‘If not now then when, and if not you then who?’

I grew up in Birmingham in the 1970s and 80s, shaped by multiple heritages and family experiences, both within my family and those of close friends. My late father was from Egypt and my paternal grandparents both 1915 Armenian Genocide survivors and refugees from Ottoman Turkey. My mother is from a large working-class family, spirited and resilient in equal measure, with roots in Birmingham and County Cork Ireland. 

I knew of and experienced the hospitalisation of several close relatives on my mother’s side, over multiple generations, including a great uncle who was incarcerated for life at Rampton Hospital.

Another relative was rendered practically unrecognisable by a heavy-handed police sectioning and first-generation antipsychotics: I remember him struggling to talk when I visited him in a local Psychiatric Hospital.

Within my broader community, several formative experiences underlined the importance of collective action, including taking part in demonstrations against Section 28, supporting the boycott of Apartheid in South Africa, and campaigns I was involved with through Amnesty International in my teenage years.

From roots to reform

I went to George Dixon – at the time, one of Birmingham’s largest and most ethnically diverse comprehensive schools and I left at 16 to start work. I left home at 17 and later commenced RMN psychiatric nurse training at All Saints Psychiatric Hospital in Winson Green, located alongside Winson Green Prison. Sadly, this was a time I recognised several members of the community that I grew up with move through these twin institutions, with social forces and diminished opportunity being key factors in their fate.

I witnessed the move from institutional care towards community care, dovetailing with the fall of the Berlin Wall and the release of Nelson Mandela from prison. The zeitgeist reflected both a need for change and reform and fear and uncertainty, driven by the degree of underfunding and gaps in the new community care pathways, alongside moral panics whipped up by the media. These would ensure the burden of stigma would not be left at the hospital walls.

I witnessed the move from institutional care towards community care, dovetailing with the fall of the Berlin Wall and the release of Nelson Mandela from prison.

In spite of this, some innovative work and some more radical service redesign was underway both locally and nationally. In North Birmingham, the move towards reform was spearheaded by Professor Sashi Sashidharan and some of his colleagues. Sashi designed and clinically led one of the first fully operational Home Treatment Services in the UK. Informed by the pioneering ‘Trieste’ community-based mental health system, this was based – in the early days at least – on a far more distinct and contextualised social model of mental health. There was greater evidence of co-production and culturally informed, person-centred care. I was also introduced to the work of Professor Suman Fernando and of the Transcultural Psychiatry Society which went on to influence a generation of mental health professionals, with assistance from service users, to confront the endemic effects of institutional racism and think about ways to cultivate anti-racist practice.

A watershed moment

In 1991, towards the end of my nurse training, I managed to get a specialist Psychology placement with Professor Max Birchwood and his team. They were developing innovative Early Detection and Intervention for Psychosis programmes at the newly opened Archer Centre at All Saints. The encouragement from Max, Martin Preston (Head of Services at the time) and other psychologists working in Birmingham led me to consider clinical psychology as a possible career trajectory, however much the odds were stacked against it. The next seven years were dedicated to further studies, professional training and getting some more relevant clinical experience as a community psychiatric nurse. 

I obtained a place on the clinical doctorate programme at Birmingham. It was a steep learning curve, but I am grateful for all the opportunities my training went on to afford me. A particular highlight during training was the opportunity to be supervised by Professor Peter Trower for the research component of my clinical doctorate in the field of psychosis and persecutory delusions.

Fundamentally, I see the role of clinical psychology as working as part of a team and with people to improve lives and systems through collaborative working, team building and engendering inclusive, supportive modes of working.

I have observed and worked through broadly three different ‘eras’ of psychological practice: psychologists working as part of departments (separate from other services), psychologists working as specialist psychology led services (sometimes co-linked with other services) and psychologists working as part of more integrated, multidisciplinary teams (integrated with other services).

With relation to the latter, I have been fortunate to work with some senior leaders within the profession, such as Dr Nasreen Fazal-Short, who themselves have modelled and instilled a greater sense of accountability to service users with those from marginalised and underserved communities. This delivery model has meant those with more complex presentations are more greatly prioritised by NHS Psychological Services. A strong imperative to end ‘postcode lotteries’ in accessing services, and a drive to ensure psychologists audit their work more effectively, remain key. 

Embedding proper change

If we are serious about developing a more diverse and inclusive profession, this work cannot be the sole endeavour and responsibility of those with the least power in our systems, or those most impacted by the institutional biases that remain embedded within the profession. For too long, recruitment to the senior appointments have been a privilege for the few, from a seriously limited range of demographics and trajectories. Each senior appointment can be regarded as a litmus test for how serious we are as institutions about embracing change and our commitment to developing a more diverse and inclusive profession.

We know from psychological research that as humans we are all prone to a series of conscious and unconscious biases. If we do not attend to these actively, they seep into recruitment practices. For example, people who are perceived by employers to look and behave like the employers themselves are more likely to be recruited regardless of their talent or ability to fulfil the role. We could use this knowledge systematically to embed proper and lasting change in these systems.

For too long, recruitment to the senior appointments have been a privilege for the few, from a seriously limited range of demographics and trajectories.

In last year’s Division of Clinical Psychology annual conference, myself, Professor Suman Fernando and Roger Kline delivered Addressing Systemic Racism in Clinical psychology: A Call to Action. Roger spoke more broadly about whether or not many of the action plans devised by senior leaders in the NHS are fit for purpose and generate real change. His ten-point action plan illustrates the scope of problems he has uncovered over many years of research and data collection. Can we assume there is a consensus to change the status quo? Are our senior psychologists modelling themselves as compassionate inclusive leaders?

Over time, I have developed confidence in advocating for a more self-reflexive and integrated model of psychology, where services better represent their communities and Eurocentric models are not the default/sole models. Working with global colleagues such as Dr Samah Jabr has helped to expand my understandings of how mental health and therefore care is impacted by context, and what postcolonial thinking could look like in action. We worked together to develop and deliver a culturally adapted, nine-month CBT training program in Palestine. Our efforts combined with those of Hunaida Iseed, Dr Mohammed Mukhaimar and Helen Macdonald from BABCP, to make possible the establishment of the Palestinian Association for Behavioural and Cognitive Therapies.

This collaborative work meant recognising the contextual limitations of the CBT model and the need for significant adaptation, drawing from anticolonial frameworks such as those of Said and Fanon. This experience inspired me to reflect on the significant internal and external work that any psychologist trained in the West must action in order not to replicate colonial narratives.

A privileged position

In my NHS work I have valued playing a role in helping set up and develop psychological pathways in inpatient, crisis resolution and home treatment teams across three different Trusts. Currently I work as ‘Clinical lead for Urgent Care’ for Oxford Health Foundation Trust and have been focused primarily on developing psychological care pathways for the newly established crisis resolution home treatment teams in Buckinghamshire. I am fortunate to work with many brilliant MDT colleagues including fellow psychologists. My typical day involves a whole range of duties as part of the clinical leadership team, some integrated clinical work with a strong focus on assessment, shared formulation and treatment planning work alongside opportunities for supporting general team development and training.

For all the imperfections and challenges, I recognise that clinical psychologists occupy a very privileged position within the NHS. Respecting this position of trust and opportunity to make a difference in people’s lives is my main motivation in the work.

As psychologists we are perhaps most convincing when we have the data to evidence any case for change.

Whilst formal retirement from the NHS grows closer, I do hope to still be able to play some role within the profession supporting and driving change. I have been incredibly fortunate to play a small part in some of the initiatives within Clinical Psychology designed to widen access for the next generation. I have also valued the opportunities to be part of the conversations informing the British Psychological Society’s 2021-2022 strategic framework and hope to be able to further play a small contributing role progressing a more open and inclusive and outward looking professional Society.

A favourite maxim of mine – one that can carry us all forward at all stages of our career and life – is ‘if not now then when, and if not you then who?’ Sharing this imperative towards action with anybody considering a career in applied psychology is a subject close to my heart. Instilling this maxim collectively takes patience and determination, but leads to more substantial change in systems.

As psychologists we are perhaps most convincing when we have the data to evidence any case for change. We know that on an individual level we know that peoples’ lived experience is not valued as it should be in psychological services (including the lived experience of psychologists); we know coercive and carceral systems fall disproportionately on those who are least powerful and most marginalised; we know there are more severe outcomes for Black and Brown staff in disciplinaries; we know there is repeated data of increased medication and decreased therapy for Black people in mental health services and we know differential health outcomes exist for marginalised peoples in mental health, learning disability and other services. Although psychology is as a profession dedicated to using research to make a positive difference to people, we rarely use a national data lens to examine our local data. If we did, we would be challenged to make significant changes and the people we help would have their lives improved.

I remain committed to advocacy work for human rights and social justice and I’m passionate about music, poetry and film from around the world. It’s a vehicle for breaking down barriers and creating global citizenship. I am proud to have played a role outside of work in supporting several diverse Middle / Near Eastern, film makers, groups and artists to perform in the West Midlands. I have supported events, especially through Birmingham’s social justice film festival ‘Screening Rights’, Celebrating Sanctuary, ‘Surge in Spring’ Festival, Marsm UK and Centrala arts space. In arts spaces, as in psychology, I believe in the power of platforming different talents and perspectives. Often this cultural resistance works to serve a key function of envisioning and engendering new realities.

[Photo: Hosting an ‘Open Bethlehem’ film and campaign networking event in Birmingham in 2017, with Palestinian film maker Leila Sansour presenting both Malala Yousafzai and Ziauddin Yousafzai their symbolic citizens of Bethlehem passports.]