“Therapists are scared of getting it wrong on raceâ€
An in depth look at research published by the UK parliament thatÌýtalking therapiesÌýprovided by the NHS, are less effectiveÌýfor people from ethnic minorities.
Research published by the UK parliamentÌýhas revealed thatÌýtalking therapiesÌýprovided by the NHS, including counselling, are less effectiveÌýfor people from ethnic minorities compared to people fromÌýa whiteÌýbackground.
Ìý
Emma Tracey hears the experience of Ayisha, a British Pakistani woman with mental health difficulties. Emma also talks to clinical psychologist Dr Hibah Hassan, whoÌýoutlines some of the reasons that underly this reduced success rate.
Ìý
Also on the show,Ìýthe blind, British model who’s walking down the catwalkÌýat Copenhagen FashionÌýWeek.
Lastly, we profileÌýtrack and field star,ÌýHollie Arnold,Ìýahead ofÌýthe Paris Paralympics.
Presenter Emma Tracey
Production by Daniel Gordon, Alex Collins and Claire Bates
Recorded by Dafydd Evans
Mixed by Ben Mundy
Edited by Ben Mundy and Beth Rose
Transcript
EMMA- Hello, this is Access All, the ³ÉÈË¿ìÊÖ podcast about disability and mental health. I’m Emma Tracey and a huge thank you to the lovely Paul Carter for sitting in the hotseat while I was off on my holidays. I’m back though, and even though I have barely had time to put away my sun lounger the team have been putting together an absolutely packed show for you. This week: why are people from ethnic minority backgrounds less likely to benefit from NHS talking therapies? A British blind model takes to the catwalk for Copenhagen Fashion Week. And we profile track and field star, Hollie Arnold, as she prepares for the Paris Paralympics.Ìý
MUSIC- Theme music.Ìý
EMMA- Please subscribe to us on ³ÉÈË¿ìÊÖ Sounds. Tell your friends about us and get in touch. We’re on the socials @³ÉÈË¿ìÊÖAccessAll or you can email us accessall@bbc.co.uk. Let’s get started.Ìý
People from Asian backgrounds are more likely to experienceÌý mental health problems compared to white people, but they’re less likely to have successful outcomes following treatment – that’s according to the latest UK parliamentary research. The chances of Bangladeshi or Pakistani women improving or recovering from conditions like anxiety and PTSD are 8% lower compared with white women of British heritage. Joining me now is Ayisha, who is of Pakistani origin and lives in Milton Keynes, and also clinical psychologist Dr Hibah Hassan, who works in the NHS in Oxford. You’re very welcome, Dr Hassan.Ìý
HIBAH- Thanks for having me.Ìý
EMMA- You’ve done some research on minority groups and why they may not be able to access talking therapies, is that right?Ìý
HIBAH- Yes, that’s right. So, as part of my doctorate in clinical psychology we did some research understanding some of the barriers that people from minoritised groups faced when accessing talking therapies. And this was specifically related actually to specific religious groups; we were wondering about British Muslims and their ability to access therapy. So, if as a Pakistani woman you attend talking therapies and you’re sat in front of a therapist, a psychologist or a counsellor who doesn’t seem to understand or ask questions about culture, faith, religion or family, all which are things that are important to you, you might leave feeling like actually that encounter wasn’t that helpful because the therapist in front of you didn’t really understand you and you didn’t feel able to express yourself in the ways that you might have liked to.
EMMA- That’s really interesting. So, would it be helpful if there were more therapists with similar backgrounds to these women who are struggling to get the good outcomes? And if so, is that likely to happen? Is there a problem in sort of recruitment and training of people as therapists with Bangladeshi or Pakistani backgrounds?Ìý
HIBAH- That’s a really good question actually and I think there’s probably two sides to this. So, one side is we can assume that if we had more therapists from a similar background if the therapist and patient were matched they might have better outcomes. But actually the research suggests that that might not be the case; that actually people from South Asian backgrounds might be worried that if they had a therapist from the same background that therapy might not be confidential. Or they might worry that actually what they share in the session might spread across the community. So, we know that people have fears about confidentiality. There’s also a risk that actually if we place the responsibility on therapists from the same backgrounds that actually we take away responsibility from white British therapists who should also be able to connect with people from different backgrounds or different cultures. So, in the same way that myself as a psychologist I for example have never experienced obsessive compulsive disorder, OCD, I can still be curious about a client who has OCD and I can still relate to them and connect to them. In the same way if I was seeing a client or a patient from a black African background for example, although I’m not from that background myself, I can still ask questions about their heritage and culture and racism. And we expect the same thing from other therapists too.
EMMA- So, do the work.Ìý
HIBAH- Do the research, ask the difficult questions. The research suggests that actually therapists are really hesitant and reticent to ask questions about race, culture and religion because they’re scared of getting it wrong. But when they don’t ask the questions it alienates the patient in front of them because they leave feeling like actually this isn’t the right space for me.Ìý
EMMA- Now, Ayisha, you’ve had treatment for an eating disorder and you’ve also had some talking therapies. What has your experience been?Ìý
AYISHA- You get 40 sessions, but it probably took roughly 20 sessions for me to begin to feel like I could be forthcoming and open. And even then I know that sometimes my brain would potentially start overthinking.Ìý
EMMA- You’ve talked a lot there about how sometimes it takes quite a while to build up that trust between you and your therapist. And some say that it’s easier to build that trust if the therapist is from a similar background to you. But you’ve actually had some problems with therapists who have a similar background to you, haven’t you?Ìý
- I kind of reached out to a bunch of different Muslim women therapists, and I tried to get some information about how I should proceed with regards to Ramadan. Unfortunately the response I got was quite worrying, and it sort of made me realise that maybe more needs to be done potentially within our own cultural understanding.Ìý
EMMA- So, were your worries about how to proceed with Ramadan connected with the eating disorder and what kind of responses did you get?Ìý
AYISHA- When you’ve got the mindset of somebody who can very quickly slip into disordered eating you can then be told not to partake in Ramadan. Now, when I reached out to this lady I just tried to explain my circumstances without going into too much detail, and it sort of puzzled me a bit when her response was, ‘Oh well, do you feel like you’re too weak to fast? It’s okay, maybe if you fast you might feel stronger’.
EMMA- Lack of awareness maybe.
AYISHA- Yeah.Ìý
EMMA- You’re still working through things, aren’t you? Your outcome still hasn’t been resolved. How are you moving forward now?
AYISHA- Well, at the moment I’m in an interesting state of limbo [laughs]. I am currently stumbling around because the therapists are trying to sort some other things out with regards to my health so they can try to understand what the best medication is, refer the problems to then guide them with regards to what could be done for my therapy. Unfortunately – maybe this is a personal flaw – it takes me quite some time to begin to open up.Ìý
EMMA- Dr Hassan, you’ve been listening to Ayisha; what do you make of what she said? Is her experience familiar to you?Ìý
HIBAH- Thanks for sharing your experiences, Ayisha. I really appreciate you coming forward to talk about these things. I think what you talked about in terms of trust was really interesting and something that I’ve seen. And I guess just to know I’m not speaking on behalf of all minoritised groups, I’m definitely not speaking on behalf of you, , but speaking to my own anecdotal experiences this thing about finding it difficult to open up with therapists and finding it perhaps difficult to trust services is a barrier that we come up against quite a lot. So, thinking in talking therapy services you might be offered somewhere from six to 12 sessions for the whole of treatment. And if it’s taking a long time to build trust and build that relationship then actually you wonder about how effective a short period of treatment is going to be.Ìý
One of the other things I wondered about from what you said, Ayisha, was about your level of control in the decision making process. And actually if you have Bangladeshi and Pakistani women in services where they feel like they don’t have control or there’s barriers such as language, if they don’t have access to an interpreter, or if the therapist doesn’t explain to them all of their options such as medication or talking therapies, whether we place people in impossible positions where they’re not able to take control over their treatment, and whether they feel like actually they can’t advocate for themselves.Ìý
EMMA- Are there other ways of helping women from these communities get better outcomes?Ìý
HIBAH- We know that the charity sector and other voluntary and community based projects exist, and there’s lot of outreach work that’s done, so accessing these women in environments which may feel more community based, so thinking about cultural groups or arts and crafts or religious spaces. Outreach work is really important because it builds trust and it tells these women that actually we are willing to put the time and the effort in to understanding and coming into your spaces and connect with you, and shows them hopefully that actually trust can be built.Ìý
EMMA- And it’s not just women who are affected; 53% of British men of white heritage say that they have had good outcomes from talking therapy, whereas for Bangladeshi and Pakistani men it’s 42%. I mean, what are the consequences, Dr Hassan, of not getting the right mental health support in the long term?Ìý
HIBAH- One of the things that we know is that people from minoritised groups are underrepresented in primary care talking therapy services, but they’re overrepresented on the other side of the mental health service provision, so we’re thinking about inpatient services. So, if we miss people at that entry point, so if GPs miss referring people to talking therapies or talking therapy therapists are unable to engage with clients at a primary care level people’s mental health can deteriorate and they can worsen. And it means that they might then be picked up later on in more difficult circumstances where they’re less likely to access talking therapy treatment and might be more likely to receive psychiatric support for example in inpatient settings. I’m conscious obviously of the racist riots and things that are happening right now across the UK and how they might impact how people from South Asian backgrounds might view services and services’ ability to help and support or protect them as well.Ìý
EMMA- And how do you think it is impacting people’s health, mental health watching these reports all the time, people from those communities?Ìý
HIBAH- I mean, it’s terrifying, isn’t it? It’s scary to think that there’s such violence occurring on our streets. And I think it’s even scarier to think that the structures that are supposed to be protecting us are seemingly not doing that. And if you see politicians and the police with slogans and messages that don’t feel like they’re protecting the South Asian or other minoritised groups, I’d say it’s not just South Asian groups of course, you might wonder actually why should I trust this therapist in front of me and what does this therapist represent.Ìý
EMMA- We asked NHS England a few questions about this topic and they provided a statement:
‘The NHS is committed to ensuring NHS talking therapies are accessible for all, which is why this year we've rolled out a public information campaign to ethnic minority groups urging them to come forward for mental health support if they need it.’
Thank you so much to Dr Hibah Hassan and also to Ayisha as well.Ìý
HIBAH- Thank you very much, Emma.Ìý
AYISHA- Thank you Dr Hassan.Ìý
HIBAH- Lovely to meet you, Ayisha, as well.Ìý
AYISHA- Yeah, likewise Emma.Ìý
EMMA- Lovely to meet you both. If you’ve been affected by this story you can go onto the ³ÉÈË¿ìÊÖ Action Line website to find details of organisations who can provide support.Ìý
If the show is sounding slightly more glamorous than usually then that could be because it is Copenhagen Fashion Week. And for the first time one of its shows features a blind British model, and not just any blind British model, but friend of the podcast, the beautiful Lucy Edwards. And Lucy is on the line. Hi Lucy.Ìý
LUCY- Hello. Oh, I’m just so excited. I can’t believe you said that in your intro. It’s a kind of pinch-me moment.Ìý
EMMA- You’re going to be on the catwalk on this show with your guide dog Molly. And the show has also been made fully accessible for blind and visually impaired people, which is very exciting. Now, Anna Cafone from Hair&Care, which helps blind people to learn how to do their hair, Anna helped to make it happen alongside the Danish Association for the Blind. And Anna is here too. Hi Anna.Ìý
ANNA- Hi Emma. It’s so lovely to be here. Thank you for having us on. We’re just so excited, we literally can’t contain ourselves.Ìý
EMMA- Yes, I can tell [laughter].Ìý
ANNA- Just so much has gone on behind the scenes to make this happen.Ìý
EMMA- Tell me a bit about what has gone on behind the scenes. What is in the show and how did you make it accessible?Ìý
ANNA- So, following on from the success of the first show that we made accessible at London Fashion Week with the incredible inclusive designer Sinead O’Dwyer, we wanted to expand on what we had expanded last time. This time round, as well as having the audio descriptions of the looks, we’ll be including swatches of the fabrics so all of our blind and low vision guests who have been invited from the Danish Association of the Blind will be able to feel before the show happens.Ìý
EMMA- Oh that’s cool, because Sinead is quite big on texture, isn’t she?Ìý
ANNA- Absolutely. And the biggest goal for us this time round was to champion the inclusion of a blind model to walk the runway.Ìý
LUCY- Yay!Ìý
ANNA- And that’s why we’re here with gorgeous Lucy.
LUCY- So cool.Ìý
EMMA- Speaking of the audio description of the looks that you mentioned, here’s a quick preview of how it sounds. And this is a recording taken from the London show that you did:
AUDIO- Model one wears a black long-sleeved open-weave stretch top with crisscross neckline, made from gathered satin, an elasticated knit. Black floor-length box-pleated culotte trousers where the waistband has a garter like belt and four metal trims.Ìý
EMMA- So, that’s interesting, she said an open-weave, I wouldn’t know what that feels like. And she also said a garter style belt in that description, I wouldn’t know what that is either. Will the blind audience members be more fashion aware than I or will there be a bit of a touch or a chat beforehand?Ìý
ANNA- Yeah, this time round Sinead will also be describing the collection. She’ll go into much more detail about the shapes, the silhouettes, the colours, the fabrics, so that each of the guests can listen to that ahead of the show happening and ahead of listening to the audio descriptions of each of the model’s looks.Ìý
LUCY- I think also Emma, just to jump in, you are totally the person that we want, if you love fashion and you are visually impaired. This is an industry that we have been shut out of. Like, of course we’re not going to know these key terms. I’m learning. But what I really know is I have lived experience of being blind for nearly 12 years now and that, along with Anna’s knowledge of the industry, makes us a powerhouse.Ìý
EMMA- Sure.Ìý
LUCY- And we’re going to do this.Ìý
EMMA- You have done so many things: you’ve been a Radio 1 DJ; you’ve been helping a company to make their AI stuff more accessible for blind people; you’re an author; you’re a TV presenter. Now you are a fashion week runway model. How does that feel?Ìý
LUCY- It makes me have goosebumps. I cannot believe that this is happening, it’s so crazy. When I went blind, like, nearly 12 years ago now I didn’t think that this would ever happen in my lifetime, I just didn’t believe it. This kind of representation, the fact that we’re talking to you guys now, and the fact that it’s happening and it’s the start of something, I really do feel like there is a massive movement.Ìý
ANNA- Absolutely.Ìý
EMMA- That’s good. And what about the practicalities, Lucy, of doing the catwalk? I mean, can you fall off a catwalk? How many times are you doing it before you do the real thing? Do you have to change outfits? What are the practicalities for a blind person in this?Ìý
LUCY- I have these really cool shoes, but I have literally been going up and down my house so many times in them because I’m like, I’ve got to look fashion, darling. So, I’m going up and down my kitchen with Miss Molls, and she’s had so many treats. And then we’ve had two fittings in the UK, and one was the other week at Anna’s studio. And basically we just walked up and down, up and down. And we even got the model who was coming to walk in front of me to get Miss Molly to sniff her and be like, hi Miss Molls, this is the model in front of you.Ìý
EMMA- Okay, so you’ll have a model ahead of you and Molly, your guide dog, will walk slightly in front of you obviously, behind that model. So, a guide dog one of the commands can be, ‘Follow, follow’ and it can help the dog to follow whoever’s in front of you. So, you wanted to get her used to the model that she’d be following on the day?Ìý
LUCY- Yeah.Ìý
ANNA- And what we’ve also done, Emma, is work with the team to have tactile markings on the runway.Ìý
EMMA- Lucy, what’s next for you? I mean, is there anything left?Ìý
LUCY- [Laughs] oh bless you, Em, that’s so funny. Just more and more activism really. I think for me it’s about changing the way we just see fashion and make-up and beauty. We need to delve deeper. I think this is a hole. Me and Anna are on a mission and we can’t be stopped.Ìý
EMMA- Thank you very much Lucy Edwards, now model, and also to Anna Cofone from Hair&Care. Thank you.Ìý
ANNA- Thank you.Ìý
LUCY- Thanks Em.
EMMA- Another place known for its fashion is Paris, but actually what’s going on there at the moment is the Olympics, so it’s all about sport. And I cannot wait for the Paralympics at the end of August. We’ve got another athlete profile for you. This time it’s track and field star Hollie Arnold:
MALE- Paris, Grass Roots to Glory.Ìý
HOLLIE- I’m Hollie Arnold and I’m an F46 javelin thrower. This will be my fifth Paralympics. Oh my god, is it the fifth!? [Laughs] When you look back at my first Paralympics I was 14. It was amazing, I didn’t have any pressure. Now of course it’s that pressure of going out there and performing. But you know what, in some ways I really like that.Ìý
MALE- Not the gold that she was hoping for, but Holton-le-Clay’s Hollie Arnold has claimed a bronze medal at the Paralympics in Tokyo.Ìý
HOLLIE- It has been a real up and down since Tokyo 2021. I’ve had a real big dip for a few years. I’ve finally come back up, I’ve found myself again, I’ve got my spark back, I’ve got an amazing support team, a new coach – all of this difference we want to take that on the stage. And I think hopefully we’ve still got a little bit more time to just go and have fun. Honestly, I can’t wait.Ìý
Coming back from the World Championships I was such a high, you’re always going to come back down, so I’ve kind of just been finding my feet again and being really honest with myself and being like, you know what, I’m not in the most amazing happy-happy place. But you’ve got to come back to real life, you’ve got to make sure you check yourself, make sure your friends, my friends know when I’m not okay as well. They’re like, ‘Are you good?’ I’m like, ‘Yeah, yeah’. They’re like, ‘You’re not yourself’. And I’m like, ‘Yeah I am’. And they’re like, ‘No, you kind of hide behind a smile’. And I think that’s the important thing is just be honest with yourself. But I speak to my psychologist, I’m really close to my family and friends, so I always check in. It makes such a difference because then you feel like, you know what, I’m not alone.Ìý
FEMALE- Lincolnshire has bagged its first gold at the Rio Paralympics.Ìý
HOLLIE- Do you know what, I am really excited, but I’m feeling everything. It’s always a whirlwind of emotions. You go from literally oh my god I can’t wait, to like, oh my god, what if everything goes wrong. And then you go in the betweens. But you know what, this is what we do for a living: we train day in and day out for these major games. And I think that instead of feeling like it’s daunting I just want to do everything, I just want to leave it all out on the field and let’s just give it a go.Ìý
I think the crowds don’t realise how important they are to us. Being able to hear their noises, being able to get them clapping. I always put my javelin between my legs and I’m getting them going and I’m like, ‘Argh!’. That is just a whole atmosphere in itself. I just think having them there and obviously people being able to see their family and friends in the crowd. I’m sure there will be kids there and hopefully banners and flags. This is what we want, we want to celebrate sport. Paralympic sport is incredible and it needs to be shown worldwide.Ìý
The little 14 year-old Hollie in Beijing in 2008 is not the Hollie in 2024. And I think that just mentally I’ve been able to deal with a lot. There’s been a lot happened in my career so far, and I think it’s just being prepared, it’s just going for it. I know I’ve got an amazing family and team around me to support me and do everything they can. We’ve still got more to go, but being a happy Hollie is certainly a dangerous Hollie.Ìý
You learn so much with time, you know: you learn from your mistakes; you learn from winning; you learn from losing. And I think that everything in one you take that pressure, that fire in your belly, as me and my dad always say, to every game, every major, and you go out there and you just do your best. You’ve got to do what you love and you’ve got to love what you do.Ìý
MALE- Paris Grass Roots to Glory, listen and subscribe on ³ÉÈË¿ìÊÖ Sounds. Ìý
EMMA- That is nearly it for this episode, and it has been absolutely lovely to be back in the hotseat. But what’s great too is that we’ve had some fab messages while I’ve been away about stories that we’ve covered. Catriona got in touch about our story around Australia and the struggle for British people who are disabled or who have someone disabled in their family getting into Australia or staying in Australia because the government there are worried that that person would cost too much. Now, Catriona has lived there for 12 years now, and she did eventually become a citizen but the medical process, she says, was very tricky. And Catriona goes on to say, ‘I was much less disabled when I got through, but I cost the government heaps in the end’. So, thank you for sending us on that feedback, Catriona, and delighted to hear that you’ve been listening to stories that are relevant to you. That’s what we’re here for.Ìý
We also heard from Alexander. Alexander was listening when we talked about ableism in football a couple of weeks ago. And he actually just happened to be the photographer at the FA disability football match where our fabulous guest, Willoughby, was playing for Norwich. And Alexander was really taken with the story and he said that these conversations are exactly the kind of thing that needs telling far and wide.Ìý
Listen, you can go back and hear every episode of Access All on ³ÉÈË¿ìÊÖ Sounds. And if there’s anything in any of those episodes that caught your attention please do let us know because we absolutely love to hear from you. We’re accessall@bbc.co.uk on the email. We’re on the socials @³ÉÈË¿ìÊÖAccessAll. And do you know what, you can even send us a WhatsApp, a voicemail or a text message, just put the word Access before you start your message. And we’re on 0330 123 9480.Ìý
Also this is [siren sounds] your final warning. That’s stupid, sorry. It is your last chance to apply for our show at the Edinburgh Festival. There are tickets online now at the ³ÉÈË¿ìÊÖ Shows and Tours website. The show is on Friday 9th August at 3pm at Dynamic Earth in Edinburgh. And I cannot wait. We’ve got Adam Hills, we’ve got Dan Tiernan, we’ve got political comedian Matt Forde, and Blue Peter presenter Abby Cook. I spoke to her just as she started her job on Blue Peter, but that was ages ago, and I cannot wait to find out how she’s been getting on. Thank you so much for listening. Chat to you next time. Bye.Ìý
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Access All: Disability News and Mental Health
Weekly podcast about mental health, wellbeing and disabled people.