Bullying and harassment

The finding that less than half of the incidents of bullying and harassment were being reported, with even fewer cases being addressed, aligns with observations in other reports.^{Reference Shields and Price12,Reference La Torre, Firenze, Colaprico, Ricci, Di Gioia and Serò13} The consequences of bullying and harassment are grave, with potential psychological implications such as work-related depression, psychosomatic symptoms, stress, reduced sleep quality and impairments in job performance and satisfaction.^{Reference La Torre, Firenze, Colaprico, Ricci, Di Gioia and Serò5,Reference Rodwell and Demir14} Workplace dissatisfaction can prompt healthcare professionals to leave their roles.^{Reference Palmer and Rolewicz15} This is likely applicable to Black psychiatrists, as survey participants reported that they had contemplated quitting their employment because of discriminatory experiences at work. Recent years have witnessed a staff retention crisis in the NHS which has been attributed to poor working conditions, including bullying and harassment.^{Reference Palmer and Rolewicz15} Retaining and supporting staff is a key property outlined in the NHS long-term plan.^{16,Reference Tamburello17}

Barriers to reporting bullying and harassment

The barriers to reporting incidents of bullying and harassment included not feeling safe and system failure. Participants felt a lack of support or believed that reporting incidents would have an impact on their careers or hurt their future, including professional development and career success. This could pose a threat to the diversity of thought among clinical leaders, which is pertinent to healthcare outcomes, particularly as doctors should be representative of the communities they serve.^{Reference Gomez and Bernet18,Reference Stanford19} Diversity among healthcare professionals would ensure a better understanding of patients’ care needs, accessibility and the challenge of healthcare inequalities.^{Reference Khuntia, Ning, Cascio and Stacey20}

The fear of job loss because of reporting experiences of bullying or harassment potentially silences Black doctors. This can lead to a cycle of harassment or bullying as racism continues. Concerns about system failure imply that the policies and procedures put in place to protect psychiatrists at work have failed them. If not addressed, these toxic work environments threaten diversity in the NHS, directly affecting patient care.^{Reference Stanford19} Furthermore, participants’ comments showed that the system was ineffective, as many people did not know how to access or use it. In some cases, line managers were perpetrators, which indicates that those who are part of the ‘system’ to safeguard psychiatrists may be failing to do so and likely make matters worse through their own actions.

Discriminatory behaviour

Almost 60% of participants experienced microaggressions in the workplace. Microaggressions, which involve othering and belittling, can often be used to propagate racism. This includes instances where participants were called ‘intimidating and scary’, reflecting prejudices that Black people may be perceived as ‘angry or aggressive’. This could foster an environment for exclusion and marginalisation. Some othering experiences in the workplace occur in the form of seemingly inquisitive secondary questions such as ‘where you are really from?’, particularly when an individual has clearly indicated being British.^{Reference Iwu and Cummins8}

Comments about their appearance, including remarks on clothes and hair, played a significant role in making participants feel alienated. This could suggest anti-Black hair sentiment occurring in the workplace. Black hair discrimination has long existed in the workplace, with some hairstyles criticised as being unprofessional.^{21–Reference Dawson, Karl and Peluchette24} Some participants reported behaviours such as ‘hair touching’ by colleagues, which suggests the constant monitoring of Black hair. This could be deemed intrusive, potentially harming the identity of Black psychiatrists and their cultural expression. Comments highlight how Black doctors were not encouraged to celebrate their differences and individuality, which exacerbates the feeling of being deemed as ‘other’.

Comments also show that participants were misidentified in the workplace, for example being ‘mixed up with other female doctors’. Although research suggests that people identify faces from their own race better,^{Reference Yaros, Salama, Delisle, Larson, Miranda and Yassa25} one participant reported colleagues getting their ‘name wrong’, despite working with them for many years. This may suggest a lack of willingness to acknowledge individuality among Black doctors, despite close working relationships that would better support familiarity. This experience in the healthcare system could be considered a microcosm for society, where Black people are likely grouped as ‘one’. Misidentification could carry the potential for missed opportunities for career progression and feeling less valued or invisible at work.

Workload inequality

One of the sub-themes that emerged was workload inequalities, which may be both quantitative and qualitative in nature.^{Reference Dhamoon26} Survey participants describe being ‘coerced outside their job plan’, which could indicate a lack of control and autonomy and pressure from others to work past their limit (Table 2). This excessive workload could lead to burnout, which would affect clinical decisions. Working outside a job plan could be considered a form of exploitation, especially without additional remuneration.

These findings seem to echo the widely reported concept that Black people must work twice as hard to achieve similar levels of success as their White counterparts.^{Reference DeSante27} Senior figures such as mentors and parental figures in Black communities have also been known to encourage relatives or mentees to work ‘twice as hard’ as their White peers to be considered intelligent or talented.²⁸

Questioning competency

Comments showing that Black psychiatrists’ competency was questioned are similar to results of previous studies.^{Reference Nagpaul9} This highlights the disproportionate scrutiny of Black doctors’ clinical ability and suggests that they may not be celebrated in the same way as their White counterparts. Commenting on education, qualifications and clinical expertise in front of others is likely to undermine perceptions of competency and fuel feelings of mistrust. Evidence suggests that Black people perceive being subjected to a professional standard of ‘Whiteness’ in the workplace.²⁹ This has led to a call for a rethink on the value systems that drive the professional and organisational discourse in workplaces.²⁹

Strengths and limitations

We used virtual snowball sampling because of its ability to improve response rates, especially when pertaining to certain participant demographics and qualitative exploration of sensitive topics.^{Reference Baltar and Brunet30} However, a disadvantage is that because of the use of snowball sampling we were not able to provide an estimated response rate. The sample for this study was psychiatrists who identified as Black working in the UK. As such, it likely represents a broad range of ages, gender, perspectives and experience. The use of snowball sampling may also increase the risk of bias. However, there were attempts to mitigate this by anonymising the survey tool, independent data analysis, online data collection and extraction.

It is unclear what proportion of responses were from the members of Association of Black Psychiatrists UK. This is a professional association that aims to provide a safe space for networking, learning, development and support. Some participants may therefore have felt more comfortable in sharing their difficult workplace experiences, thereby improving the yield of responses to the sensitive issues being raised.

The geographical representation of workplace experiences across the UK was not explored in the survey as participants were not asked what area they worked in. Furthermore, this paper is based on descriptive statistics. Bivariate statistics would have further explored whether or not there was a relationship between variables such as experience of discrimination and gender.

Implications

This study has highlighted under-reporting of discriminatory behaviours against Black psychiatrists in the workplace, and future work should seek to critically examine the organisational and structural hurdles that exist in reporting discrimination and related behaviours. Taking an anti-racism stance must be a deliberate decision. The Royal College of Psychiatrists’ guidance for employers on tackling racism in the workplace is a call to action, encouraging organisations to address discrimination at a strategic and systemic level.³¹ Its 15 recommended actions are grounded in expert evidence and their adoption could assist organisations in creating more equitable workplaces, which would be beneficial to current and future employees.³¹ This, in turn, could lead to effectively addressing adverse workplace experiences, fostering a positive culture for psychological safety, facilitating necessary learning to deconstruct harmful behaviours and implementing monitoring of progress to address these issues.²⁹