Adopting a trauma-informed anti-racist strategy and actions to cultivate community learning and systemic change

Introduction

In 2021, Health Education England (HEE) awarded all Clinical Psychology Doctoral programmes in England funding to increase access and improve experiences and outcomes of ethnic minority applicants. HEE stipulated that core deliverables would be the offer of mentoring programmes to aspiring trainees from racially minoritised backgrounds to widen participation and anti-racism training for clinical supervisors. At Exeter University, we initially developed a Racial Equity and Inclusion team consisting of staff (Dr Sabinah Janally, Dr Suzanne Azer and Dr Alicia Smith) from racially minoritised backgrounds with expertise in anti-racism across different domains – mentoring, staff training and research. We have since integrated this work with broader activity, progressing equity, diversity and inclusion and developed an EDI team and an EDI Committee. In this article we will be outlining our journey over the last few years to develop an anti-racist strategy, initiatives and culture change.

A trauma informed approach was adopted to all areas of the anti-racism workplan, this began with working to develop a shared programme understanding of the effects of racialised identities and racism on trainees and staff, and exploring how we can be in dialogue together. These early steps were often uncomfortable, however, the team had a clear focus and vision as well as specialist supervision to resource them. The EDI team has focused on several core deliverables, all of which have ongoing evaluation: developing mentoring programmes for aspiring and current trainees from racialised minority backgrounds; Positive Action in trainee selection; developing anti-racism training for supervisors; decolonising training for all internal and external lecturers; supporting international trainees.

Mentoring schemes

At Exeter we deliver two mentoring schemes, at the core of the schemes is the foundation set by the teams’ use of racial trauma informed anti-racism practice. For instance, all qualified clinical psychology and trainee mentors are from the global majority. This is significant as it acknowledges the power of being mentored by someone who may have similar and relatable lived experiences. In recognition of the often-unseen commitment to supporting racial equity work, qualified mentors are paid and trainees who contribute to workshops can acknowledge this on their clinical paperwork. In addition, all mentors are asked to attend mentoring training, which enables mentors to have a space to learn, embed and reflect on racial trauma and anti-racism, as well as mentoring competencies and skills. Both schemes initially offered one-to-one mentoring, however, due to the small representation of racial minoritised qualified and trainee psychologists in the profession we have moved to a group mentoring model.

The Breaking Through Mentoring Scheme is a joint initiative between Exeter and Plymouth DClinPsy courses, established by Dr Sabinah Janally and Dr Nneamaka Ekebuisi in 2020. The scheme is for global majority aspiring clinical psychologists and was developed in recognition of reported personal challenges global majority individuals faced in attempting to break through into the career of clinical psychology.

The scheme has completed one phase of one-to-one mentoring and two phases of group mentoring. For group mentoring, mentees are matched according to their stage of career development. The groups consist of 6–8 mentees, who are invited to engage in six sessions of mentoring delivered by a qualified clinical psychologist. Mentees can also attend a trainee led reflective practice session and workshops based on a variety of topics such as research, leadership, and tips on applying for the DClinPsy. So far, 111 mentees have participated in this scheme which is offered nationally.

Our evaluation of the scheme found that the mentoring sessions provided a reflective and supportive space: the group setting enabled mentees to see that they were not alone with their feelings and experiences. Mentees reported developing a stronger sense of self and belonging, and it gave them affirmation and validation of their skills and abilities. The sessions focused on gaining advice on the DClinPsy as well as sharing individual and collective stories of inequality and social justice.

The second scheme is the Amplify Trainee Mentoring Scheme (ATMS). ATMS was established in 2020 by Dr Sabinah Janally, following her experience of being a racially minoritised trainee in the Southwest. Racially minoritised trainees and qualified psychologists have reported feeling different and isolated from mainstream clinical psychology, experiences of racism and a need for psychological safe spaces to heal and connect (Adetimole, Afuape & Vara, 2005; Pauraj, 2016; Odusanya, Winter, Nolte & Shah, 2018). ATMS was developed in recognition of the need for dedicated support that attends to the personal and professional development of racially minoritised trainees; trainees in the South West (Exeter, Bath, South-Wales, Plymouth, and Southampton) are invited to take part. The scheme delivered one-to-one mentoring to 13 mentees in 2021–2022 and monthly group mentoring for 14 trainees in 2022–2023. Mentees have reported that the space enabled them to reflect on personal and intersectional experiences; they felt validated and less lonely. The mentors were seen as positive role models who enabled honest conversations. Trainees also reported that their mentors enabled them to find their professional voice, helping them to explore ethical issues and future career plans.

Two quotes from ATMS trainees:

Positive action

It is now well established that Clinical Psychology is dominated by those who are White: in 2015, the BPS reported 88% of psychologists are White (BPS, 2015), matching the racial composition in the psychological professions of the South West of England (PPN, 2021). Ahsan (2020) highlights that a major reason for this is because of discrimination at the stage of selection, with White applicants having a 1 in 5 chance of being shortlisted for interview, compared with a 1 in 13 chance for those from the global majority. Alcock’s work (2019) shows that these barriers take place during shortlisting, but at interview, everyone has an equal chance of being offered a place on a programme. We analysed the shortlisting data from our programme and found this was also the case. We worked closely with university’s legal team to introduce Positive Action at the shortlisting stage of selection. We collected the shortlisting scores of all those excluded from interview who were from the global majority. We compared these scores with minimum interview criteria, as we did not want to set up candidates to falter at interview if they did not have a minimum of clinical and research experience. For those who reached the minimum interview criteria, we put on additional interviews; this way, no one who would have been interviewed thorough our usual practice of shortlisting missed out. Neither candidates nor panel members knew who had been offered an interview because of Positive Action as opposed to the first round of shortlisting.

As a result of the changes we have made, 57% of our first-year home student trainees are from the global majority, compared to 4% in the second year and 9% in the third year. We want to reiterate that we did not implement Positive Action at interview, these students earnt a place on the course because they are ready and because of how well they performed at interview.

Trauma informed supervisor training

Drawing on experience of developing anti-racism training for staff in an NHS Psychology and Psychological Therapies service in the region, a survey was sent out to placement supervisors to ask what, if any, anti-racism training they had accessed during their professional trainings or as CPD since then. Supervisors reported very little prior training in anti-racist clinical practice or in cultural competence. None had accessed anti-racist supervisor training before.

A Racial Trauma informed approach was taken to developing this new training (McKenzie, 2009; McKenzie, 2016; Pieterse, 2018). This approach emphasises the importance of education about and engagement with racial trauma, rather than focusing solely on skills and techniques or a human rights legislative approach. Supervisors are invited to draw on understanding and skills they have already developed in trauma informed care and to extend this understanding to racial trauma. Anti-racism and cultural competency are viewed as specialist skills which, similar to other areas of practice, require study time, engaging with training, specialist supervision, reading and is also enhanced by joining communities of practice. The experience of racialised minority clinical psychology trainees and staff was also drawn on to inform the training.

Due to supervisors’ availability being restricted, a pre-recorded webinar was developed followed by live training. The webinar was for supervisors to engage with individually, covering theory and the rationale for the training. This was new material for many who had not accessed this type of training before. The live session was facilitated by Dr Suzanne Azer, with an external facilitator and focused on ‘broaching’ (Jones et al., 2018) – supporting participants to build confidence to proactively initiate conversations about race and racism with supervisees.

Fifty-five supervisors attended in December 2021 and January 2022. All participants said they would recommend the training to other supervisors and shared that what was important was their shift in mindset - that it was better to be curious and attempt dialogue than to avoid or ignore out of the fear of getting it wrong. When asked how the training had impacted their understanding of effective and inclusive supervisory practice, some reported that it was important to consider their own race as well as the supervisees’, and how that might impact on relationships with clients in clinical as well as supervisory contexts. They recognised the importance of starting conversations earlier and broaching the topic more directly, rather than waiting for something to ‘trigger’ the conversation. Some participants reported feeling more empowered, less avoidant and wanting to embrace discomfort to improve competence in this core skill. The skill set felt transferable to working with clients, despite this not being the main focus of the training. Several supervisors said they would value ongoing support in developing this skill set and would like their own supervisors to attend the training. This raises interesting considerations for the ‘supervision of supervision’ in the profession.

Feedback on improvements that could be made to the training indicated a preference for a full day of training as making time to engage with the webinar was difficult for some. We noted that there were at least 10 supervisors who had registered and did not attend at short notice. We hope that attendance would feel easier with more explicit support from service leads and line managers for prioritising this professional development as anti-racist practice begins to be seen as ‘core business’. For future training, we plan to remove the webinar and instead deliver a whole day, hoping that this will also improve attendance as people have protected time to attend.

Internationalism

In service of running a training programme that actively promotes diversity and inclusion throughout all strands, we have developed our staff structure to now contain key roles in the support of international students.

Although the challenges that international students may face on clinical training may intersect with home students from the global majority, there are key, unique features of their experience, including loneliness, isolation, and financial strain (Newsome & Cooper, 2026; Wawera & McCamley, 2020). Many international students struggle with a sense of belonging and this is critical to their education experience and potentially their career, with many international students aspiring to be NHS clinicians. At Exeter, we have been taking 2 international students per cohort to date, which is likely to increase in future years as our cohort sizes in general have increased.

It was recognised that in addition to the anti-racism training, placement supervisors needed support to orientate to the issues of international students. Furthermore, international students spoke of their experience of isolation being compounded by a gulf of understanding between themselves and their supervisor. We offer a training event to all supervisors on supporting international trainees, highlighting these issues and facilitating practical skills to offer support.

We have a dedicated job role within the programme team to oversee the experience of international students and these students receive additional reflexive tutorials with their clinical placement tutor to explore the context in which they work and their placement experience. In collaboration with international students, we have developed a survey regarding their experience, which we will be distributing to postgraduate students to more fully understand their experiences and highlight unmet needs. We have also linked our trainees with support for international students provided by the wider university.

Decolonisation of the curriculum

It is important that all trainees, and the clients and staff they work with, are not only represented in what we teach, but that previous oppression and discriminatory practices are recognised and discussed. We recognise that psychology is not an exact science, we have constructed the categories of mental health that we then use to ‘treat’ clients (Cohen, 2018). These categories shift and change over time as social-cultural context change – not only are they are not fixed ‘facts’, they also serve to protect and promote those in power (Kutchins & Kirt, 1997). Acknowledging this requires us to consider the lens and influences that have produced psychological knowledge, which have been described elsewhere as WEIRD (Western, Educated, Industrialised, Rich, Democratic; Henrich et al., 2010). By only presenting one perspective on psychological health and wellbeing, we are effectively ‘colonising’ psychology, imposing a WEIRD understanding and descriptive language, and supressing ‘indigenous’ or ‘other’ ways of understanding (e.g. that mental distress might be due to ghost possession; Messant, 1992) and dismissing them as ‘unscientific’. The concept of ‘psychoeducation’ makes this dominance clear. Only focusing on WEIRD perspectives means that alternative ways of understanding mental distress that might be of use and benefit (in the way that Mindfulness has been adopted by psychology) can be missed.

In our decolonising workshops, we introduce these ideas to our lecturers, so that they adopt a critical lens to the topic they are teaching. We ask them to examine the assumptions that sit within it, whose perspectives are represented by these ideas and whose are excluded. Recognising that our external lecturers are busy NHS clinicians who we do not pay to attend this training, we have created two one-hour workshops. In the first workshop, we explore what decolonisation means and why it is relevant to clinical psychology. The rest of the hour is a reflexive space to consider how lecturers are positioned in relation to their topic, particularly given that most of our lecturers are White, and we pay them to train students in their psychological knowledge and expertise. We explore what it would mean to let go of some of that expertise and facilitate explorative discussions with trainees to deconstruct the concepts they teach.

There is a month between the first and second workshop, during which time participants are asked to look at their teaching slides and identify ideas and dilemmas of how they can decolonise their teaching. This is because for this work to be sustainable we need lecturers to ‘own’ it and be curious and willing to do the work themselves. We discuss their ideas together as a group to bring in multiple perspectives on how to decolonise their teaching, and then share some pre-prepared ideas of what could be done (many of which participants have already come up with themselves).

So far, we have had 47 lecturers attend the first workshop and 34 attend the second. We have kept a record of who has attended so that we can encourage people to complete the two days, and so that we can reach out to lecturers who have not yet attended. We are currently evaluating the workshops via a trainee Quality Improvement Project, based on this we will revise the workshops and run them again monthly.

[For those interesting in decolonising their teaching, there are a list of useful questions published in The Conversation (Morreira & Luckett, 2018)]

Conclusion

On the DClinPsy at Exeter, our anti-racist work is at the heart of our ethos and cuts across every aspect of the programme, from selection, to supporting placements, lecturers and supervisors to develop skills in trauma-informed anti-racism. We have recently launched an Equity Impact Survey to learn more about how trainees experience every aspect of the programme. The results will be brought to the EDI Committee and future actions planned. We hope to expand this survey to also gain feedback from programme staff. We acknowledge we are in the early stages in our pursuit of racial equity and organisational culture change, but we are moving forward, and setting new goals based on evaluation and feedback from trainees, staff and our NHS partners and stakeholders. Funding for 4 staff members to make up the EDI Team supports this work and dedicates protected time and resource to it. This continued journey will bring challenges and opportunities for new learning, growth and, we hope, an inclusive and trauma informed environment for trainees, staff and external stakeholders.

For more information on the EDI team’s anti-racism stance and activity please contact:

Dr Sabinah Janally for mentoring, Associate Professor Catherine Butler for decolonising and positive action, Dr Alexis Clarke for supporting international trainees and Dr Suzanne Azer for trauma informed anti-racism training for supervisors.