#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’

#OTalk 21st July 2020 – Improving BAME Representation in OT – #OTalk Diversity in OT Series (UK Focus)

With the #BlackLivesMatter movement sending ripples around the world on top of the #COVID-19 pandemic, efforts to adjust to the ‘new normal’ are underway and the #OccupationalTherapy profession is no exception. Over the years there has been repeating and intermittent awareness of the need to increase inclusive representation within the profession. Talk needs to be followed by action, and more needs to be done in order to lead to sustainable change. We need to address the systems and processes that make real lasting change difficult. It is not just about making people who don’t usually represent the typical presentation of an #occupational therapist, fit the mould, but about embracing the diversity and strengths that widening access and participation has to offer our profession, and more importantly the people we serve. Moving forward we need to continue to build alliances within the professional membership, regardless of skin colour and ethnicity, to have a depth of impact in change. We can do this as a profession with the help of local activity, diverse local champions, diverse local leaders and @theRCOT.


This #OTalk presents an opportunity to share our thoughts on this subject, in light of the recent #BlackLivesMatter events and the public health report highlighting that #BAME (Black Asian Minority Ethnic) communities are disproportionately affected by the COVID-19 pandemic.


We would like to emphasise (and for the RCOT to take note) that focus on the BAME community should be regularly reviewed and discussed. This will keep the subject an explicitly ever present agenda for the profession in order to challenge and change structural based inequality. We also acknowledge that while the term BAME can be problematic, it can be helpful for exploring issues of representation. If in doubt ask the person their preferred term of reference.


This discussion on occupational therapy and UK-based BAME communities is part of an #OTalk series on topics of diversity. Other topics to be explored later include: Disability (including Neurodiversity), LGBTQIA+ and Gender Issues.


Some preliminary groundwork in preparation for this series is encouraged:


  • Look Deep. Acknowledge any privileges you may have. This resource on Privilege and Intersectionality may help: https://guides.rider.edu/privilege
  • Come to the chats with an open mind and heart and be prepared to feel uncomfortable – it is through discomfort that we can begin to make the necessary changes.
  • We need to unite to be actively against (anti) any forms of prejudice / oppression.
  • As always, respect each others’ views and acknowledge that there will undoubtedly be differences of opinion.
  • Develop an awareness of microaggressions and be mindful of how they may impact the colleagues you are interacting with on this topic: https://www.vox.com/2015/2/16/8031073/what-are-microaggressions
  • Accept that you will make mistakes and if these are pointed out, reflect on them and make the necessary changes.
  • Be clear about the differences between Inequality, Equality, Equity, and Justice. Check out this graphic created by @lunchbreath based on Shel Silverstein’s The Giving Tree.

Questions for the #OTalk chat will be as follows:


1 A) How ethnically diverse do you perceive our profession to be now? B) Has this changed over the course of your time as an OT? (Q Hosted by @Occ4LifeLtd)

2 A) Why would we want to encourage more people from BAME backgrounds to enter the profession? B) Does the OT staff group in your area represent the population you serve? (Q Hosted by @sherriikapp)

3 A) What racial / cultural discrimination have you experienced, seen or even perpetrated (even unconsciously)? B) What did you do about it? (Q Hosted by @KwakuOT)

4 A) What barriers do BAME occupational therapists face for progression into roles in leadership, academia and research? Please refer to the list of questions prepared by @HannahtheOT https://twitter.com/HannahtheOT/status/1267852336443150341 (How many Black lecturers / placement educators / managers have you had? Can you name 10 Black OTs you’ve worked with throughout your career? Can you name 10 white OTs? Name an OT theory, model or standardised assessment developed by a Black OT? How many articles/books have you read that were written by a Black OT?) (Q Hosted by @MwelaSihle)

5 A) What responsibility do you / will you take for exploring and educating yourself on issues of race and culture? B) What is one change you can make tomorrow? (Q Hosted by @LecturerMish)


Some useful resources: 


*Will COVID-19 be a watershed moment for health inequalities: https://www.health.org.uk/publications/long-reads/will-covid-19-be-a-watershed-moment-for-health-inequalities


*AHP Leaders Podcast: Changing the Culture of Conversations (featuring AHP leaders from across the UK)



*The OT & Chill @ot_chill podcast, Episode 11 – L . O . V . E – Let’s Talk About Race #BLACKLIVESMATTER: https://open.spotify.com/episode/4sPh0qghwAiozaXLSM0re2


Akala deconstructs race, class, and Britain’s modern myths | Unfiltered with James O’Brien #32 https://www.youtube.com/watch?v=atfVUgyEIOI


Dr Karen Whalley Hammell WFOT Congress 2018 keynote ‘Building globally relevant occupational therapy from the strength of our diversity’ https://www.youtube.com/watch?v=9WipUPXx_Kk&t=7s


*George Floyd, Minneapolis Protests, Ahmaud Arbery & Amy Cooper | The Daily Social Distancing Show https://www.youtube.com/watch?v=v4amCfVbA_c


Hey White Therapist! Here’s where we start! https://courses.clearlyclinical.com/courses/free-ceu-racial-awareness


Why I am no Longer Talking to White People About Race by Renni Eddo Lodge: https://www.theguardian.com/world/2017/may/30/why-im-no-longer-talking-to-white-people-about-race (this is the preview article for the book)


Guidance for white allies who are trying to help https://ladders4action.org/news-blogs-videos/blog/do-no-harm/


Why “I’m not racist” is only half the story by Robin DiAngelo https://www.youtube.com/watch?v=kzLT54QjclA (a good summary of her book ‘White Fragility’)




A few real life scenarios to get you thinking:


In one occupational therapist’s work place it was identified that approximately 50% of inmates in a prison setting are from BAME backgrounds, with only 10% accessing occupational therapy services. Many reported discomfort in accessing services as they felt that the staff body was not representative of their backgrounds and lacked understanding of where they were coming from.


A Black occupational therapist received comments from a supervisor which suggested that they were perceived as lazy and uneducated. This Black colleague felt they had to work ten times as hard as white counterparts and also sees white colleagues get away with things they are reprimanded for.


A white Muslim occupational therapist who wears a hijab went to an interview and saw visible shock on the interviewer’s face. Feedback suggests that she couldn’t have answered the questions differently but she wasn’t offered the job.


A Black student turns up to a university admissions interview wearing jeans – they demonstrate more knowledge and insight than a white student who comes wearing a suit or smart attire. Which applicant gets awarded a place on the programme?


This #OTalk session and blogpost was made possible through the contributions of:


Sihle Mwela @MwelaSihle

Kwaku Agyemang @KwakuOT

Jo Bresi-Ando @otStones

Musharrat Ahmed-Landeryou @LecturerMish

Elaine Rutherford @Cariad_OT

Jou Yin, Teoh @teohjouyin

Grace Chikelu Amamilo (not on Twitter)

Kirsty Stanley @Occ4LifeLtd or @kirstyes

Somia Jan @SomiaOT

Carolyn Connage @CarolynOT

Nichole Yam @nicholeyam

Ed Sum @musedNeuroOT

Sophia Awan @Sophia OT

Yasmin Anisuddin Ward @Yazz_OT

Geraldine Kinkead-Richards @GeriLKR

Hannah Daisy @HannahtheOT

Simone Welch @Simzy_x

Ally Plusii @Ally56642911

Sheri Braimah @sheriefeb


One change our group thought was that RCOT could easily introduce is to appoint an Equality and Diversity Officer dedicated to organising research, study, networking and publicity events, and for influencing policy. A diversity mentorship / support scheme was also suggested to provide opportunities for people to discuss common issues. It would also be useful to have some dedicated webpage resources similar to those on the CSP website – https://www.csp.org.uk/workplace/equality-diversity. Do keep informed on the RCOT progress following the RCOT BAME Big Conversation – a summary of which will be posted on their new Equality, Diversity and Inclusion pages here – https://www.rcot.co.uk/equality-diversity-and-inclusion


Some immediate actions you can take: 

Vote for Dr Kee Hean, Lim @lim_hean to be member of the RCOT Council. He is the sole candidate to represent the BAME population and has a long, consistent track record of enabling equitable student recruitment and retention at Brunel University London. The Brunel University London student body has 30-50% BAME representation thanks to the efforts of Kee Hean and his fellow admissions tutor Dr Ayana Ifekoya. The Brunel University London occupational therapy team have a tweet thread documenting their recent efforts contributing towards Racial and Cultural Equity: https://twitter.com/OTatBrunel/status/1281145935502942209

Please consider answering the call for stories, poems, comics, etc for an eBook “We Are OT: a brief history and personal accounts of diversity in the profession of occupational therapy within the UK” to be published on World Occupational Therapy Day 2020. https://occupation4life.co.uk/2020/06/05/we-are-ot/


Occupational Balance – Saying Goodbye to Valued Occupations

I’m sure the astute among you will notice that I, @kirstyes, haven’t had much involvement in #OTalk of late. New members may indeed wonder who I even am.

When I helped co-found #OTalk six years ago I was in a very different place in my life. I was lecturing in OT and OTalk was a way for me to keep in touch with lots of different aspects of Occupational Therapy and to look at engaging with Occupational Science too.

Tuesday nights were part of my routine and if I wasn’t hosting a chat I’d be taking part in it. It was an extension of my day job AND a leisure activity.

Now I’m back working part time in clinical practice in a specialist field and I started to find that #OTalk started feeling less like fun and more like work. Not in a bad way and the team and the community are awesome but I was finding my capacity for it had diminished.

I won’t bore you with the details but I’ve had my battles with depression and fatigue and I’ve had to consider where to spend my time and energy.

Those of you who have stuck with me through my absence will have spotted that what time that I don’t work I spend reading and doing booky things and may know I harbour an ambition to be a published fiction author. Well it is time for my previous valued occupation to step aside and to be replaced with writing and editing.

I’ve loved my time on the team and have been honoured to work with some fabulous people past and present. It has been great to see the student interns develop into competent practitioners and join the team as full members and I hope the team continues to take on new OT talent and support the OT community with their CPD.

I have asked the team if they are happy for me to still share a connection with #OTalk as Sponsor (I’ll continue paying for the ongoing techie side of things – I’ve also offered research proofreading skills). I’m off to do some CPD this weekend at the MS Trust Conference and in time maybe I’ll pop back to take part in the odd chat.

I hope some of you still consider staying with me on twitter. Especially if you like books, after all if I get one finished I’ll need some people to buy a copy 😜.

ke Hogwarts – OTalk will always be there to welcome you home. We all belong to the Order of the Phoenix.

So, it is with some sadness and also much gratitude that I say goodbye to OTalk and welcome space for a new balance of occupations in my life.

How have you found saying goodbye to valued occupations that you have taken part in?

#OTalk 13/9/16 – Media Club: The high price of criminalizing mental illness: Wendy Lindley at TEDxOrangeCoast

This #OTalk will be hosted by @BillWongOT

Mental health is an area we have core knowledge at as OT practitioners. We at least sometimes work with patients with mental health diagnoses across the lifespan- from kids to criminals. And for those of you who work in forensics/mental health settings, I am pretty sure this TEDx Talk will hit pretty close to home to you. Although I don’t claim to be a mental health expert, I think it is an awesome TEDx talk to do a media club on because we might see criminals with mental illness across different stages of life. From pediatrics point of view, it can be prevention in form of education of making appropriate life choices. From forensics mental health point of view, it can be relapse prevention of preventing them to commit crimes again. From geriatrics point of view (my current setting), it can be rehabilitation to maximize their quality of life.

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