OTalk

#OTalk 15th Dec – Improving Representation in OT – Update and Key Priorities for 2021


If you haven’t been able to attend the previous chats do take an opportunity to look at the blog posts/transcripts on the links below.


BAME

Disability

LGBTQIA+ and Gender


In this chat we will be reviewing where we are now and what steps we still need to take in 2021 to take this forward.

  1. What have you learnt about representation and diversity in OT?
  2. What actions have you taken to improve representation in your area?
  3. What challenges/barriers are there to improving representation? And how can they be overcome?
  4. What opportunities can you capitalise on?
  5. What should the key priorities be for OT in terms of improving representation and embracing diversity in 2021?

Thank you once again for your participation in the chats. Don’t forget to purchase your copy of ‘We Are OT’. More details here.

Kirsty (@Occ4LifeLtd)

POST CHAT

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OTalk

#OTalk 17th Nov 2020 – Fatphobia – an Occupational Science perspective – towards #BoPoOT

Trigger Warning: This #OTalk may not be suitable to attend for anyone currently struggling with disordered eating. If you need help and support with this at this time do check out BEAT – https://www.beateatingdisorders.org.uk/.

Watch this video about Ytisebo

In some respects I see this as an expansion to the diversity in OT series but also fatphobia as an issue impacts so much on people in society and within healthcare in particular. In this chat, Sarah, Alice and I hope to expand your awareness on one of the last great “socially acceptable” forms of discrimination.

Alice Hortop is an OT lecturer at UWE who has keen interests in the therapeutic use of humour, hygge and occupation and infertility. @laughingot
Sarah Merton is a Social Sciences student at LSBU exploring the body positive movement on instagram. @sociology_sarah
Kirsty Stanley is an Independent OT who is passionate about ALL OF THE THINGS – but sadly not her own body. She once lost 5 stone with Slimming World but because – funnily enough – losing weight didn’t fix all her life problems has put it all back on and more!
She has recently been diagnosed with ADHD and is just learning more about the food = dopamine connection. @occ4lifeltd

Scenarios

Consider this discussion between friends:

“It’s because I’m fat.”
“Oh no you aren’t, you are beautiful. I don’t like to hear you so down, where’s your cheerful self?”

And this within a healthcare situation:

Person: “I dropped my laptop on my toe and I think it’s broken.”
Dr: “There’s not much we can do about that but have you thought about losing weight?’
“Oh I have lost a stone over the last couple of weeks”
“I thought you looked thinner. Well done.”

Or this scenario:

Walks by a colleague and is eating a biscuit that was brought to a team meeting.

“Be careful, I don’t want to have to buy you a bigger uniform again.”

In the first scenario:
Fat identity is not legitimised.
Thinness is equated with beauty.
Looks are associated with ‘being worthy’.
The ‘cheerful’ fat friend narrative is continued.

In the second there is a danger of alienating people we work with. If all they ever hear is about their weight they they may disengage with services. This may also lead to them actually putting on more weight. It also risks health issues being missed, e.g. rapid weight loss and cancer. Or recognising that bodies change over time. Alice and I have both written about fertility, to access support with fertility issues women are often made to lose weight in order to ‘try and conceive naturally’ and investigations into other medical issues are delayed – creating a vicious cycle with subsequent mood disorders and unhealthy eating patterns. Also BMI has been criticised no end but it is still being used widely within healthcare.

Fat is not a moral failing.
Fat is a feminist issue.

It will have taken that person A LOT to ask for a bigger uniform, to belittle that is traumatic. You never truly know the struggles people have around food.

A summary of Sarah Merton’s research on Body Positivity

My name is Sarah Merton and I am a second year PhD student from the Social Sciences department at London South Bank University. During spring 2020, my online survey went live as part of postgraduate study into the body positive movement on Instagram. It was a tense time. The study was unveiled following 18 months of preparation just as large proportions of the global population entered into state induced lockdown. However, the research experience was one of community and camaraderie. Not words always readily applied in conversations about ‘toxic’ social media spaces.
I received over 500 survey responses submitted by Instagrammers who had used a #BodyPositive hashtag, or as they are more colloquially known, ‘BoPo Warriors.’ Originally, the study aimed to understand whether the Instagram platform could be conceptualised as a ‘protest site.’ Yet it soon became apparent that, although to some the app signalled an arena for hashtag activism and/or feminism, an overwhelming majority regarded Instagram as a therapy space. 71.2% (n=351) of Instagrammers described the platform as a site of solidarity with other women.

The summer was spent reviewing the hundreds of emotive first-hand testimonies generously shared by BoPo Warriors and it made for a heart-breaking experience:
‘After suffering with Bulimia and hating my body for years and dieting over and over again I wanted to find a better way.’
‘I struggled with eating disorders my whole life. I was on instagram telling my weightloss story for 3 years or so before I ran across the hashtag Body Positive and read some of the posts.’
Though the body positive movement is borderless and networked in constitution, the impact of fatphobia, sizeism and weight stigma united dispersed but substantial populations. Diet culture permeated a diversity of cultures. When looking at the most common precursors to joining the body positive movement, eating disorder recovery presented the highest ranked reason for women seeking out connectivity.

In fact, 85.8% (n=429) of body positive Instagrammers said they used social media to share stories of struggle against narrow beauty standards. Beyond the filters, the jiggle and the wiggle, there was another underbelly of brutal biographies. There was shame, blame and weighing scales. The fatphobia that put the fire in those bellies.
The fat female body is endlessly prodded and policed by external agencies from media to medicine. This often prompts an alienation from your own sense of bodily autonomy because it feels like everybody else’s property rather than your own. The summer I spent reading the stories behind the Instagram Stories, belonging to body positive hashtivists, alerted me to the shared struggle beneath the selfies. I had thought that I understood BoPo Warriors, but I only knew the half of it, up until then I never fully comprehended the body battles preceding the Insta-ready performances. The real-life reasons underlying the rallying cries of, ‘Riots not Diets!’

Alice’s poem from We Are OT (available here: https://occupation4life.co.uk/books-by-occupation4life/)

Wearing Grief Alice Hortop

It surrounds me, inches pad my broken body,

As the fruitless years pass, the padding grows,

A physical barrier, consciously and uncomfortably worn.

Visible grief, heavy on my bones,

Heavy with judgement,

And the irony?

The unwanted padding of grief,

Traps you into the childlessness that caused it,

Fat people aren’t allowed to be mothers.

Sea Swimming and Body Positivity – Alice Hortop

A miracle happened after years of fat shaming and desperately trying to shed pounds but actually making myself very ill. I gained weight through the grief of involuntary childlessness. I was refused IVF for being a size 16 at 5’11, I tried for 2 years to lose the weight, only managing to gain a few stone in desperate fad diets and developing IBS. I went on to be fat shamed by social workers when I tried to adopt for increasing to a size 18. I am curvy, voluptuous with a big bust, bum and hips. I was conflicted and outraged that my whole humanity, my human right to have a family, to be a mother recognised by international laws, was reduced to the numbers on the weighing scale. My body abandoned me in my greatest desire to have a family but further left me open to endless cruel and humiliating judgments from strangers in health and social care. It is hard to love yourself, love your body, when you are treated as if you are lazy, weak willed, greedy and undeserving of a family as a result. Everyone should be told they are attractive, it’s really not hard to compliment the warmth in a smile, a sparkle in a pair of eyes, the colour of an item of clothing that flatters or an engaging body language. I found except from my partner and a handful of friends that compliments were rare, especially as I gained weight. Family praised weight loss but in my yoyo weight loss and gain cycle those were few and far between especially when they finished with the deflating encouragement to lose more. I had been a triathlete and surfer in my twenties but stopped due to back and hip issues. I have lived by the sea for most of my life, including now. I have always loved the sea and swimming but never felt body confident, whether a size 10 or 18. A friend up north was raving about wild swimming for about a year, she is inspirational and brave to my mind, but I could not imagine doing it. The previous summer I had been in the sea with my dog as it was boiling, I wore a dress to avoid exposure. I have dozens of bathing suits, always bought in the sale in bigger and bigger sizes but always looked awful. This summer was boiling and I failed to fit into any of my swimsuits. I had a sudden thought, I wondered if they did tall swimsuits. They did! I bought a tall polka dot swimsuit and it actually fit, smaller than the bigger ones that did not! The first day I went to the sea I had an argument with my partner, one of those ones where you disguise the row by arguing through a grimace of closed teeth. In summary I wanted to get as close to the sea as humanly possible before revealing my swimsuit body. In the water I had a wonderful time, laughing out loud and splashing in the waves. The next few times I became less self-conscious and dare I say it brave! Now, I am a fully-fledged mermaid! I recorded my World OT Day 30 sec film on the life affirming occupation of wild swimming, with no makeup and in my polka dot bathing suit in the sea! It’s November and I still go in most days, happily strutting around in my bathing suits… I have many tall ones now! I do not care who sees me having an epic time, often enjoying boisterous camaraderie with the rest of my sea-swimming pals. It is interesting that many of us were body shy but not anymore. Who knew that wearing far less would give us the armour of body confidence we needed. My body feels so gorgeous in the water, how could I continue to hate it? I honestly feel I could teach a lecture in my bathing suit now, my body didn’t let me down, society did.

Recommendations/Key Discussion Points for OT


Activity related rather than weight related (or BMI) goals. A target weight is often never enough – there is always that extra couple of pounds to go.
Support people with access to food, time, routine and skills for food preparation, help them balance alternatives, e.g. is it better to eat 3 moderately nutritious meals, than to eat a ‘perfectly balanced’ salad and binge late at night.
Do not shame or bully people into weight loss – it doesn’t work!
Please don’t buy into the lockdown or post Christmas weight loss narrative – or the shame associated with it.
Consider this for people of ALL genders.
No Body (Type) can be wrong – this is an ableist narrative. Health does not have a look or aesthetic. It can’t be beat into submission, it is not a machine.
No food is naughty.
Be aware of the societal focus on individualistic responsibility. What about the mantra ‘wealth over health’.
What whole society changes could we support, e.g. governmental responsibility vs Marcus Rashford – MacDonald’s offering free meals. Deprivation and Gluttony dichotomy. Conflicting messages.
Don’t assume that people are using instagram passively – when they are actively engaging in social justice issues around Body Positivity.
The joy of movement – joyful movement. Exercise for the fun of it and not to burn off calories. Dance like nobody is watching. If you do exercise that you don’t enjoy it stresses the body. (https://www.theactivetimes.com/fitness/why-hate-working-out-science).
Recognise people’s lived experience.
Consider all of this when working with “bariatric” clients.
Obesity related conditions often related to the stigma rather than the weight itself (https://onlinelibrary.wiley.com/doi/abs/10.1111/spc3.12172?fbclid=IwAR1sc3zgtdwojzg64n04KyMUMEqF3tUzwQR3-2cF0qd8kLRkOxu-A6J4_AA)

Questions for the chat

  1. Share an image of the “perfect” body type? Why? How does that make you feel about your own body?
  2. Fatphobia and Body Positive Occupational Therapy #BoPoOT – what do they mean to you?
  3. After the Prime Minister’s ‘War on fat’ what steps will you take to be ‘fair on fat’?
  4. How can we support people to live their lives in a body positive way, love their bodies, and step back from the need to strive for the stereotype, whilst also promoting health and wellbeing?
  5. Can instagram/social media be reclaimed as a protest space and a therapy/recovery space?

We would love to start a #BoPoOT Movement. Share your thoughts and reflections (and images if comfortable to) using the hashtag.

Resources

Embrace by Taryn Bumfritt
https://bodyimagemovement.com/embrace/

Hope Virgo petition – stop calories being listed
https://www.change.org/p/eating-disorders-are-not-just-about-weight-dumpthescales

Fat chat podcast
https://twitter.com/FatChatPodcast

Fattily Ever After – Stephanie Yeboah
https://www.goodreads.com/book/show/50693537-fattily-ever-after?ac=1&from_search=true&qid=6mpXwY5Z0b&rank=1

Happy Fat – Sofie Hagen
https://www.goodreads.com/book/show/42653524-happy-fat?ac=1&from_search=true&qid=iOsQXXcKh1&rank=1

Shame, Blame & Weighing Scales – Sarah Merton
https://atcconference.wordpress.com/p29-sarah-merton/

Fat Shaming and RSD

https://www.additudemag.com/fat-shaming-rejection-sensitive-dysphoria-adhd/?utm_source=facebook&utm_medium=Social&utm_campaign=adult&fbclid=IwAR0ELlnlhCsDTeDiLtm7j2EhVZy79YoFqahXhwP34U-15-IptrIsX_9xMI0

“Social distancing is something I am good at…” Bjarne was isolated living with obesity.
https://www.truthaboutweight.global/global/en/people/bjarnes-tips-on-obesity-and-covid-19.html?cid=ps-tw-dp-img-obe

An Evidence-Based Rationale for Adopting Weight Inclusive Health Policy (Hunger et al)
https://spssi.onlinelibrary.wiley.com/doi/abs/10.1111/sipr.12062

Woman overcomes BED
https://metro.co.uk/2020/09/23/woman-overcomes-binge-eating-disorder-body-dysmorphia-walk-across-tower-bridge-underwear-13181200/?ico=taboola_feed_desktop_entertainment%3Fito%3Dcbshare&fbclid=IwAR3pLk0dxqOO5mPoqO8dJludIx2ekzRYzAi1zo_rtPbw61CtVzBxPKWnIHo

Weight Stigma 101 by Dr Carolynne White

https://t.co/RTY3q5Gy1qhttps://t.co/RTY3q5Gy1q

A few Body Positive Companies – Share your favourites in the comments below
Snag Tights
Dove
Simply Be

Diversity and Justice in OT, OTalk

#OTalk 27th October 2020 – Improving LGBTQIA+ and Gender Representation in OT – #OTalk Series (UK Focus) –

Welcome to the third in this #OTalk Series on Improving Diversity in the OT Profession with this one taking part next week on #WorldOTDay.

Do check out the transcripts of our previous chats here – on BAME https://otalk.co.uk/2020/07/13/otalk-21st-july-2020-improving-bame-representation-in-ot-otalk-diversity-in-ot-series-uk-focus/ and Disability https://otalk.co.uk/2020/08/23/otalk-25th-august-2020-improving-disability-representation-in-ot-otalk-series-uk-focus/ Representation, and do also put the 15th December in your diary for an Update on where we are now and to take a look at what our key priorities for 2021 should be in order that we keep taking this forward.

In the UK-based context of societal assumptions of cisgender* and heterosexual ‘normatives’, this chat is actually exploring two different aspects of diversity – gender identity and sexual orientation, aspects of diversity which are commonly summarised and abbreviated under the umbrella of the LGBT+ acronym (lesbian, gay, bisexual, transgender and plus representative of additional diverse identities for example, queer or questioning, intersex and asexual). These two topics often get conflated and confused, and so they are combined not because they are one and the same, but to try and dispel some myths and misconceptions.

*cisgender (cis) is the word used to describe people whose gender identity, their personal experience of gender, is aligned with the sex with which they were assigned at birth.       

Transgender (trans), in its’ simplest and most encompassing sense, is the antonym of cisgender and, again in its’ most encompassing sense, is the term used to describe gender identity not congruent with sex assigned at birth.

Similarly, non-binary is an umberella term for people whose gender identity may sit outside of the polar binary of male or female. Non-binary people may or may not identify as trans and vice versa.

Please see AOTI’s excellent 2019 publication LGBT+ Awareness and Good Practice Guidelines for Occupational Therapists (available at: https://www.aoti.ie/news/AOTI-LGBT-Awareness-and-Good-Practice-Guidelines-for-Occupational-Therapists or refer to https://www.stonewall.org.uk/ for further consensus definition of terms.      


With huge thanks to @hspenceruk and @Hunter_2802 for their input in preparing this chat and accompanying blog post.

First up I think that when people think of gender representation in OT they, like me, have a tendency to think of the binary – i.e. that there are more female than male OTs. In thinking this, are we perpetuating societal binary ‘norms’ and overlooking the diversity of gender identity and expression beyond the commonly perceived binary? And what implication does this have in terms of diversity, wellbeing and accurate representation of our workforce? The image below is a helpful visual representation of how we may consider and understand gender beyond a polar binary, but do take a look at the link https://www.genderbread.org/resource/genderbread-person-v1 for the original image and a discussion about its limitations.

Genderbread Person Image  which features a gingerbread person and 4 'scales' which look at Gender Identity, Gender Expression, Biological Sex and Sexual Orientation.



Hannah (@hspenceruk) has particular interest in this topic area and completed their MSc research project around understandings of gender variance and relevance to occupational therapy practice from which they intend to publish in due course. In the meantime, they had this to add:

Acknowledgements of multiple-fold injustices (occupational, health and otherwise) experienced by trans, non-binary and gender diverse populations are plentiful alongside what are arguably longstanding societal assumptions of cisnormativity. With respect to healthcare settings in particular, a report recently published by the LGBT Foundation (2020) highlighted  that ‘80% of trans people experience anxiety before hospital treatment due to fears of insensitivity, mis-gendering and discrimination (LGBT Foundation, 2020, p.60)’. Though potential campaign agenda biases must be acknowledged, similar statistics are echoed through research by the likes of Stonewall and the Government Equalities Office, easily obtainable through a quick Google search.

A lack of understanding among multi-disciplinary healthcare professionals across general health care services is a dominant theme throughout research such as that cited above, though there is a relative absence of either occupational therapy-specific research or mention of occupational therapy elsewhere. This essentially reiterates that theme of lacking knowledge and understanding of the specific needs and experiences of trans, non-binary and gender diverse populations, particularly with respect to specific occupational needs as are the unique focus of our profession. Take, for example, our pre-chat challenge (see below).   

What does all of the above mean for us as occupational therapists, evidence-based professionals, working towards optimum health, participation and quality of life for our service users and as part of a diverse workforce?

With respect to sexual orientation, Hunter (@Hunter_2802) previously carried out a literature review around LGB (lesbian, gay and bisexual) identity disclosure as part of his research project and subsequent conference presentation entitled  ‘In Or Out?? Which is it to be? and What do OT’s need to know???’ from which, together with experience in practice, he draws below:

As a gay OT, I felt sexual identity disclosure has significant occupational impacts, as we are all occupational beings. I want to make a point, this research was done in 2015, so there may be more articles published since. However, at the time the following findings were identified and since this, in practice I have experienced and observed similar issues. And so,  a summary of key elements of my research that are most relevant for all OT students, OT’s and academics. The 8 themes were:
        1)       Disclosure and Non-Disclosure have negative and positive health and wellbeing implications.
            2)       Support systems have a significant impact on disclosure and are impacted by disclosure with both perceived and actual negative and positive implications.
            3)       Identity is significantly impacted by disclosure and non-disclosure or repression.
            4)       Demographical factors such as age, religion, culture, ethnicity and social economic status have impacts on individual disclosure/non-disclosure.
            5)       Disclosure is a process often beginning with self-identification/self-disclosure, disclosure to friends and then family; with different extents of disclosure.
            6)       Fear of perceptions, expectations and actual reactions has significant implications on occupation, health and wellbeing.
            7)       Occupational and activity based impacts emerged significantly as a result of both positive and negative disclosure experiences.
            8)       Heterosexism and Homophobia were commonly experienced which had implications on individuals occupations, health and wellbeing through disclosure and non-disclosure.

            I’m not going to go into the themes in details, but the key points involved were people would need to self-affirm and self-disclosure prior to disclosing to close friends, then if positive experiences were to happen they would disclose further, if not then they would not. However; the impacts of this was that where positive experiences and affirmation happened; internalised homophobia was diminished, yet where this was not the case it reduced future disclosure.

            More importantly, disclosure in itself was identified as a need. Disclosure had impacts on identity, where negative experiences and non-disclosure occurred it could fragment identifies; with development of heteronormative identities for self-preservation from stigma and threats   to traditional expectations of the individual. Disclosure also had impacts such as conflicting with cultural identifies, which as Occupational therapists, we know identity is core to activity  and vice versa.

            People with negative disclosure experiences had detrimental impacts on mental and physical health, occupational participation, engagement in detrimental occupations, increased risky sexual behavioural and detrimental impacts on vocational/academic performance. Conversely, positive experiences increased self-acceptance, and a core characteristic of positive disclosure experiences is the presence of positive relationships. On the other hand, there were fears of losing family, losing work, losing friends and impacts on occupational performance and satisfaction. Positive relationships are a key part of positive disclosure experiences; having an affirmative and positive LGB environment also led to positive experiences of disclosure, with increased occupational satisfaction and participation.

            Finally, in terms of demographics, due to what’s going on I am going to focus on Race and LGB identity. With Race, individuals experienced a dual level of discrimination; with experiences of racial and sexual identity disclosure also having negative impacts. So Race is a key factor, but also considering more people are coming out at a younger age another factor to consider is have their coping mechanisms to manage reactions to disclosure matured/developed enough, or do they need support with that.

            Implications
            Occupational Therapy emphasises dignity and equality, but to do this the profession needs to recognise and challenge the heteronormativity and heterosexism that exists. By doing this, positive LGB disclosure environments and interventions can be developed and facilitated. It is clear the therapist is responsible in providing the appropriate environment, tools and skills to facilitate this so as to enable optimal occupational satisfaction, fulfilment and participation. However, without knowledge about disclosure and its impacts, it is something that cannot be expected to be put into practice within Occupational Therapy.

            In the process of conducting my review, there was a significant lack of LGB identity disclosure literature within the Occupational Therapy/ Science fields. This lack of evidence indicates a lack of education is identified. Having knowledge about disclosure is important, not just to provide equitable and equal assessment/intervention, but also to provide a safe and inclusive profession where both therapists and students can be their authentic selves. Hence there is a key need for an education base surrounding disclosure and sexual identity which would enable our students, academics and practitioners to develop practices to be more      inclusive and person centred. Furthermore, the lack of research specific to this endeavour was concerning considering it is a topic which is so socially important and impacts on mental and physical health.


            While I have had some experiences myself which for now I will keep personal, the many experiences of other LGB OT practitioners I have spoken to have shown me that heteronormative practices and heterosexism being pervasive throughout teams, practices and places of employment. These can leave you feeling isolated, outcast and discriminated against, which is why the call for research, education and continued professional development is ever more important; not just to better ourselves and better serve our patients/clients/service users, but also so we can be that truly person-centred profession with positive affirmative environments in which we can work and also gain that occupational satisfaction, participation and enjoyment!


Chat Questions

We have a challenge for you before the chat. Pop the word Transgender and the acronym LGBT into any of the OT Professional Bodies web pages, RCOT, WFOT, AOTI etc. and try the Physiotherapy ones, e.g. CSP, too. What did you learn?

1. What did you learn from the pre-chat challenge? What is your reaction to this?

2. Do you perceive Occupational Therapy as a profession to be informed and inclusive with regards to specific needs of LGBT+ populations as service users and as part of the workforce? Do you think that it is necessary/relevant for OTs to have knowledge and understanding of LGBT+ identities? (Why/why not? If yes, how could this be best facilitated?)

3. Do you feel you provide colleagues and clients with safe spaces to live authentically? Are you aware of any commitment to LGBT+ needs within your workplace setting?


4. Having read the blog post and considered answers to the above, what does that mean for us as occupational therapists, evidence-based professionals, working towards optimum health, participation and quality of life for our service users and as part of a diverse workforce?


5. Are there any actions you have taken to increase knowledge and understanding regarding the specific and diverse needs and experiences of LGBT+ populations? What actions will you take forwards to make your workplace more inclusive with respect to gender and sexuality?

Releasing on the day of this chat, and World Occupational Therapy Day – 27th October 2020 is the e-book – ‘We Are OT’ that serves as a space to discuss the benefits and challenges of being a ‘diverse’ part of the OT workforce. It uses narratives to pose reflective questions to challenge your practice, and looks at how you support and uplift your colleagues.

The ebook will be priced at £1.99 with the option of adding an additional donation. All profits to go to a scholarship fund. The link to buy will be on my website on the 27th Occupation4Life.

Kirsty

OTalk

#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’

Diversity and Justice in OT, OTalk

#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)

https://www.youtube.com/channel/UCb722uXf9XJpegA_d-ApBUg

 

*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/