#OTalk 25th August 2020 – Improving Disability Representation in OT – #OTalk Series (UK Focus)

Thank you to those of you who attended the Improving BAME Representation in OT chat on July 21st 2020. You can find the blog post and transcript here. On this post we shared some general resources that we thought would be useful for this whole series of chats.

For this chat we are focusing on disability but I’d like to re-highlight the resource we mentioned on intersectionality which recognises that those from BAME backgrounds who also have disabilities may be doubly disadvantaged.

First up – I make no apology for being provocative in this post. I, like I’m sure, many others are, are tired. And angry. Fed up of disability related limitations as being seen as an individual failing and not a societal or cultural one. I have shared some very personal examples. I’m not going to name names because I simply do not believe my experiences are unique. I believe similar things happen all the time. I’ve seen it supporting clients with disabilities with their employers and I’ve witnessed it with colleagues and experienced it myself. I also acknowledge that OTs work within the wider systems of health and social care and some of the experiences people share in the chat may not refer to Occupational Therapists specifically but to others from their workplaces.

From a personal perspective I have now decided to work in independent practice purely because I do not believe that I can maintain good health in employment. I’m not even sure if this is true now but I’ve lost confidence based on my previous experience. I have not felt understood or as supported as I feel I could have been.

I guess some of you will be thinking, why do OTs need to talk about disability representation. Surely as OTs this is something we consider for our clients so it must be second nature to uplift those with disabilities, right?

Not so. Consider the following:

Students with disabilities still have to do 1000 hours of placement and they have a maximum of 5 years to complete the degree. Often placements are scheduled so that to complete at the same time as their cohort, students need to complete full time hours on placements (when in practice they might only work part time) or they run placements through holidays not getting a break.

On most courses and meetings I’ve been in it has been offered and usually taken up (by me too on occasions) to skip a break so we finish earlier. Why is the default to push through? Often you end up finishing at the same time anyway just without having had a break. Not only does this probably make us all less effective, it actively discriminates against those with a number of disabilities.

There often seems to be a ‘we went through it and had it hard’ so they need to as well attitude. So even OTs with disabilities themselves put pressure on students/newly qualified staff to fit in with the status quo. The ‘real world’ defence to bad practices. We should be the change agents when it comes to social injustice.

When asking for flexible start times in an NHS setting due to mental health challenges, I was told ‘You can’t just pick and choose your hours.’ ‘If we do it for you we’ll have to do it for everyone.’ When then proposing a time that I felt was most achievable I was offered 15 minutes before that time or 15 minutes after! I could not understand the reason given for this at all.

Phased returns to work after illness or injury are often time limited and then people are expected to use leave or have a reduced salary in order to continue reduced hours (and then get no break later). When they’d often be paid full time (or half time) when off sick. Where is the forward thinking? There is an ‘I want you all or I want none of you’ attitude rather than understanding that sometimes people need extra time to adjust. Surely it is better to get some hours of a qualified and competent OT than none. How often are ‘Fit to Work’ Notes actually used as such?

Occupational Health – I am fairly sure we have all had variable experience with occupational health departments and support for reasonable adjustments. A major point to note here should be why aren’t more OTs working in Occupational Health, or in job centres?

Some phrases that fill me with fury, frustration or wariness are:

“For the needs of the service”/Flexible working (When it usually seems flexible only one way).

“Resilience” – personal resilience should not be the only way to deal with work place stress.

“Absence Management” – The processes and policies of absence management disadvantage people with disabilities and long term conditions. Often they limit how many days/episodes you have off before pushing you up to the next disciplinary stage despite the validity of your time away. Meetings are meant to be supportive but often come across punitive. ‘You are good when you are here but if you have any more sickness you might lose your job.’ There is no acknowledgement that presenteeism of other staff may directly impact on more vulnerable staff and in many workplaces now you are unable to attend health appointments in work time/have to take unpaid leave to do so. Maybe a question for the new Institute of Public Health to consider. Have such policies impacted the take up of preventative health screenings?

A policy was if you don’t reply to a letter inviting you to an ill -health hearing it would take place without you. No attempts to contact. No checking if you even got the letter. No way to pick up if you actually e-mailed someone who then went off sick so your reply wasn’t seen! Considering oftentimes people are off with mental health challenges this is discriminatory.

Social Media Policing and Ableism: ‘I need to talk to you about some things you put on Facebook when you were off sick.’ (Sick people aren’t allowed lives outside of work – and yes I do know there are some people that take advantage of this but you can see the same attitudes in the PIP and ESA assessment processes).

Union Support – My personal experience with union support have been quite variable. I have had excellent support and support where I think things the employer said should have been challenged more. Unions are now direct gatekeepers to legal support too – they will seemingly only refer cases that they are confident of winning. Not many people want to put themselves through a grievance or tribunal so discriminatory employment processes will continue to happen. You don’t want to be without union support but how can you guarantee they are doing the best for you. Often union reps work for the employer and I do struggle to see how they can maintain an unbiased view, let alone truly be supported with time away from their day jobs to help members. Workplaces also refusing to speak to union representatives to arrange meetings, and the ’sick’ person having additional pressure placed on them as a result.

Other Reading:

Do check out last week’s #OTalk on Ableism and covidled by Susan.
Georgia’s #OTalk on Experiences of the Journey from Service User to a Professional which included an interesting discussion on disclosing disabilities to clients.
My post for the Liberal Democrats Disability Association –  (Other political parties are available!)
This news article on Nursing and Disability
In August’s OT News a group of OTs (Rebecca Twinley, Danielle Hitch, Bill Wong, Michelle Perryman-Fox, Diana Sheridan, Sarah Selaggi Hernandez and Claire A Keogh) have written about their experience of neurodiveristy.
And look out for a forthcoming article exploring the experiences of disabled OTs in Canada and the UK.

Questions to guide this #OTalk

1. We’ll start with a refresher question on last week’s topic? Has the covid-19 pandemic opened your eyes to ableism? Do you think things will change in society/for OTs with disabilities as a result? @SusanGriffithsOT and @Occ4LifeLtd
2. During admissions, recruitment or induction when you hear a student/colleague has a disability what are your immediate thoughts? If you have a disability what are some of the things you’ve been asked? Both that have been helpful and that haven’t been helpful. If you are a recruiter have you been on unconscious bias training? Are interviews even the best method of recruiting? @Occ4LifeLtd
3. Do you disclose your disability? When? To Who? Line Manager, Placement Supervisor, Lecturer or University, Colleagues, Wider MDT, Clients? Why/Why Not? What have your experiences been? @GeorgiaVineOT
4. Is there is difference do you think in how OTs with physical and mental health related disabilities are treated? Do you react differently if a colleague goes off with stress, anxiety or depression, than if they go off with cancer? What about neurodiversity? Invisible vs Visible disabilities? Have you ever been directly or indirectly been accused of faking an illness or disability? Why? How did that make you feel? @SusanGriffithsOT
5. What are reasonable adjustments for OTs, and what aren’t? Why, why not? For example should the 1000 hours placement requirement be adjusted for students with disabilities? Could more placements be virtual? Can start times be flexible? Could absence management policies be amended for those with disabilities/long term health conditions? Should we be looking at different, more accessible ways of delivering OT that might work for both clients and therapists with disabilities? @melissa-chieza
6. Staff Wellbeing is Key to Patient Wellbeing – Discuss @Occ4LifeLtd
7. What’s one action you can take back to your workplace today to level the playing field for colleagues or students with disabilities? @Occ4LifeLtd

Huge thanks go to @GeorgiaVineOT, @SusanGriffithsOT, @melissa-chieza, @ABraunizer and a number of people in the DisabiliOT Facebook group for their contributions.
Kirsty @Occ4LifeLtd and @kirstyes


If you’d like to share your story of being an OT working with a disability do consider submitting to ‘We Are OT’

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