The professional and personal journey of a Senior Psychiatrist of colour in an unnamed mental health trust is the focus of a new four-part blog series: 'Surviving at the Frontline'. Written during the pandemic, she shares her challenges around race, privilege, gender bias, structural and interpersonal racism, as well as her own mental health journey as a clinician of colour. She says: “It isn’t the volume of work that burns one out. It is the moral injury of being a part of decisions, conversations and a culture that is completely misaligned with one’s core values.”

Synergi Collaborative Centre Stroke

The colour of justice in leadership

In my first blog post for the ‘Surviving at the Frontline’ series, I signed off with the intention to start the work of ‘justice from within’. Since then, I have wondered how much of that was about retreating into my own mind and body to recover some control versus the Gandhian belief of “Being the change we want to see” which is an arduous yet correct path.

For me, it is about identifying one’s purpose and living by the values that uphold it. This cannot be confused with mission statements and the values we see etched upon the walls and windows of organisations when, behind closed doors, the story is misaligned. In such circumstances leadership, speaking up and even self-care become a matter of ‘political warfare’.

Are we all given a level playing field for self-actualisation? Do we all have the same degree of control and power over our purpose? Do we all have the freedom to define our own leadership styles within institutions?

These questions have cause me to reflect upon the intrapsychic, interpersonal and group dynamics of oppression. There can be no ‘racism’ without (an) other. Like the Paediatrician and Psychoanalyst Donald Winnicott famously said, “There’s no such thing as a baby; only a mother and baby dyad”

Racism is relational. It’s a dynamic. It affords power to the oppressor to project unwanted aspects of their own psyche onto the ‘other’. When groups do this collectively, based on race, religion, nationality and gender, we see racism, fanaticism, nationalism and sexism at play.

Throughout this pandemic, I have found myself both challenged by and challenging various notions of oppression. For example, I have watched too many of my colleagues of colour being told that they require more training and education when asking for career progression while the real opportunities get showered upon those closer in proximity to power and whiteness.

Before Covid, I tried to keep an open mind, to keep the value of meritocracy alive in my heart because without this hope, it would be difficult to justify my parents coming to the UK from India. My parents wanted the security, believing that the outcome would be proportional to the effort made, no matter who you were, where you came from or who you knew.

So I put on a façade of calm when asked to step down from a Consultant post to a staff grade role at a trust that I had newly joined. The fact that I held a certificate of completion of training and had been a substantive Consultant for two years wasn’t enough. The reason I was given was that I lacked leadership skills.

I was employed as a locum to backfill the clinical work of two colleagues who were promoted to ‘leadership’ roles within the organisation. I was told in no uncertain terms “We need someone to mop up the shit here and you are not doing that”.

Now picture these white colleagues saying this to a woman of colour who holds the same qualifications and experience as they do. I dare you to not imagine a single colonial image. Who here is playing the race card and what is it like to be on the receiving end of this game?

I enrolled on two NHS Leadership Academy courses consecutively, to learn about leadership and refused to step down, as requested. However, the hurt of being told that I wasn’t good enough for a job that I was fully qualified for and experienced in creates a dent in one’s trust in the system and inspires the rise of primal and ancestral rage with nowhere to go.

At the Academy, the most valuable learning came from the lived experiences of other participants rather than theoretical models. “What is it like to be at the receiving of me?” was a central question we were asked to reflect upon to develop reflexive learning.

I contemplated deeply about our NHS – its formation, its history, its invitation to healthcare professionals of colour, such as my grandfather, before I was even born. I tried to visualise how our ancestors carried the NHS on their shoulders over generations.

Images flashed across my mind: of my mother sobbing at having to start as a house officer when she was a Consultant back home. My father being ridiculed for his pronunciation of ‘potato’ at the hospital canteen and deciding to go hungry instead. My grandfather’s GP practice being vandalised with ‘Paki, go home’. This intergenerational oppression goes back many years when there were no leadership courses for leaders of colour.

Against this historical context, who gets the chance to be on such courses now? New leaders. Where are most staff of colour positioned? In non-leadership bands. And for those of us who have the privilege of being a new leader and secure an Academy place, how do we answer the question of ‘What is it like to be on the receiving end of me?’ within an institutionally racist NHS?

We know all too well what it’s like to be on the receiving end of us. It evokes fear, rivalry, disdain, stereotype and conscious bias – the full catalogue of ‘othering’ projections. And dare we call it out, we are perceived and received as angry black women, playing the ‘race’ card, behaving hysterically (at best) and mentally unstable, unwell and of high corporate risk, and even dangerous (at worst).

The word ‘leadership’ has a nebulous definition in the NHS. A place where the snowy white peaks afford the ‘male and pale’ the power to brand good leadership on their own terms. Will this truly ever change?