The British Psychological Society
Psychologist Logo
  • My BPS
    • Psychologist logo
    Colourful illustration of different people in silhouette
    Physical Disabilities, Work and occupational

    ‘It’s as if it’s seen as an unfair advantage rather than an attempt to level the playing field’

    Lucy Wilkinson and Cleo Wisdom look to lead change for disabled workers in psychological professions.

    25 July 2022

    Share this page

    "I'm sorry, but we would be unable to offer you this position as we cannot make the required adjustments to accommodate your physical health needs". This was not the first time I had heard a rejection after occupational health had deemed me 'unfit' to be an employee within the team. It didn't sting any less. My experience is sadly not unique: many disabled psychological practitioners face barriers when securing and working jobs within the NHS.

    The NHS is renowned for its professional values and ethos, continually striving for inclusivity and diversity, whist ensuring patients and employees alike are treated with dignity, compassion, and respect (NHS, 2022). There has been a push for these values to be instilled in practitioners to deliver patient-centred care, but does that extend to how healthcare providers are treated themselves?

    My colleagues and I have reflected on the barriers that disabled health care practitioners face when attempting to progress in their careers. As Frances Ryan wrote in 2019's Crippled: Austerity and the demonization of disabled people, some of these barriers have at least been acknowledged and attempts to address them made. The NHS has tried to empower those at a disadvantage by introducing more inclusive schemes. The Disability confidence Scheme ensures that disabled candidates who meet the minimum criteria for a role are guaranteed an interview (Disability Rights UK, 2016), whilst Occupational health is a multiple disciplinary service concerned with the physical, mental and emotional health of employees and ensuring that 'reasonable adjustments' are made for disabled employees to ensure they are not disadvantaged within their role (UK Government, 2021).

    It's a start, but more change is needed to truly achieve inclusivity and diversity within the workplace. We hope to raise awareness of where gaps remain in NHS inclusivity initiatives, and to address these in order to truly embody the ethos and values the NHS promotes.

    Recruitment

    It is hard to even secure an interview in the intensely competitive world of psychology. Perhaps some of you remember the feelings of excitement when you finally received an invitation to one. As a neuro diverse person, I have found that while the disability confidence scheme is beneficial in terms of securing an interview within a service, it does not offer any support for disabled individuals during the interview process.

    Neuro diverse individuals have different learning and communication styles; we process information differently to our neuro typical colleagues. In an interview I may not be able to perform at my best, often struggling to organise my thoughts, process questions and formulate an answer that reflects my professional capabilities and knowledge. Many of my neurodiverse colleagues agree that providing the succinct package within a set timeframe is a challenge, and hiring processes that rely heavily on job interview performance therefore represent an unfair bias.

    The disability confidence scheme does not benefit physically disabled people during the interview either. As someone who suffers from a degenerative disease, my physical symptoms can be sporadic and unforeseen. I can't know whether I will be physically able to attend the interview until the day, or I may feel so unwell that I already know I am going to perform poorly. If I can attend the interview at all, my actual skill as a practitioner is often not reflected within my answers – physical health issues such as chronic pain, chronic fatigue, migraines, vision impairment and cardiovascular issues, on top of nerves, aren't conducive to a well thought-out answer.

    I often ask for some form of support either prior or during the interview. I explain my circumstances and what I need, such as 5-10 minutes to regather myself or manage my physical symptoms. This request has always been declined. It's as if it's seen as an unfair advantage rather than an attempt to level the playing field. Yet employee initiatives such as Microsoft's Neurodiversity Hiring Program and a Ford program focused on hiring people with autism show that it is possible to take the emphasis off interviews, and better support neurodiverse and physically disabled people through the recruitment process.

    We should also consider how job interviews work, regardless of whether you are disabled or not. Do you feel they are an accurate representation of your skills as a clinician, or more of a performance? Multiple interviews, role plays, tasks, all accumulate in vague feedback that "you scored highly but there was someone who scored just higher". It can feel we are being judged against criteria that are subjective and impossible to prepare for. Adopting more flexible recruitment styles would potentially benefit all candidates.

    Challenges identified when employed

    Occupational health has been put in place for employers to support those with disabilities, in an effort to make employment more accessible and to ensure employers are providing equal opportunities for everyone. As a disabled individual you are often told that you are an "expert by experience" or an "expert of your own illness". Yet when speaking to employers and fellow senior healthcare professionals we are often overlooked, and it becomes clear this is pleasantries and platitudes.

    This becomes even more apparent when an able-bodied/ neurotypical employer is the one to decide what is considered a 'reasonable adjustment' and what is not. Under the Equality Act 2010, employers are required to make reasonable adjustments to ensure disabled employees do not face disadvantage when doing their job. However, there is evidence that some employers may not understand their legal obligations or purposefully flout the law (Mind, 2018). Many of these employers may not have experienced a disability, so do not understand its impacts, and do not deem necessary adjustments as 'reasonable'. This results in disabled employees feeling unable to perform to the best of their ability at their job, negatively impacting on their wellbeing (Ryan, 2019).

    From a neurodiverse perspective, within the NHS, it is apparent that employees with disabilities are still disadvantaged. I have found that occupational health can be very helpful for certain needs such as laptops with assisted dictation and alternative keyboards. However, I don't feel as though there is enough awareness of the difficulties faced by those who are neuro diverse, such as the barriers faced when communicating verbally, nonverbally and written. This lack of support comes in many forms, for example sensory needs, communication styles and information processing. This can cause a breakdown in relationships within the workplace, due to miscommunication causing hostility/friction (Duffy, 2013). And in terms of adjustments, they could be as simple as reading pens, alternative lighting options and desk partitions to better accommodate sensory needs.

    From a physically disabled perspective, I have found that there is a complete lack of accessibility for disabled employees. An example of this is having poor digital accessibility features for those with limited mobility and workplaces being inaccessible for those in wheelchairs (Leonard Cheshire, 2019). It is clear that when developing services there is little consideration for those who have impaired mobility (Dwyer, 2018). This absence of assistive technologies and basic wheelchair access may be the sole reason an individual is deemed 'unfit' for the role by occupational health. Yet this is not a deficit in the employee's capabilities or skills – it's a deficit in the service's willingness to provide the appropriate accessibility requirements.

    Changes that need to be made

    It is clear more could be done, and needs to be done, for employees with disabilities (EHRC, 2017). Why isn't it happening?

    It has been argued that many do not make these adjustments due to cost and lack of funding. But implicit in this is a pessimistic view of disabled people's ability to perform well in the workplace (CAB, 2017). Preconceived notions that disabled employees will not be able to produce the same quality work, or will be more absent from the workplace due to their condition, are unequivocally false. Personally, once in a role, my performance often 'exceeds expectation' as I manage my conditions, thus often having less absences than abled bodied employees. This appears to be consistent across many psychological settings who do hire those with disabilities (Wolstenholm, 2019), and the charity Scope have highlighted the huge benefits disabled employees bring to services. It is important, therefore, that hiring managers become aware of their unconscious biases, and that managers learn how to manage a workforce to include those with disabilities (CAB, 2017).

    It's not just about managers, though. Staff culture can have a large impact on the treatment received by disabled employees (CAB, 2017). A common reflection among disabled employees is they are met with judgement from colleagues, and labels are placed upon them including 'unprofessional' and 'high maintenance' (Mind, 2018). A common experience that our co-workers reported feeling is that those with disabilities can 'slack off'. Such sentiments can cause a hostile workplace environment (CAB, 2017). To combat this, employees should also participate in further training and sessions aimed at raising awareness of the challenges faced by neurodivergent and physical disabled colleagues (Disability Rights UK, 2016). Disabled individuals have lived experiences that allow them to provide informed care to patients, and different perspectives which can prove invaluable. Helping colleagues appreciate this could reduce stigmatisation in the workplace and create a more positive work environment for all.

    Then there are wider considerations beyond people. The fact there are healthcare services and psychological buildings which are not wheelchair friendly is another indicator of the disregard for disabled employees. This lack of consideration acts as an outward message to people with disabilities that they do not have an equal right to work (Mind, 2018). Resolving these issues is a priority: removing physical barriers is just as important as removing stigmatisation and discriminatory attitudes (Leonard Cheshire, 2019).

    Leading the way

    It is time for the person-centred care that has been implemented for patients to also find its way to colleagues and employees. Creating an inclusive environment that accepts the norms of disabled employees would not only help disabled employees focus on providing excellent patient care, but also facilitate employees putting their energy towards improving services and focusing on positive patient outcomes.

    We in Psychology should be leading the way in this. Psychological professions are beginning to understand the value of disabled employees, as often we offer a different perspective, with disabilities largely going hand in hand with mental health problems (Minotti et al., 2021). Research shows that those with lived experience are often able to build strong therapeutic relationships in a short amount of time (Mills, 2017). These benefits of therapeutic relationships and patient satisfaction arguably outweigh the drawbacks (Boyd et al., 2016), and psychological professions should therefore be more willing to take on disabled employees.

    There's something even wider at play too. The issues raised here are not unique to psychological services. Yet there is often the notion that we psychological professionals should go 'beyond therapy', engaging in social change, raising issues such as discriminatory practices within the institutions that we work in. We should critique these policies and offer psychologically informed alternatives engaging with policymakers to facilitate change (Rahim & Cooke, 2019). Barriers have forced the disabled community to remain underemployed, underutilised, and in poverty (JRF, 2020). Often, we think of barriers as challenges that individuals overcome, but it's time to change this narrative (Mind, 2018). We, collectively, must choose to actively break down these barriers. A commitment to disability rights and inclusion is nothing short of necessary (Disability Rights UK, 2016).

    Executing these changes would help to secure the futures of those with disabilities, ensuring inclusivity and acceptability to ensure that the best care is provided (Leonard Cheshire, 2019). The NHS is an amazing service that allows people access to essential healthcare. We owe it to our clients that employees who are providing this invaluable care are supported. You can't pour from an empty cup; providing better care for employees allows for better care for patients.

    About the authors

    Lucy Wilkinson, Higher Assistant Psychologist in Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust. [email protected]

    Cleo Wisdom, Assistant Psychologist in Mersey Care NHS Foundation Trust

    References