Frequently asked questions about Act Against Racism

In 2020 the College found that almost six in ten psychiatrists from a minoritised ethnic background had experienced racism in the workplace, affecting themselves, their colleagues, or patients.

Many instances were not reported, and when reported, action was not taken in the majority of cases.

The following year, we published an Equality Action Plan, undertaking a range of programmes, with an emphasis on implementing change and supporting individuals and organisations to achieve equitable outcomes for staff, patients and carers in mental health services.

As part of delivering this plan, and through listening to the experiences of our members, we developed our Tackling racism in the workplace guidance.

We launched the Act Against Racism campaign to promote the Tackling racism in the workplace guidance, and to encourage mental health employers to adopt the 15 actions in the guidance.

We want organisations to sign up to adopt the guidance and be part of a supportive network.

Allies and others can support the campaign, using resources like our social media campaign banners, our email footer, and the 15 actions poster. 

A 2020 Royal College of Psychiatrists survey found that almost 6 in 10 (58%) psychiatrists from minoritised ethnic backgrounds reported facing overt or covert racism at work ^13,14.

In December 2020, Unison reported that 67% of Black NHS Wales staff had experienced racism at work ¹⁵ .

In September 2021, the Mental Welfare Commission for Scotland (Mental Health Welfare Commission) reported that 30% of staff had experienced racism in their wards/teams.  Most of these respondents were White Scottish with comments showing that they were mostly referring to the experience of witnessing their colleagues being subjected to what was, in their view, racist abuse. 70% of staff acknowledged gaps in training on equality and diversity¹⁶.

A 2022 BMA survey found that just over 90% of Black and Asian respondents, 73% of Mixed and 64% of White respondents regarded racism in the medical profession as an issue¹⁷.

76% of the doctors surveyed by the BMA had experienced racism in their workplace at least once in the last two years. 28% of respondents believed that their experiences of racism had been exacerbated by gender and 30% believed that the racism they had experienced was linked to religion^18.

In 2023, the NHS Workforce Race Equality Standard (WRES) found that in 93.5% of Trusts in England, a higher proportion of “Black, Asian and minority ethnic” staff compared to White staff had experienced harassment, bullying or abuse from other staff ¹⁹.

Senior executives report that 70% of their key development is learning from experience in role and on the job, yet we know that minoritised ethnic staff are less likely to be offered these “stretch” opportunities. There is evidence that minoritised ethnic staff are subject to unfair processes, attitudes and behaviours which prevent them from being able to take up these opportunities. This includes not being invited to participate in development activities, influenced, in part, by senior staff deeming them unsuitable not because of their work performance, but because of an unwarranted regard for social factors that are heavily influenced by race, gender and class^20,’21. There is also a lack of recognition and assertive action to address the issue that in some cultures, stepping forward for opportunities is not always encouraged²².

To develop the guidance, we convened a taskforce of experts, many of whom had lived experience of racism in the workplace.

The taskforce reviewed existing survey data, policies and research on workplace racism over the last five years which highlights the extent and ongoing nature of the problem for those working in mental health services, and specifically psychiatrists.

The taskforce also held facilitated discussions to share learnings and collated examples of good practice. Together, we used this wide-ranging evidence to develop consensus-based recommendations that are consistent with equality legislation, in particular, the Public Sector Equality Duty (PSED).

While developing this guidance we considered actions that are specific to employer organisations, their duties (PSED) and responsibilities towards their workforce.

In parallel, we focused on, the rights of individual employees to be free from discrimination in the workplace and where psychiatrists do experience racism from patients and carers, colleagues and line managers, how to access support and take action. We also thought hard about how those who witness racism can become an ally or active bystander.

We established:

Staff who are from minoritised ethnic backgrounds have a much worse experience at work, and there is strong evidence that intersectionality compounds the impact of discrimination.

• Bullying and harassment, because of race and/or ethnicity, exists and is often covert rather than overt.
• A disproportionate number of performance and disciplinary actions are taken against people from minoritised ethnic backgrounds.
• There is a lack of support and recognition for staff experiencing racism.
• Inequality of opportunity remains, with a disproportionate number of inferior jobs given to people from a minoritised ethnic background. This impacts on earning potential.
• Poor processes and a fear of reporting incidents are commonplace.
• There is a lack of confidence that action will be taken against racist behaviour.

For individuals, the impact of these situations and experiences can include:

• Low morale and low self-esteem.
• Limited career progression.
• Toxic work culture.
• Poor staff satisfaction, performance and retention.
• Trauma/mental health issues.

There are direct implications for healthcare:

• Recruitment and retention challenges.
• Reduced diversity and representation which may impact innovation and quality of care delivered.
• Increased costs associated with lengthy tribunals.

The impact of racism is widespread. It increases the likelihood of minoritised ethnic staff entering disciplinary processes. It affects their career development and wellbeing. It can impact on patient care and staff retention at a considerable cost to the health service.

• The NHS Medical Workforce Race Equality Standard (MWRES) illustrates the systemic impact of racism, with limited career progression for people who are from “Black and Minority Ethnic (BME)” backgrounds. Although 41.9% of NHS doctors are from a minority background, this drops to 20.3% within the subset of medical directors. Pay for medical staff who are “BME” is, on average, 7% lower than for comparable White colleagues²³.
  
• NHS England provide disaggregated data analysis looking at the intersectional relationship of racism and sexism. It shows that for all roles, on the metric of discrimination by manager, team leader or other colleague, “BME” women consistently fared worse, followed by “BME” men, with White women and men overall reporting such discrimination less frequently ²⁴.
  
• The BMA found that 60% of doctors who experienced racism said that the incident had negatively impacted their wellbeing, increasing their stress levels, and causing depression and anxiety²⁵.
  
• The Royal College of Psychiatrists found that 29% of psychiatrists who experienced racism reported that it affected their health; 41% reported an impact on patients or carers²⁶.
  
• The Association of Black Psychiatrists UK found that as a direct result of racism, 32% of Black psychiatrists surveyed had considered resignation²⁷.
  
• The NHS has estimated that bullying and harassment costs NHS England over £2 billion per annum28. The McGregor-Smith Review reported that the potential benefit to the UK economy from full representation of “BME” individuals across the labour market, through improved participation and progression, is estimated to be £24 billion a year, which represents 1.3% of GDP²⁹.
  
• Research by McKinsey found that more ethnically diverse companies were 35% more likely to outperform financially those which were less diverse.

Despite the high prevalence and significant negative impacts of racism, there is a low level of reporting of racist incidents, and a lack of support from institutions towards those who report racist behaviour:

• The majority of racist incidents towards doctors are not reported - approximately 70% of cases³⁰.
  
• Reasons for not reporting include a lack of confidence that the incident would be addressed, and fear of being labelled a troublemaker³¹.