‘Trying to change the world on my own would not work’

In his final year studying psychology at university, Lawrence asked his tutor for advice on how to become a clinical psychologist. 'Don't bother, it's impossible', came the reply.

After successfully training as a clinical psychologist Lawrence worked clinically and in the management of services for people with a learning disability. This led on to commissioning health services, policymaking and systems planning. He is currently chair of the British Psychological Society's Division of Clinical Psychology West Midlands Branch and active 'politically' in Birmingham.

Do not be put off, but be realistic!

'Mine is a good luck story', Lawrence tells me. 'A number of chance things led me to becoming a psychologist. I grew up in a council house and initially failed my 11+. I didn't get a university offer after my A-levels and finally got a place through clearing at Keele, where I studied psychology and history.'

His interest in psychology started at school. 'In the lower sixth form you were offered the option either to do sports or voluntary work. Mine was a single sex school and I initially chose sports because they were organised jointly with the local girls' school. But a number of my friends chose to work at the big – what was known as "subnormality" – hospital, Botleys Park in Chertsey. Over 1200 people with a learning disability lived there. My friends came back and told me how strange but also how fascinating it was, so I started volunteering too.'

'I worked there every summer while I was in sixth form and at university: as a nursing and play assistant, in occupational and industrial therapy and in locked wards. I found it absolutely fascinating; it taught me a great deal about life, and my summer pay got me through those years of study! The work also gave me an impressive body of relevant experience for a clinical course, and the opportunity to work with and learn from many different professionals.'

'At Keele in the first year we studied everything from Russian to Astronomy, then students did a dual-honours degree and by the end I was focusing on abnormal psychology.'

'The comment about the impossibility of becoming a clinical psychologist spurred me on. I had applied to get on a clinical course during my degree, but it took me three years to achieve this, working initially as a nursing assistant then as a psychology assistant. I think three years is still the average time it takes for applicants to get on to a clinical course after finishing at university. Given the prevalence of unpaid internships it must be so hard for applicants nowadays. I finally got onto a two-year MSc at Birmingham University.'

Along with the BPS West Midlands and East Midlands Branches Lawrence is currently planning a programme to visit every University in the Midlands to talk to undergraduates about careers in psychology. I ask him what sorts of things he suggests to students he talks to today. 'It's hard. You need to build up a portfolio of work, publications, and activities, but I think it is essential to be realistic about how long you are going to keep trying to get on a clinical course. Do not get transfixed on clinical psychology. You need a Plan B with a timescale. The more I talk to members of the "Psychology family" the more exciting the range of options seems.'

Not a conventional career

On the topic of the training itself, Lawrence is gently optimistic, but points out some key areas that need to be addressed. 'There's just been an announcement of more training places which is great. But as many people have been saying a key issue is the time and cost it takes to build up the experience to get onto a course. Those who can afford this may be from a restricted segment of society; one which is distant from where so many of our clients come from, especially when you look at the wonderfully diverse communities we have in a city like Birmingham. We need to do so much more to include more BAME students and those from more diverse and disadvantaged backgrounds in our profession.'

Lawrence's early employment involved working as a clinical psychologist in North Warwickshire NHS Health Trust. He moved through a number of roles and in the early 2000s led the delivery across England of the Mental Health National Service Framework. He finally left the NHS in 2013 and started his own consultancy. This is, perhaps, not a conventional psychologist's career.

'I will always remember, probably in the summer of 1977, I was working as an Occupational Therapy Aid in the "subnormality" hospital. During our lunchtimes we would volunteer to support young people with profound physical and learning disabilities on the wards to help them learn to feed themselves. One day I realised that we taught them for five lunchtimes a week, but the rest of the time they were spoon fed by nursing staff. Any tiny step forward we might achieve during one week was surely forgotten after the weekend. If instead I worked with/supported/trained nursing staff, so between us the children were consistently taught to feed themselves, maybe we could really help them. Trying to change the world on my own would not work, but by working and organising together we could really have an impact on people's lives.'

A manager with a background in psychology

In 1999 the Blair government introduced the Mental Health National Service Framework, a policy which he views as strongly informed by psychological thinking. It directed the development of mental health services in seven areas: health promotion, primary care, access to specialist services, the needs of those with severe and enduring mental illness, carers' needs, and suicide reduction. It had a series of targets, such as the development of 200 assertive outreach teams for people with long term mental health problems who found it hard to engage with services as well as 335 crisis resolution teams and 50 early intervention teams for young people who were moving into a first episode of psychosis.  

'I was asked to join the Department of Health (DoH) to lead the implementation of the framework, working with the mental health leads in English Strategic Health Authorities. I needed to really understand the evidence and research behind these new services, be able to share that with leads, and work with them to see how it would work practically in their area.  I then needed to square those local realities with the DoH Performance team! For example, Herefordshire was meant to have three crisis teams, but with half the county's population in Hereford City and the rest sparsely distributed in a huge rural hinterland we agreed locally to implement two teams each larger than the model, and then I had to convince the DoH performance team that two was three! This goes back to my point about my early experience of working with diverse groups of people. I had to deal with different geographies, clinical priorities and ways of doing things. It was about storytelling, negotiation, putting people together, and, I suppose, leadership.'

In his role in the DoH and in an earlier role advising commissioners, Lawrence wasn't employed specifically as a psychologist or in a role described formally as a 'psychologist' job, but for his wider range of skills and expertise. 'It raises interesting issues about professionals being involved in policy development and delivery,' he says. 'Are they employed to represent their professional group and because of their professional training or because of their ability to form teams, provide more generalised leadership etc.? As an example, in the late '90s I worked advising NHS commissioners. They invited the local Trust and local charities to bid to develop some psychological support programmes in GP practices, and asked me to assess the bids. The local charities had produced an exciting bid; by contrast, the Trust's psychology department submitted a rudimentary bid which felt off-the-shelf. Was I there to speak on behalf of psychology or the local people? After some soul-searching I advised they commissioned the local charities service.'   

We talked about potential moral issues, such as those faced by the scientists on the panel of Covid-19 news conferences, or potentially by nurse and doctor members on Trust boards. 'I was very fortunate not to face those types of dilemmas, I'd love to believe I'd be a hero, stick to my principles and walk away. That would be fine for me, but if I had a young family, I'm really not sure.'

What are Branches for?

Our conversation moved to Lawrence's present activities. He chairs the Society's West Midlands Division of Clinical Psychology Branch and is a member of the West Midlands BPS Branch. 'There is real tension in the BPS. It has been well signposted that we have a really complex structure – 150-160 branches, groups, faculties etc. I think. So there needs to be change. I am a great fan of Branches; they support, enable, and develop their members, and can also engage with local people and local health structures. But we also need to do more to work across Branches, be that between DCP Branches or between the BPS, DCP and other structures. '

What does Lawrence's future look like? 'My term as chair of the West Midlands DCP finishes at the end of this year and I want to focus more on work across Birmingham and the West Midlands. The Make My City Fair initiative – an anti-austerity programme we're working to develop here, is a real focus for me. We are looking at whether we can help drive big initiatives – like the "Preston model" for community wealth building – or micro-changes, as ways forward to transform our city.'

Some interviews in The Psychologist have highlighted the need for psychologists to have more influence on policymaking. Often this seems to require a more proactive, assertive communications stance, using white papers and press releases as well as personal influencing of key figures. For me, talking with Lawrence about his career highlights a different method of influencing: working as a manager in policy-sensitive areas, using psychological background, knowledge and experience.

- What should psychologists understand about austerity, and ways to broaden the role of psychologists in order to combat its effects? Read insights from 'Make My City Fair' in Birmingham

We are aiming to put together a special edition around the theme of 'From poverty to flourishing' for summer 2021. If you have ideas for topics / authors, please get in touch with [email protected]