18 minute read
CULTURALLY-SAFE SUPPORT
from NR Times issue 23
Delivering culturally safe support to South Asian clients
After marking South Asian Heritage Month,
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Shabnam Berry-Khan, director and clinical psychologist at Psychworks Associates, shares why the traumatic experiences of people coming to the UK in previous generations continue to impact today - and why, for that reason, a wholly bespoke approach to trauma within this community is needed from medico-legal professionals
Recently, we have marked South Asian Heritage Month (SAHM), from July 18 to August 17. It is significant as an opportunity to celebrate the South Asian contributions to the UK - currently there are around two million South Asian people living here - and to recognise stories from these times, both positive and difficult. This year, additionally, SAHM commemorates two key milestones - the 75th anniversary of the partition of India into India, Pakistan and Bangladesh, and the 50th anniversary of the Ugandan expulsion of South Asians by Idi Amin. SAHM has been marked by us at Psychworks Associates and is a topic that is dear to my heart - not just because I’m a brown person whose parents were both refugees in the respective India and East Africa crises. But also because, as a psychologist, these experiences will be alive and active in brown clients that we all see. Regardless of whether it is their direct experience, and regardless of their awareness of it. South Asian people make up the biggest minority group in the UK - but what is commonly known about their experience? And how does and should that experience impact the work we do with them? For many of our South Asian population in coming to the UK, there is often trauma associated with that - this can stem from within their family and heritage and can impact for generations to come. You can learn more about the reasons for this in our Q&A below. An interesting paper that came out this year by Prajapati and Leibling (https://link. springer.com/article/10.1007/s40615-02100993-x) highlighted how South Asians feel about engaging with professional mental health services.
Notably, these stood out for me: > How seeking help triggers powerlessness and threat, and how behaviour changes when anxieties are heightened. > The importance of collaborative care: Service users described experiences of feeling disempowered and dehumanised when accessing services. > The importance of the input including family and friends: service users often valued the presence of family members for reassurance and support and felt services did not always value family input, seeing it as a hinderance. > Language is important to feeling like a service hears them in a way they want to be heard, because sentiments can be lost in translation. > The importance of trust in the professional relationship which can be enhanced when professionals look like them or can demonstrate at all times a sensitivity to the impact of cultural experiences on daily living.
If you look beyond the mental health context, many of the themes will apply to our work as personal injury professionals. As a traumainformed psychological service, trauma and its impact is central to how we at Psychworks Associates approach our cases.
We know that traumatic experiences: > present in so many different ways: anger, low mood, compliance and conformity, outbursts, disengagement, calling out bias, feeling unsafe with unfamiliar others. > exist in the mind and body, so while we might understand the psychological effects, we also need to remember that the body also feels the effects (presenting as increased pain, worsened chronic conditions, somatisation etc). > are intergenerational and are transmitted down the lineage, so a grandparents’ direct experience in 1947 will be experienced in some way in 2022 by the grandchild (who may be our client or grandchild) > trigger other possibly unrelated traumas such as being bullied, ACEs, DV etc. and so what we see is an accumulation of traumatic experiences.
This is very applicable to the experiences of many South Asian people, and is something we should bear in mind not just during SAHM, but beyond that, and into the experiences of other people from other diverse backgrounds. At Psychworks Associates, we are passionate advocates of the need to implement equality, diversity, inclusion and belonging within our daily lives. We believe developing an inclusive and equitable service must be at the heart of any organisation. Collectively, working within the medicolegal sector, we have a long way to go in effectively challenging long-held practices and approaches - but we are proud to help lead the efforts in providing diverse, inclusive, equal care to increase a sense of belonging and cultural safety. As a takeaway from SAHM particularly, we see that without engaging with these changes, South Asian people will be labelled unfairly as hard to engage and easy to ignore. Here are some questions and facts about the South Asian communities that you may know personally or professionally, and a little about the stories they have lived and heard. “From empires such as the Mughal, the Duranni, the Vijayanagar and the British, from indentured labourers forced to travel to the Caribbean and East Asia, and other migrants who travelled by choice to Africa and beyond, to the journeys that families made to the UK with just £3 in their pockets, we have all been affected by the journeys of empire.” - SAHM website
Did you know that up to 20 million people migrated to/ from India in 1947?
A huge number, making it the largest forced migration and refugee crisis in living history. Once the British left the colonies, communities were realigned according to religious beliefs and up to 2 million people were thought to have lost their lives while being displaced. My dad was a refugee moving from India to Pakistan as an eight-year-old. He found the most upsetting part was having multi-religious communities and neighbours suddenly turn into enemies overnight. It was frightening: many people feared for their lives and others did not make it. Rebuilding their life was not easy either, but what choice did he and others have? 27,000 of these displaced Indians went to East Africa to start afresh. However, when ‘Africanisation‘ policies started in 60s, following independence from Britain, the same brown people who had came to seek refuge 20 years earlier, became again a persecuted group. Many came to the UK. My mum was a survivor of the East African expulsions. She was one of the lucky ones whose family voluntarily left only a couple of years before many were forced out. The sadness of leaving her home with whatever they could carry in such an uncertain times was masked by the relief of arriving her family in tack. For those who stayed behind in a newly carved up Indian subcontinent, they had to start from scratch - despite being from the same original land. It became a hidden refugee experience which isn’t always recognised because migration outside of original India was not made.
What was it like arriving in the UK back then in the 60s?
For the vast majority - possibly including for our clients or their parents/grandparents - the hardship and struggle continued. The Brits were unwelcoming and unhelpful towards those arriving as refugees who had left their lives behind. Housing was difficult to get, employers were reluctant to offer roles to brown people who were suitably qualified and spoke English. And racism and prejudice was explicit resulting in the next generations - including me - being told directly or indirectly “to keep my head down…not to do anything to draw negative attention…don’t think people here like you”.
What does this mean for brown people in the UK today and for those of us with brown clients?
The plight of brown people in recent history as a ruled people for 200 years, who then turned into refugees, and who then faced and can still face significant explicit and implicit racism while trying to survive is important to acknowledge and recognise. The immediate reaction might be the overwhelming sense of loss and grief, the stress and fear of starting over, the disbelief that this has happened to you and helplessness that might ensue, let alone an overwhelming sense of injustice and anger that people can be allowed to treat others so disrespectfully. The impact on brown peoples mental health is immense. Trauma and anxiety affects relationships, parenting, the ability to engage - pretty much someone’s entire life. This can also be heightened by the disengagement many feel through the apparent ‘need’ to confirm to Eurocentric practices. And we also know how trauma can present and affect social interaction: wanting to stick to our own, limited trust, protective parenting, fighting for fairness/justice, sensitivity to injustice or disregard of cultural comforts. But, we now also know that traumas of the past - whether directly experienced or carried through the generations - are carried in the body as well as the mind. There is no surprise, therefore, that brown people have health issues that are linked to trauma: high blood pressure, heart disease, diabetes, amongst the classic chronic conditions. Understanding the historic journeys of brown people in the context of a biased society is fundamental to offering a culturally sensitive service that is marked with safety, inclusivity and allowing brown people to live their authentic life without bias - because we need to work hard for them, not the other way round. If this topic interests you, have a listen to our Psychology of Case Management podcast episode on racism on the 3rd page of our podcast listings:
www.psychworks.org.uk/podcast/?270-page=3
Changing the game in concussion
Through its combination of cutting-edge science and use of existing technology, MYndspan is helping to revolutionise the detection of concussion. NR Times speaks to chief scientific officer Dr Benjamin Dunkley about its progress and potential
While awareness of the risks of head impact and concussion in sport continues to grow, backed by evidence of its neurological consequences, the ability to detect seemingly ‘invisible’ injuries has remained challenging. Frequently, those who sustain a mild head injury can present as having recovered through a series of cursory assessments - although the true impact can remain hidden, particularly against a background of previous head traumas. But in a huge boost for the diagnosis and detection of concussion, MYndspan has created the means to discover these unseen impacts using non-invasive Magnetoencephalography (MEG) brain scanning technology. The use of MEG, which is already in use globally, has traditionally been used in diagnosing and monitoring epilepsy - but through its application in concussion, MYndspan has enabled a significant breakthrough in protecting athletes, in a move hailed as having “immeasurable value” by sports head injury charity Head For Change. MYndspan - which is now commercially available in its first UK site, at Aston University, following successful pilots at the SickKids Hospital, Toronto, and The University of Helsinki - combines MEG scans with gamified tests of cognitive function, which measure a range of mental processes such as attention, memory
and visuospatial processing, giving new levels of insight into brain health, which can then be benchmarked and reassessed over time. And with research detailing the impact of head injury in sport leading to growing calls for change, MYndspan could have a key role to play in this, believes Dr Benjamin Dunkley, chief scientific officer at the business. “North America had its watershed moment some time ago in realising concussion was really a silent epidemic, an invisible injury that was having a lot of impact on player welfare,” he tells NR Times. “It was affecting people in the armed forces and their welfare as well, as well as young children, older adults. “I think the UK is now having its moment that maybe we had in North America a number of years ago. It's really coming into the public awareness now in the UK. “At MYndspan, we’re trying to leverage cuttingedge science alongside existing technology, to help to make positive change. At the moment, a lot of the decisions made are taken purely based on on people's reported symptoms. But with MYndspan, we can give people objective information about their brain.” Dr Dunkley, an associate professor at the University of Toronto, first saw the power of MEG while studying in Cardiff, and realising its potential in wider neuroscience. He then moved to Canada, where he saw the role it could have in a wider forum. “Straight away, I was immersed in this world of concussion, which was a big problem here,” says Dr Dunkley. “Hockey, American football, these are very physical contact sports, and I was immersed in this issue and how some passive head impacts prognosticate. After a concussion or an mTBI, 70 to 80 per cent of people do genuinely recover quite quickly and spontaneously, but the only relatively reliable prognostic marker is if you've had a previous concussion. “So for every subsequent concussion, it increases chances that we have persistent postconcussive symptoms. Otherwise, there is no way of predicting this.” Having also worked with the Canadian Armed Forces, Dr Dunkley saw its application in that field, too. “I started working with the Canadian Armed Forces at a time when the war in Afghanistan was still ongoing,” he says. “Brain injury and TBI was a real big problem in the forces as well as PTSD, and there are a lot of overlapping symptoms there. “But these are psychological stress injuries, as well as brain injuries, and it's really difficult to tease them apart. “None of the imaging that we have was fit for purpose in this regard. So there was a pressing need for a new way.” Working alongside MYndspan founders Caitlin Baltzer, ex-VP of operations at functional brain imaging company Croton Healthcare, and Janne Huhtala - previously CEO of brain imaging leader MEGIN - Dr Dunkley’s research around the potential for MEG created a truly groundbreaking proposition. “To some degree, I guess it has been serendipitous that this technology existed and we've applied it in this context,” he says. “MYndspan saw a need for this. Through leveraging the technologies available, this is a great way to help people understand their brain functioning. “Through these brain injuries, whether an mTBI or continual impacts, the structural changes in the brain, which we can't see, cause a huge neurochemical cascade.
eventually led to all kinds of issues. “There was also the death of a young girl called Rowan Stringer, following a second concussion within a week, she unfortunately died due to Second Impact Syndrome. There was outcry about the failings of amateur sports, head injury protocols, head injury assessments. It really hit a nerve here and very much resonated with the public consciousness that this is a big issue. “People realised this is not just affecting adult professional sports players or guys in the military, it’s affecting your children too. “When I was doing my post-doc with sick children, and we had an imaging scanner that was used with epilepsy and in pre-surgical mapping, we said ‘OK, why don’t we apply this in concussion?’ “It seemed like it could be a great tool for trying to understand these invisible injuries. We've tried MRI, we tried CT, and nothing was really working. These traditional ways of evaluation weren’t really fit for purpose in that regard. “We don't really have a reliable biomarker currently, there's no way to evaluate these brain injuries, there's no really reliable way to
“There are a lot of inflammatory changes in the brain. There are all kinds of metabolic changes, all kinds of neural damage to these highways of the brain, and connections that link up the neurons that really serve all of our thoughts and feelings. “It’s a case of converging evidence from from multiple lines, from neuropsychology, cognitive testing, symptomatology, clinical history. And this will be another piece of that puzzle. I certainly think the technology isn't far from giving people an accurate diagnosis - and it is already incredibly useful from baseline assessments. “We can show that your brain hasn't quite healed yet, and that there’s a risk of exacerbating that injury and making it worse. We can see if there is residual dysfunction there and to monitor it over time. “This evaluation of brain injury over time will really start to give us more information about when it’s safe to return to play, when military personnel can be deployed and return to work, when people can return to doing what they love. I think we have a huge part to play in that.” Through continual advances in technology, MEG is being made even more accessible through its ‘miniaturisation’. While traditionally available through large static scanners, its application can now also be through what can be equated to a portable cycle helmet, which also widens its potential into supporting children - a vital area to address, says Dr Dunkley. “We think that kids are relatively robust and when they have a concussion, they will recover very quickly. But there's increasing evidence that’s maybe not the case,” he says. “But we haven’t been able to scan them with traditional MEG, because it's just an adult system at the moment. “The traditional systems currently have an adult-sized helmet, so it makes it difficult to to scan children probably below the age of about 10. We can go down to about six but often their heads are so much smarter than adults, the scanner moves around a lot and makes it difficult to pick up a good signal. “Going forward, MYndspan will certainly look to build this into their system. There are some really exciting things on the horizon, and gaining this insight into children is a huge question, and one we want to address.” And also, looking ahead, Dr Dunkley sees the potential of the portable MEG scanners being readily available for athletes as and when they need them. “I think it's very close to being taken to a stadium. You could have an immediate pitch side evaluation, a head injury assessment, using this technology,” he says. “It's not really a million miles away to envisage that potentially one of these systems would be stored in in the stadium, and eventually, in the back of the van and take them around to smaller stadiums pitchside. I don't think we're very far away from that. “Sometimes scientists talk about experimental technologies that are a lot of years away. A few years ago, I would have said this was still a way away. But I have been really impressed with how quickly the tech has been moving. There is huge potential.” After the successful pilots, its first UK site at Aston University launched earlier this year, and MYndspan is now looking to establish dedicated facilities in London and Toronto in the near future. “The response at Aston has been fantastic. After a successful trial in in my laboratory, we are seeing great success in Aston,” says Dr Dunkley. “That's currently the UK hub, but we do share facilities with the University, so we're hoping to quickly expand into London and Toronto with our own sites. “Currently, we are leveraging the existing store base of MEG scanners but we're very positive about having flagship sites in London and Toronto very soon that we can completely dedicate to this kind of service. “We’ve got an amazing team with amazing expertise and we are very excited to see what the future will hold.”
Following a restructure, Dr Pedro Areias Grilo has been appointed Clinical Head at Richardson Care. Part of the Senior Management Team, he is responsible for leading the multi-disciplinary team (MDT) and ensuring the quality of clinical care.
Pedro is a Consultant Clinical Psychologist and has been part of the MDT at Richardson Care since 2014. He has special interests in progressive and non-progressive neurological conditions and mental illness. He holds a consultant role within the NHS and he is a Visiting Lecturer at the University of East Anglia and at the Portuguese Institute of Psychology and Other Sciences. Pedro comments: “It is my privilege to be trusted the role of Clinical Head at Richardson Care. The organisation is growing and the future ahead is extremely positive. I am really excited about this opportunity and I look forward to being part of this journey alongside the great team and family that Richardson Care is.” Richardson Care has a portfolio of specialist residential care homes for adults with brain injury or learning disabilities in Northampton.
For more information call 01604 791266 or visit www.richardsoncares.co.uk
Respect & Restore
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