical Tutor, Dr Kat Alcock (both from UCL) spoke about their fascinating work interviewing psychologists who actively engage with policy. They gave a brief history on public health inequalities, including mention of the 2010 Marmot review and the UCL Institute of Health Equity study in 2014 which looked into inequalities in physical and mental health as well as the social inequalities at the root of these problems.

But, Browne and Alcock asked, what can psychologists do about social deprivation and who is already doing this kind of work? For her thesis project Browne carried out interviews with 35 clinical psychologists working in policy or engaging in policy work. Policy, Browne pointed out, can be at the local level, in an NHS trust, Department of Health or even at an international level. A thematic analysis of the interviews is ongoing, but Browne and Alcock shared some of the themes emerging so far. There was a general feeling of frustration among clinical psychologists that the field focused on individuals, often without considering external or societal influences on mental health. Some of the key processes in their policy work involved forming good relationships with colleagues and those outside of psychology – many people mentioned these relationships helping them to have more influence. Taking risks or accepting opportunities also emerged as a key theme – whether this be involvement with the BPS [e-mail [email protected] to express interest] or putting themselves forward for other responsibilities, as a group these psychologists tended to take risks, speak out and stand up. Also important were the understanding of organisations and their structures as well as developing personal and professional skills and competencies.

What were some of the barriers and facilitators to policy work? The agendas and timescales of policy makers themselves can be a barrier to affecting change, whereas having a mentor or people that share your views can be a huge help. Browne and Alcock concluded by encouraging people to get out of 'one to one' appointments and experience society – placements for trainee psychologists in public health or government may be useful in helping to understand the wider contexts of treatment.

Clinical psychologist and blogger Dr Masuma Rahim gave a stirring keynote address pointing to the system of clinical psychology as part of the problem with regards community psychology. She said from her first job upon qualifying she realised there was something wrong with the system – the field had never focused on prevention of mental health problems in any large-scale way. Rahim painted a picture of psychologists having to battle to give people treatment as resources are stretched so thin. She gave the example of people with eating disorders who may be turned away from treatment for 'not being thin enough': 'You are left almost wanting them to get more ill to prove how desperate they are for your help. What kind of a system is that?'

Rahim said younger psychologists are often great at questioning the status quo, as they may be less disillusioned with the profession. She said: 'There are a lot of us, what could we do if we got out of our world and into other people's?' As someone who had used mental health services herself, Rahim said that in the current political and economic climate it was more important than ever that people challenge inequalities and societal issues. 'The health and social care system we have was set up because there was a will and a spirit to do things better. Those principles are being stamped upon every single day. People who need the most help are getting less and less and it's not going to get any better.' It is not enough to carry out one's day job and do nothing more, Rahim urged. She encouraged the audience to speak about the issues which bother them, speak to their supervisors about them, and consider doing work with the media. She said: 'Be troublemakers. Be the grit in the oyster, it's the troublemakers that change things.'

A fascinating session was held by the London Playback Theatre group. This form of theatre sees the audience's feelings, stories and experiences improvised through movement and music by a small group of performers. Leader of the group Veronica Needa asked the audience themes and stand-out words and messages from the conference and improvised movement and short plays around these ideas. The group of four performers along with a musician left many in the audience stunned by the emotion conveyed in their short plays. The performers were largely from social care, psychological or therapeutic backgrounds, and they demonstrated that sharing stories and seeing them acted out in very imaginative ways could be a deeply moving experience.

Members of Psychologists Against Austerity, Edward Mundy, Rachel Tribe, Sinead Peacock-Brennan and Christopher Jones, held a workshop giving information about their own activism as well as tips for those psychologists who hope to make a larger difference with their work. They pointed to evidence showing the damaging effects of austerity – particularly on already-deprived and disadvantaged groups. The group's briefing paper, The Psychological Impact of Austerity, outlined five 'Austerity Ailments' – experiences which they argue have increased due to government cuts and which lead to mental distress, namely increasing levels of; fear and mistrust, humiliation and shame, instability and insecurity, isolation and loneliness, and experiences of feeling trapped and powerless. They group argue instead for policies which promote agency, security, connection, trust, and meaning.

Following group discussion on the contribution psychologists could make to key societal issues, the conference closed with a panel and Q&A session featuring input from BPS President Elect Peter Kinderman, Anne Cooke (Canterbury Christ Church University), psychology undergraduate student Stephanie Allan (who experienced a psychotic episode in 2010), newly qualified clinical psychologist Sam Thompson and Gemma Budge, a trainee psychologist from the University of Plymouth.