Navigating turbulent waters with hope to co-create islands of safety
Afrah Abdullahi, Sureya Ali, Lauren Canvin, Kim Coulson and Shirin Mustafa
As fi ve trainee clinical psychologists, what unites us is a strong ethical commitment to social justice in combating inequalities and injustices at the heart of individual and community distress. T roughout this article, we will be referring to the metaphor used in narrative therapy called the ‘riverbank position’ (Denborough, 2014). T is metaphor describes the process of helping people fi nd a safe place to stand in order to respond to the storms of life. We refl ected on the challenges we face as we learn to become mental health practitioners in the increasingly medicalised and marketised world of mental health. At times full of hazards and dangers, we consider this as ‘turbulent waters’ and describe our ‘riverbank position’ as ‘islands of safety’ where we draw hope and inspiration.
Navigating turbulent waters | the exclusion of social determinants of distress and the impact of unjust social policies
The impact of a decade of austerity
has increased the overall burden of distress, stigmatisation and discrimination against already marginalised groups of people. Marginalised groups, such as people seeking asylum in the UK, who are struggling with their mental health, are not being off ered the support they need. At the same time, welfare and other public services are having to respond to increased demands in the context of funding cuts. We have been struggling to navigate these ‘turbulent waters’ as professionals and, more broadly, as communities. As trainee clinical psychologists, we have
noticed a tendency for social determinants of distress to be excluded or misrepresented in particular psychological theories, formulation and research. This neglect arises from the perception that these social factors are too large and structurally embedded to change. Critical psychologists argue that mainstream mental health practice predominantly involves more human-sized biological and psychological interventions (Newnes, 2014). However, there has been overwhelming empirical evidence that our mental health is shaped by the social, economic and physical environments in which we live (Allen et al., 2014). Given this, how can we respectfully acknowledge, consistently raise awareness of, and resist the impact of unjust social policies? If we simply take distress out of context,
there is a danger of maintaining these structural features of society, which
Context 164, August 2019
systematically marginalise and disempower the people we serve. It is crucial to acknowledge and address the relationship between the individual and the historical and sociopolitical factors which contribute to personal and collective distress in our clinical work and beyond (Patel, 2003).
No place on the liferaft | limits to accessibility and acceptability of psychological therapies
We entered this profession motivated
to help and support as many people as possible. Therefore, it has been challenging to be confronted with the limited accessibility and acceptability of psychological therapies. Resources are always limited; therefore routine practice to send opt-in letters and speak with a stranger for an hour every week in a small stuff y room, serves as a measure of their
‘motivation to change’. Terms such as ‘readiness for therapy’ and ‘psychological mindedness’ are frequently used and some people are even described as ‘untreatable’. Not only do the narratives around mental health in the West already locate the ‘problem’ within a person or family, but also this is compounded by an additional level of blame – it’s also the person’s or family’s fault for not being able to access or benefi t from the therapy or support we are off ering. One in ten people living in the UK do
not use English as their primary language (Offi ce for National Statistics, 2011). It is well established that language barriers contribute to health inequalities across the healthcare spectrum (Saha & Fernandez, 2007) for a diverse range of people including those from black and minority ethnic and deaf communities. For instance, people from minority communities are over-represented in
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Navigating turbulent waters with hope to co-create islands of safety
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