Are we paying attention to all variables that lead to decreased mental health in return to work?

Transcription

1 Unconscious Bias and the Impact on Patient Care; Understanding What We Think We Already Know Are we paying attention to all variables that lead to decreased mental health in return to work? Rehman Y. Abdulrehman, Ph.D., C. Psych. Assistant Professor, University of Manitoba Clinic Psychology Manitoba Consulting Lead With Diversity

2 Understanding the Scope of the Problem of Discrimination & it s Role in Mental Health. Part 1

3

4 Canadian Demographics 21.9% of Canadians born outside Canada. 22.3% of Canadians identified as a visible minority. 4.9% of Canadians had an Indigenous identity. 82.3% of Canadians have ancestors outside Canada. (Census Poll, 2017)

5

6

7

8

9

10 Is Ethnic, Cultural, Religious Discrimination on the Decline? Representation Earnings

11

12

13

14

15

16 Canada Census Data (2015) Significant pay discrimination Indigenous People average $19,000, vs. $33,000 for all other Canadians 57% Visible minorities (non-indigenous, non-caucasion) average $25,514 vs. $36,538 for white Canadians 69.8 % Men earned 65.9 per cent those of white men. Women earned 75.6 per cent those of white women. 2nd Generation Educated in Canada, earned $44,591 vs. $50,729 median earnings for white people %. Racial income differences have the greatest impact on : West Asians (Middle Eastern), Blacks & Chinese Canadians.

17 Canadian Labour Congress Canada Census (2015) Employers are about 40 percent more likely to interview a job applicant with an English-sounding name despite identical education, skills and experience. In 2011, the unemployment rate for visible minority workers was 9.9 percent compared to 7.3 percent for non-racialized workers. Black males living in Toronto are three times more likely to be stopped and asked for identification by police. There were 1,401 reported hate crimes in Canada in percent of Canadians are satisfied that we have overcome racial discrimination.

18 How does this impact health?

19 Human Experience Thoughts Beliefs Emotions Behaviors

20 Diathesis Stress Model Genetic Factors Social Stressors Early Learning Experiences Vulnerability Trauma Illness Family Poor Coping (substances)

21 WHO Health Impacts Assessment (HIA) The determinants of health include: the social and economic environment, the physical environment, and the person s individual characteristics and behaviours.

22 Determinants of Health Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. Education low education levels are linked with poor health, more stress and lower self-confidence. Physical environment safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions people in employment are healthier, particularly those who have more control over their working conditions Social support networks greater support from families, friends and communities is linked to better health.

23 Determinants of Health Culture - customs and traditions, and the beliefs of the family and community all affect health. Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills balanced eating, keeping active, smoking, drinking, and how we deal with life s stresses and challenges all affect health. Health services - access and use of services that prevent and treat disease influences health Gender - Men and women suffer from different types of diseases at different ages.

24 Illness vs. Stress Spectrum of mental health Diagnostic criteria don t always necessitate difficulty. Workplace stress can impact functioning without a psychiatric diagnosis. Racism can impede functioning without producing an illness.

25 Clark and clark (1940) Clark and Clark (1940) asked African American children about their attitudes on ethnicity by asking them to point to African American or Caucasian dolls in response to a series of evaluative questions. They found that African American children demonstrated a preference for the Caucasian doll and attributed negative qualities to the African American doll (e.g. ugly; bad). Similarly, Native children have been found to attribute the success of Caucasians to ability and hard work but attributed Native peoples success to luck and task ease (Corenblum, 2006).

26 We Are Who We Are Treated As Thoughts Beliefs Emotions Behaviors

27 Teach someone they are less worthwhile, and they eventually believe it Cultivation Theory (Gerbner, 1990): prolonged exposure to a certain set of beliefs (e.g., stereotypes) can overtime lead people to cultivate beliefs about the world that coincide with the beliefs of their environment. Greater exposure to stereotypes via media use with Latino adolescents was associated with lower self-esteem. (Rivadeneyra, Ward, & Gordon, 2007) Increased exposure to stereotypical portrayals of minorities lead to increased values and beliefs about those people (including the minority group) that resemble those stereotypes. (Preiss et al., 2007).

28 Negative outcome of avoiding diversity Ethnic minority groups with a positive relationship with their ethnic and cultural identity are more likely to have improved self esteem (Smith et al. 2009), academic success (Brown & Chu 2012), lower levels of substance abuse (Schier et al. 1997), and positive social behaviors (Street et al. 2009). In contrast, rejection of ones of one s ethnic group or culture has been demonstrated to undermine feelings of self-worth (Berry, Phinney, Sam, & Vedder, 2006; Mendoza-Denton et al., 2002) and predicts lower individual self-esteem (Cohen & Garcia, 2005). This relationship has real world consequences, as worrying about confirming negative ethnic stereotypes has been associated with a drop in GPA and lower performance on standardized tests (Cohen & Garcia, 2005).

29 Discussion & Questions

30

31 Developing Skills to Have Better Discussion About Discrimination with Clients Part 2

32

33 Multicultural competence acquisition of awareness, knowledge, and skills needed to function effecitlvey in a pluralistic democratic society (ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds). Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice. John Wiley & Sons. (pg. 65)

34 How do we approach diversity and inclusion?

35 Multicultural competence Cultural-infused counselling (Arthur & Collins, 2010) 3 Domains: Cultural awareness of self including own biases and assumptions about the world. As these beliefs and world view determine our actions. Cultural awareness of the client as their beliefs and world view will determine their actions. Culturally sensitive working alliance. *Addressing social justice.

36 Two Parts For Every Resolution Our stuff The clients stuff Social Justice

37 Our Stuff

38 Personal Exercise On a piece of paper, write down as many words as you can that come to mind when you see or hear this word.

39 What comes to mind when you see or hear this word:

40 canadian

41 muslim

42 terrorist

43 How do we approach diversity and inclusion?

44 Addressing our own bias Bias is a negatively associated term. Places us on the hot seat. Makes us feel uncomfortable. Yet this insight is critical to growth, specifically cross cultural competence. Bias does not always mean you re a racist. Admitting bias and working to correct it helps us move away from discrimination.

45 Bias is not always about intentional racism.

46 Discrimination is not discriminatory

47 Resolving Bias & Instituationalized Discrimination Thoughts Beliefs Information Education Emotions Behaviors Policy & Practice

48 Bias a Reflection of a Lack of Information Being able to talk about it & learn offers that information that alters thinking patterns. Insight Informs Policy and Practice Alters behavioral patterns of interaction.

49 The Clients Stuff

50 Microagressions (Sue, 2010, 2015) brief and commonplace daily verbal, behavioral (non-verbal), or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. Can be applied to any marginalized group (including women, LGBTQ, religious minorities). Each group has themes associated with it (e.g., Black people and violence, LGBTQ and sinfulness). Often well intentioned. Outside level of awareness. Correlated with worldview.

51

52

53

54

55

56

57

58 Microagressions Significant psychological impact Invalidation Isolating

59 TRUST Lower levels of trust in minority and newcomer populations. Feeling misunderstood. Feeling exoticized (at best). Feeling patronized. Paranoid? Chip on shoulder?

60 The Resolution

61 How We Now Talk About Mental Health Being able to talk about it offers an infrastructure and makes it a reality. Increase our understanding through education. Reduces stigma. Develops a richness and understanding of what is involved with struggling with mental illness or mental health difficulties. Validates. Normalizes. Understanding allows us to come up with practical solutions.

62 Multicultural competence Cultural-infused counselling (Arthur & Collins, 2010) 3 Domains: Cultural awareness of self including own biases and assumptions about the world. As these beliefs and world view determine our actions. Cultural awareness of the client as their beliefs and world view will determine their actions. Culturally sensitive working alliance. *Addressing social justice.

63 Social Justice Be aware of your level of awareness. Obtain information. The client is the expert in their own experience. A positive relationships is more likely to improve therapeutic outcome, including a potential return to work. Determine what role you may have in advocating for equal treatment. Stating the problem is half the solution. Lends credibility to otherwise quieted voices.

64 Ally Privilege of allies can help make movement toward social justice faster. Does not take the power away from the client, but rather lends a supporting voice, when their voice is not easily heard.

65 Summary Questions Do I hold bias? Am I able to address my bias? Do I ask about experiences with discrimination? Am I able to ask questions to understand the experience of the client? What resources can I offer? How can I be an ally within my role?