OTnews October 2021 | Page 17

OCCUPATIONAL THERAPY WEEK 2021 FEATURE

Challenge inequalities

Rachel Booth-Gardiner # OTsForEquity : Launch event panel member , talks about the action needed
OTnews : What are the main factors that stop a person from achieving their best health ? Rachel Booth-Gardiner : The correlation between lack of access and opportunities is well documented ; the factors preventing this are wide and variable – institutional discrimination , lack of quality education , income , pay and wealth gaps , inadequate housing , unsafe environments , and a health postcode lottery when it comes to what is provided in the place you live .
I work for a mental health trust that covers a large part of the North East , with of the most deprived areas in the country . Demand for services only went up during the pandemic , but where were the news cameras showing the impact of COVID-19 on mental health hospitals and services ? A major factor includes what is in the media ’ s agenda , what is being reported and what is being ignored , and who controls this ?
OTnews : So , how can the profession begin to tackle the factors that create health inequality ? Rachel Booth-Gardiner : By beginning to tackle institutional discrimination within the profession , developing a culture that embraces criticism , listens to voices often not heard , and tackling the issues that arise with compassion and a willingness to change . Ensuring inequities are challenged , the profession needs to become more open to giving opportunities to those that would otherwise not be heard , and promote and develop models of practice that encourage real collaboration and are culturally diverse .
OTnews : Can you give us some examples of work that occupational therapists can do to support people with specific needs ( for example , ethnic and racial minority communities , people living in low income households , or members of the LGBTQ + community ) and to help promote health equity ? Rachel Booth-Gardiner : The very question itself does not embrace health equality . I don ’ t mean this as a criticism . We should take time to look at individual groups , such as the examples given , because all of these groups will have specific needs , but they will also have health inequities in common .
The question misses a large group : about 15 per cent of the world ’ s population , with up to 190 million ( 3.8 per cent ) of people aged 15 years and older having significant difficulties in functioning , often requiring healthcare services . The number of people living with disability is increasing , in part due to ageing populations and an increase in chronic health conditions ( www . who . int / news-room / fact-sheets / detail / disability-and-health ). Disability is extremely diverse and makes up a large part of those using occupational therapy services .
Hui et al ( 2021 ) investigated sources of institutional injustice and the effects on people from marginalised groups with experience of mental health problems . Semistructured interviews were conducted with participants ( n = 77 ) from four groups : people with self-identified experiences of psychosis , Black and Minority Ethnic populations , people not well engaged with by mental health services , and those for whom lived experience was a requirement of their work role . Sensitising concepts emerged through inductive analysis : processes of institutional injustice ( discrediting experience , voice and [ multiple aspects of ] identity ); and outcomes of institutional injustice ( disengagement from formal institutions , reduced affiliation with informal institutions , negative impact on mental health and wellbeing ). The authors suggest that one way of reducing inequalities is through culturally informed approaches , within existing clinical practice and by moving towards a more diverse and representative workforce .
Reference Hui A , Rennick-Egglestone S , Franklin D , Walcott R , Llewellyn-Beardsley J , Ng F … Slade M ( 2021 ) Institutional injustice : Implications for system transformation emerging from the mental health recovery narratives of people experiencing marginalisation . [ Online ]. Plos One , 16 ( 4 ), 1 – 12 . doi : 10.1371 / journal . pone . 0250367
At the very least the work occupational therapists can do to support health equality is to be self-aware , to understand our own privileges . We are after all a majority female , white , educated profession , that will have influenced how the profession has grown .
Occupational therapy services are often misunderstood , watered down and under resourced , becoming part of the problem . Occupational therapy is about understanding what causes barriers to engaging in life , working alongside others to find ways to do the occupations they need to , want to and are required to do .
The profession has the knowledge and skills to fight health inequities , but the system we work in ties us up . Don ’ t be afraid to question and challenge every decision an organisation makes ; the profession should be politically aware and help in the fight against health inequities . We should seek ways to open up access for minority communities to both use occupational therapy services and to become part of our profession .
Rachel Booth-Gardiner , lead occupational therapist for TEWV NHS Foundation Trust , email : rachel . booth . ot @ gmail . com , @ OTalk _ and @ AbleOTUK team member
EVIDENCE LINK
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