‘Change needs to happen on a real systemic level’

Paul Jenkins: The emergence of the Black Lives Matter movement has highlighted, once again, the issue of how we promote a genuine culture of diversity and inclusion in NHS organisations. The need to do so is central to how we respond to the needs of the populations we serve and how we deliver good and equitable outcomes for all who use our services, whatever their background.

As part of this, as white leaders, we need to recognise that we have failed to give sufficient attention to the conscious and unconscious barriers faced by black and minority ethnic staff. The best place to start is to listen attentively to the stories of BAME staff and hear at first hand the experiences, good and bad, which have helped shape their careers and their insights into what needs to change to make a difference.

So, Tosin, we are going to have a conversation about your career and your experience of being a black woman, and how that has impacted on your career and its development. Really importantly, I'm very keen to explore how we can learn as an organisation from your experiences, to make sure we are giving genuine equality of opportunity. To set the scene – could you describe your career to date? What were the strongest influences for you?

Dr Tosin Bowen-Wright: I am a clinical psychologist working in CAMHS. I currently manage the Clinical Intake Team which is the front-door service for Camden CAMHS. I have had a desire to work with children as a child psychologist since I was a child myself, and following qualification in 2007, have worked in CAMHS settings in London. I have worked here at the Tavistock and Portman Trust for 10 years this year, initially working in the Fostering, Adoption and Kinship Team, as well as in the Youth Offending Service based in the Camden Local Authority.

The strongest influences have been my own experiences, and support and guidance from my mum, who really supported me to realise my ambition to be a child psychologist. That desire stemmed from my own need for help when I was a child. We moved as a family from Nigeria to the UK when I was eight years old. The experience of moving from Africa to the UK was quite difficult, both for me personally, but also for us as a family. It was a big adjustment, a very different environment, and I remember really struggling to fit in and feeling a huge sense of loss for all that I had known, and for the way that I had been naturally accepted as a person in Nigeria. I found the UK quite alien and hostile initially, particularly at school. I also missed having family around me in the way that I had been used to. The emotional difficulties I had as a child inspired me to want to be able to help children like me one day.

Now I am a mother, I am thinking about these sorts of issues from the perspective of a parent. I think child and adolescent mental health services have an important job to do to support parents to help their children. Ensuring that parents get the support they need to help their children is now a driving force for me.

Paul: What were the steps you took to realise your ambition, and what have been the breaks or frustrations?

Tosin: I've been to some extent quite fortunate in my career, particularly up to the point of becoming qualified. I definitely had the ambition to become a psychologist, but I don't know that I quite had the drive before getting on to the doctorate. However, my mum did, and she was the one who found the adverts for the two assistant psychologist jobs that I applied for and got! My first assistant psychologist post came about through an advertisement for three assistant psychologists at a CAMHS in Folkestone. After the interview, the head of service who interviewed me contacted me to say that I didn't get any of the posts, because I did not have any assistant psychologist experience. She went on to say that she decided to create another post, for another assistant psychologist without that experience. The experience I got in that job was pertinent to my application and interview for my next assistant psychologist role in Brixton, during which I got onto the clinical psychology doctorate at UCL.

People who are aware of the path to clinical psychology know that it is very competitive. I was the youngest on my course, and I got on to the doctorate on my first application, which at that time was rare. I think getting on to the doctorate quickly was a combination of my own skills and talents, and the support of people who knew what I needed to be doing and saying to get on to the doctorate. I was fortunate to have worked with clinical psychologists when I was an assistant psychologist who could see what I had to offer and supported me and believed in me.

I also had good support during training – I had excellent supervisors, some of whom I still have a relationship with, and a very supportive course director.

I had my own mental health difficulties during training, and I wondered whether I could keep going. Some of my difficulties were related to my past and to personal issues. However, some were also about holding onto my confidence and belief in myself, being the only black person on the course, and managing the negative remarks – that I now understand as microaggressions – by some of my peers, as well as other qualified professionals I worked with. I really felt that I had the course behind me to ensure that I got the support that I needed to thrive despite those difficulties. This was another example of having the right people around me who have believed in me and encouraged me.

Paul: When we have talked before, I recognised that picture in my own career. Could you say more about how should we look out for people and give them that extra bit of confidence?

Tosin: I think those people were interested in me as a person, and were also curious about me. We got to know each other well. Although at times they struggled with how to articulate their curiosity, they were able to show it in a way that allowed me to let them know more about me and what I was about. I experienced some people's initial scepticism and wariness, but in time they came to respect me and valued what I had to offer. I did feel that I had to work harder than others and tone myself down; try to be softer to prove my worth to them. I was very aware of their doubt at the beginning. Those who believed in me from the start, like that first clinical psychologist and head of service, were encouraging of my ability to be forthright and challenging and understood me as a passionate person.

Paul: Have there been things about coming from a BAME background that can make it more difficult to have those relationships?

Tosin: As a black person I know that people have all sorts of thoughts and ideas about me that are not initially positive because of the colour of my skin. I remember a few times during my clinical training people struggling to accept and acknowledge that I was the trainee clinical psychologist. People would often refer to me as the administrator or nurse or trainee social worker, as though those were the only professions I could be qualified for. It seemed that there was something really bewildering about encountering a black trainee clinical psychologist. At times that was painful and frustrating to deal with and to break through. I feel I have had to be very forgiving of people.

Paul: People from white background who have supported you – what was different? Did they acknowledge the difference, or have they been 'colourblind'?

Tosin: I think they have been willing to talk about these things and be curious, not shy away from uncomfortable conversations. Also, when I think about it, they were people working in settings with a strong BAME population, I think they understood some of the challenges that community was facing, and could bring that experience to me.

Paul: I hear a strong message that the important thing is to talk about it. It is better to have said.

I've been reflecting on the fundamentals of how mental health services have not been meeting BAME needs, particularly the needs of young black men. As a practitioner, what is wrong, and what do services most need to do to address this?

Tosin: I think mental health institutions need to think about what change means, and what to do differently. We work from such a Eurocentric perspective. It is difficult for me sometimes because, as a Black African woman, there is a real tension in me, about what we're doing as a service/organisation and whether our thinking is right for these families. People have to be socialised to this Eurocentric model to get the best from it. Often people from BAME backgrounds, particularly parents from African or other ethnic minority backgrounds, don't have this Eurocentric language about their difficulties and how they are dealing with them. So they are working in systems that in some ways are working against them, as the system doesn't think in the same language as them, or have a genuine curiosity and interest in their experiences.

Over the years we have come a long way though, we are getting a lot better at having conversations about these issues, amongst ourselves and with our families.

I also think that having more people who look like the people they serve and understand the background of the people they serve, is the way that we have to go. In the criminal justice system there are just not enough people doing the judging, sentencing, and sectioning that have any idea of what it is like to be a black boy or man. I would like to think that there would be fewer black boys caught up in those systems if there were more black men and women in more senior and powerful positions making decisions. Change needs to happen on a real systemic level, especially at the top.

Paul: It is interesting that a lot of our models about talking therapies are Eurocentric. Do you think there's scope to make those more culturally inclusive, or do we need to rip them up and start again?

Tosin: I think some approaches lend themselves to cultural inclusivity. The systemic approach for example, which talks about the 'Social GGRRAAACCEEESSS' – not a typo! – when thinking about people's experiences. It is also about the people who are delivering therapies. Some people are drawn to particular approaches that are more or less Eurocentric. There is some work to be done about increasing diversity in the more Eurocentric approaches, to make them adapt to being more culturally inclusive.

Paul: Moving back to within the organisation… What are the top three things to put substance behind the promise of equality of opportunity? Where do we start?

Tosin: I would start with the leadership. I think an organisation is a reflection of the leadership. The work begins with the leadership genuinely wanting to understand and be held accountable for bringing about change. There has to be some thinking and feeling about the stuff that is uncomfortable to talk about. There needs to be a review of what has been going on, what hasn't been dealt with, and how things could be done differently.

Recruitment is another thing – how do we make sure it is fair, and that we are recruiting in a way that is pulling in people from diverse backgrounds? What are we doing as a Trust that shows that we genuinely want to be more diverse and culturally inclusive?

I also think that there is something about good support, both for those who are coming in and those who are moving up in the organisation. The Black Lives Matter movement is bringing to light what people have been struggling with, that they have not been able to acknowledge or speak about. When George Floyd's death was being so highly publicised, I realised that I just try to suppress this stuff. I know racism goes on all the time, but it is too painful, too traumatic, to constantly think about. On a daily basis I am really struggling with this stuff. If I am having difficulties, I'm wondering how much what I am experiencing is about the fact that I am a black woman. It may not be, but the fact that I can't talk about it, that other non-Black people are not curious about it, makes it more and more of an issue for me.

What has helped me has been talking to other Black people in the profession, who can help bring perspective to what is going on and say, for example, "Yes, racism might be playing a part, but it might also be these other things as well". It is hard to find support though. I have had to work so hard to work out who I could go to when I needed help, who I could trust to want to genuinely help me, and what that support was going to look like. I think the Trust has a responsibility to ensure that people have the support that they need to really navigate the very complex issues that they are going to inevitably face.

Paul: So, can we crack this?

Tosin: I hope so. As a Trust we're about making a difference in the lives of the people in the communities that we serve. I do believe, having worked here for so long, that we are a group of people who really want to make a difference, and want to make this a place where everyone feels they can be a part and belong.

However, it is going to be difficult. We are all going to feel quite uncomfortable, perhaps for some time, but in the end it will benefit everyone. I think we shouldn't move too quickly into action, but we should spend a bit of time really thinking and feeling about this, ensuring everyone across all levels is part of the process.