International Women's Day 2023 podcast

The theme for International Women's Day (IWD) 2023 is 'Embrace Equity'.

We conducted a two-part podcast with Professor Henrietta Bowden-Jones OBE and Dr Trudi Seneviratne OBE on the importance of equity for women in the mental health space.

For more information about the range of resources and activities we produced for this day, please visit our dedicated International Women's Day page.

Transcript

Peter Markham  00:05

I'm conducting an interview with Henrietta Bowden-Jones for International Women's Day 2023. Henrietta, please, could you just introduce yourself and tell us a little bit about your role in psychiatry?

Henrietta Bowden-Jones  00:23

Well, thank you, first of all, Peter for having me here on this podcast for International Women's Day. It's a real honour to be here. I have multiple roles in psychiatry, but my area of expertise is behavioural addictions. And I set up and run the National Center for Behavioral Addictions based here in London, under which set the National Problem Gambling Clinic, which I set up in 2008, as a first-ever NHS clinic, treating gambling disorders. And then, many years later, in 2019, I started the National Center for gaming disorders. And again, it's the first ever NHS treatment centre for gaming disorders, the populations are very different, I'm sure we'll have a chance to discuss all that. But primarily very young, younger people in the gaming.

I'm also a national expert advisor on gambling harm. So, I spend a lot of time advising parliament, House of Lords, NHS England and many other people. And I also of course, at the Royal College of Psychiatrists, I have been the spokesperson for the college now for well over a decade on gambling, and indeed other behavioural addictions.

Peter Markham  01:46

Thank you, Henrietta. Now, this International Women's Day, one of the things we're discussing is gender equity and gender equality. So, what do you think is the difference between equity and equality? And why is it important to differentiate you think?

02:04

Well, one of my past roles was President of the Medical Women's Federation. I was enrolled for two years and another two years as president-elect. So I have navigated the whole concept of equity and equality at length within medicine, I'm taking that we're discussing medical setting, particularly. And I think one of the biggest issues that we always came across was the idea of quotas or non-quotas in relation to medical women in senior positions. And should they should it be something we might advocate for or not.

And interestingly, despite having spent all those years, and actually, I was vice President before that, so I have six whole years surrounded by medical women in terms of the officers at trying to work out what the best way forward was. And I think it remains very complicated, because whereas we're very clear what we want to achieve, which is justice, just a very equal representation in terms of gender, in senior positions, within the medical sphere, in all areas.

And I mean, therefore, also, in academic medicine, for example, where there is still a long way to go. How one gets there is far more complex in relation to how much would one be instrumental, at a sort of systems level to ensure this happens. And now that I'm vice President at the Royal Society of Medicine, I do see something really good happening where actually some instrumental changes are occurring, where people will say, well, I won't speak on this board because there are no women. And someone else will say, yes, there are no women because actually, there are no senior women senior enough in this particular sphere to participate and the other person will say, well, actually there are you just haven't looked hard enough.

And, indeed, you know, female colleagues who have specialism in those areas will be put on the board and the RSM feels very proud to be encouraging this. And on this note about equity and equality there is now a wonderful organisation that provides female speakers in all specialties in medicine in order for in order to avoid these particular issues that have really fallen upon us for many years where you end up with particular boards and not being representative enough. I hope that answers your question.

Peter Markham  04:58

It doesn't it sounds like good news. So, the next question is what role does gender equity have within the mental health space? And I suppose you've been talking about that with respective doctors. So, does it have a role in the patient care space at all?

Henrietta Bowden-Jones  05:18

I'm so glad you've asked me this. It is a real issue. I think, in addictions in general, as you know, a lot of well, in general mental health, a lot of the research in the past was conducted on men rather than women. And generally speaking, I do still believe there is not enough parity of esteem between genders in the treatment and approaches to research. And particularly when you look at pharmacological interventions for women.

So, I don't think it's enough to say we've got to what you tend to see in addictions often is we've got a women's group. You know, women don't feel comfortable, therefore, we've got a women's group. And then you look at the women's group, and often it's talking therapy, counselling, instead of evidence-based interventions. And so, what I've done here at the National Problem Gambling Clinic, where I spend most of my time is to try and ensure that we give people the opportunity. And I mean women in this particular case, to be treated in exactly the same way.

Now this sounds are completely normal. Why would you not? Well, because just that sort of gender bias in relation to treatment, I think is slightly pervasive when it comes to off-licensed prescribing, for example. So, I'm talking of Naltrexone here, and the fact that we do know, there is enough research to know that people with gambling disorder who are not responding well enough to cognitive behavioural therapy might benefit from Naltrexone.

Now, there isn't strong evidence because not enough studies have been done, however, enough studies for the college to have it on their website as an intervention for the NICE Guidelines to be considering it now before their publication. And so I have been giving this prescribing it to mainly male patients. And at some points a few years ago, I thought, well hang on a minute, am I displaying what is unconscious gender bias in relation to pharmacological interventions? Is it actually that myself and my team are not giving our female patients enough of a possibility of being prescribed this medication? So now I do. I'm making an active effort to offer it. And some, some women will be keen on it, some won't.

But the fact is, women suffer from gambling disorder in a severe way, just as much as men do. Yes, there are only 10, or actually at our clinic now that it's higher, it's about 15% of the population, but they need to be treated in the same way. And in the old days, even a decade ago, we were offering these very supportive, let's call it's slightly psychodynamic, but also more kind of nurturing groups. And I look back and I think, no, that's, you know, I do believe that's unconscious gender bias, and I hadn't read up enough about it, and all had my team to really understand that whatever people present with, they deserve evidence-based approaches, because that's what we know works, everything else can be added on top. And that's what we tend to do now.

So, I hope I've given you a very clear demonstration. And just one other thing. If I talk about the gamers, the young gamers, they're mainly boys, when girls come along, they deserve to be treated again in exactly the same way. So, we are now absolutely clear, they will get treated with CBT, just like the boys, despite the fact that they are young girls, or maybe other things going on, etc. It doesn't matter if it's gaming disorder, it gets treated that way.

Peter Markham  09:16

That's a really, really interesting example. And it makes me wonder, can the College do more to promote gender equity?

Henrietta Bowden-Jones  09:27

I think the college is doing an enormous amount in relation to the medical side of things. If we're looking at gender, and doctors, and positions, and power. And I think really having been involved with the College, always, you know, I was one of the first one of the young people who got involved in the Faculty of addictions as soon as I you know, pretty much as I became a specialist registrar, I was taken on and I remember how, you know, nurturing the college has always has been in relation to, to gender.

I think I've always feel the College is gender-neutral in that respect. It's meritocratic, I think, and, and a wonderful College because of that. But I think in relation to patients and gender equity, they're difficult to know exactly what could help. But potentially, you could argue that, you know, one day a year, there should be, you know, a whole conference on this in relation to publications who's doing things? Well, what are we seeing? Who is able to address that balance and start to conduct the studies that have historically been male?

You know, you know, all about the cardiovascular research and how that's been so predominantly based on men, that women end up dying, because they're not treated in the same way as men when it comes to heart attacks, etc. When I do wonder whether the College could focus on interventions, pharmacological interventions too, in relation to women's psychiatry, and maybe, you know, have goals that are year in on a yearly basis get addressed, because we are all potentially, victims are falling prey to this unconscious gender bias. That's one of the things that have been President I've ended up and who really made me realise. And there are great books, it might be also worthwhile thinking about a list of books that we could have on our website, both about things like the health gap and positions of power and the gender gap, but also very much around patience.

Peter Markham  11:49

Thank you, some great ideas, that for us to think about. You've spoken a little bit about this already. But what do you do personally, to promote gender equity in the workplace, I'm thinking you've given a bit of an example of that already, or outside work?

Henrietta Bowden-Jones  12:11

What I what I did when I left the presidency and moved across to the Royal Society of Medicine, initially, I was just on the psychiatry council, and then I became President of Psychiatry at the Royal Society of Medicine before becoming vice president. And at each stage, I was determined not to lose that gender, that female leadership, that equality agenda, and what I did actually, in the last year, I've set up these special meetings that they're all society of medicine, that are on leadership and gender equality or gender gap, health gap issues, and these are continuing and they are also such as medicine, Medical Women's Federation events or they are through the RSM as leadership and women events when it comes to medical female colleagues. And they have been enormously successful.

One of the days was attended by hundreds of women and the thing they enjoyed most was the interactive, more mentoring-like afternoon roundtables, where people were really supported through working through examples of things they may encounter as difficulties. So, it comes down in a way it's you know, it's fine to talk in an abstract way about what one believes in. But if you can actually deliver stuff that is helpful to others, for example, these evenings at the RSM or the full day, Parveen Kumar is amazing in this. Jane Daycare, another great guru, a great, great medical woman who has done so much with the leadership courses at UCL.

You can take people with you, they look at you as someone who is leading the way because you've achieved things in your career, but you can actually say look, yes, I am. But here are all the things I'm doing to have you with me on those days to really understand and network. And that's been wonderful. And actually, I do have some people I know who've asked me, you know me if I if I would help mentor them, etc. And I tend to do that. Although I do prefer working on a slightly larger scale because it is very difficult when you are so busy with your weekly work schedule to also have time to meet people individually, whereas I think these evenings where everyone gathers and you kind of talk people through when you Share your tips and your views, and you'll have panels. I really encourage anyone listening to this to look up the Royal Society of Medicine's Medical Women's Federation nights that I've, you know, hosted.

Peter Markham  15:16

Wow, it sounds like you're doing a lot in all sorts of ways on this. And so, my last question is, what advice would you give someone starting their career in psychiatry?

Henrietta Bowden-Jones  15:28

Well, I'm glad you say someone because you know, again, then you go back to being gender neutral, I really, really am. In that respect, I don't particularly feel, you know, I'd like to sort of talk to everyone who's listening, not just women. So, I've got a really clear piece of advice, I really believe that if you can find a niche, and you can become an expert in that niche in psychiatry, you will contribute in a far greater way, with enormous benefits in terms of professional returns and rewards.

So, when we looked at a lot of the research, in terms of work satisfaction, when I was the precedent of NWF, making a difference, making a difference was the highest rated criteria. And actually, I really believe that in terms of my career, feeling that, you know, you set up the first ever clinics, 1000s and 1000s of people have been through it. Now, there are about to be 15, identical clinics all over the country, you feel you have changed people's lives, in terms of informing not just the treatment, but also what government can do to address a specific issue.

Now, it's harder to do if you're dealing with a whole set of things, because people will tend not to focus on them in the same way. But if you can do your psychiatric training, find something that really stimulates you intellectually, then that will bring enormous rewards not just to the patients, and therefore, to the population at large, but to you, as well. And my last tip, which goes hand in hand, is that one of the best things I ever did was to do a doctorate at Imperial. In neuroscience, it allowed me to understand the essentials of what I was treating in relation to the neurobiology of the illness. And it allowed me therefore, to be able to publish and have a sort of research hat. Now, I'm not suggesting everyone needs to do that.

But I will say, people come up to me or often women, sadly, and say, "oh, I, I'm no good at research", you know, and you just think, well, everyone can be good at research. Clinical research is vital, particularly when it comes to things like gender bias. And therefore, it is absolutely unhelpful to the individual and their career to talk about being no good at research. A research should accompany professionals and allow them to demonstrate in an evidence-based way, what it is they're doing, what their outcomes are and what they're seeing, even if they don't venture into the neuroscience of of the presentation they're writing about.

Peter Markham  18:42

Henrietta Bowden-Jones, thank you very much for speaking to us.

Henrietta Bowden-Jones  18:47

You're welcome. Thank you so much for having me on the show.

Peter Markham  18:49

So, Trudi, thank you for joining us to celebrate International Women's Day. Please, could you start by introducing yourself and tell us a little bit about your role?

Trudi Seneviratne  19:09

You're very welcome. Thank you. Thank you, Peter. So, I'm Dr Trudy Trudi Seneviratne. I am the Registrar for the Royal College of Psychiatrists. I also work at South London and Maudsley in SLAM NHS Trust as a clinician, where I am an adult and Perinatal psychiatrist working in the mother and baby unit and our community services, and a manager there where I'm a clinical director. And I think also relevant to women's days and the fact that I'm a mother of two boys, teenagers, to one teenager and a young man. Thank you.

Peter Markham  19:51

Good. So, this year's theme of International Women's Day is embrace equity. So, can you tell us please why it's important to understand the difference between equity and equality?

Trudi Seneviratne  20:05

Yes, of course, yeah. So that's really important to get, right. I mean, obviously, we all want to be boosted, so that we achieve the best that we possibly can. But the fundamental difference between equity and equality is an individual equity. So, equality is everybody getting basically the same package to move forward. But that may not mean that a certain individual gets to the same level or the same bar or some someone else.

So, equity is giving a tailor made package for the individual to boost this, you know, what they need, in order to get to a certain level. So for somebody that may be a different and a bigger package to somebody else who needs a slightly smaller package to get to the same level or the right bar. So that's essentially the difference.

Peter Markham  21:02

That's a great answer. And I think that's, that's very clear. So, what role does gender equity have within the mental health space? And can you tell us about your experiences, perhaps when you've realised more needs to be done? Or maybe you've had some really positive experiences?

Trudi Seneviratne  21:21

Thank you. Yeah. So, I think it's really important to remember that gender equity applies as much to men as it does to women. But of course, it's you know, we're talking about international women's day here. And so, I'm going to focus on thinking about the needs of women. So, I'm also going to think about how gender equity is important and translates into areas in the mental health space.

So let me start by think so clinicians, how it applies to clinicians, as a psychiatrist, and also to patients and clinical care. So, if I start with clinicians, I can think of sort of two immediate areas that come to mind with people that perhaps I look after trainees or other doctors, female doctors, and the two areas, it really comes up gender equity comes up over and over again, are people who are parents or have caring roles of some sort. And people who are either pregnant or have young children or older children, or children with disabilities, or are carers of old people, older people, or just other caring roles.

There are always slightly different packages of support and care that we need to give to our emote. It's mainly women that come forward, particularly in caring roles. It's mainly a female population of psychiatrists that come forward asking for specific needs. So, it's always really important in those conversations, that we are supporting women in those parenting roles, and also in those caring roles. And it's, you know, tailored towards individual needs. So, what one person needs is, you know, might be very different to what somebody else needs. So that's thinking about the clinician and thinking about perhaps the patient aspect of it. I am a perinatal psychiatrist.

So, I deal with women a lot. And in discussions and conversations with patients, either pregnant women or when they've had a baby, again, issues that come up again, and again, when women are recovering from their mental illness, and severe mental health problems, whether it's psychosis or depression or anxiety, are issues to do with childcare, return to work, the balance between going to work having childcare responsibilities, and again, you know, the specific package of care that they need. Or it might even be the support that they need. And support might be different for different women based on what their needs are, and cultural backgrounds are on social backgrounds are. And it's really important to tailor the support that they need based on who they are, and it's different.

So that's where the gender equity bit comes in. Because for them to reach their potential when they return to work, having had a baby will be different for each person. So, it's to sort of help them to go on to have the right conversations, either with their partner or their family, or indeed in the workplace to make sure that they get the right level of support.

Peter Markham  24:48

That's interesting. And in the workplace, do you think that those things are happening as well as they should be and could be?

Trudi Seneviratne  24:56

No, I absolutely don't. So those are often very, very are hard conversations for women to still have today in 2023. And so, I don't think it is adequately thought about. Often people feel embarrassed to ask for what should be there, right, actually, or they feel a duty to return to work. And then there might be other stresses related to sort of the financial, you know, they need to have income coming in, so they don't want to be looked to be asking for something that, you know, is not there is actually there, right. But they don't want to be asking for it. So, there's, you know, women still have, certainly, a lot of women still aren't embarrassed to ask for what is rightfully theirs. So, it's not easy. So, I think there's, there's an awful lot more that can be done.

Peter Markham  25:48

That's, that's interesting. And so in terms of gender equity, what more do you think the college could do to promote gender equity, and to move things forward?

Trudi Seneviratne  25:57

I think the college has done a really good job in taking gender equity forward. So, you know, in the last few years, we've really helped to think about this in a way that, you know, I don't think the college thought about many, many years ago when I was a younger psychiatrist, for example. So, I think the college has done some good work in this. But that's not to say the story is over.

I think there's a lot more that we can do to promote it. I think we can be supporting workplaces, I think we can be encouraging mental health organisations, both NHS Trusts, but also in, you know, other organisations and independent practice, wherever psychiatrists are working, whether they're working full time, or whether they're working in less than full time roles. So, we can be supporting workplaces. So that's, that's a big piece of work, I think we can do.

Peter Markham  26:56

Excellent. And may I ask what do you do personally to promote gender equity, either in the workplace, or maybe even outside work?

Trudi Seneviratne  27:08

Yeah, so just thinking about that, I think the place that I probably do it the most is probably in those conversations with actually quite quite a lot, with my trainees, for example, and with consultants during appraisals or job planning, and I think conversations around gender equity car, pretty much in every conversation, helping oriented have coaching or mentoring conversations where we're thinking about a balance in life and making sure that there is a balance between all the roles that an individual has, whether it's instead of their role in the workplace, in their clinical space, their education, space, their research space, balancing that with whatever might be going on at home, if they do have parenting responsibilities, or carer responsibilities.

And in that sort of planning of their work, helping them to ask for the right support that they need, so that they are able to achieve the best that they can possibly achieve. And I often find that women of all grades from you know trainees, through to senior consultants, and senior SAS doctors, I often find that people, women don't ask for what they need. And that always surprises me, that even really competent women that are at the top of their game in lots of ways, feel that it's a struggle for them to genuinely ask to have all the things that they need to achieve their best.

Peter Markham  29:00

And why do you think that is?

Trudi Seneviratne  29:02

It's really, really good question. I think even though the world has moved so far forward in the space of equity and gender equity, I still think it's very, very, it's a very small minority of women who are able to genuinely ask for everything that they need to reach the bar that they need to get to. And I think there is still a fear that if you ask for with one ask for what's rightfully yours, that you will somehow be seen as a, as a pushy, as a pushy person or as a you know, as a forceful woman. And that's not I mean, no, that's absolutely not right. That's wrong. Will you'll be perceived of as an aggressive person in some way.

So I think there is a fear there, women will often feel guilty as well about asking for things. So, I think that's partly of sort of a makeup of women, of many women, where they feel constantly that they, you know, they're not worthy. It's not, you know, somehow, they're not, they're not worthy of getting something and have to feel guilty for asking for something. So, that I think that is an inherent sort of makeup of a woman if you like, which makes it difficult. Things are moving, things are changing. But I think, again, I think there's a long, long way to go.

I think this, you know, some of this can can happen with kindness, where women are encouraged to, you know, to ask for absolutely everything they, they deserve to have, and that it's okay. And you, you know, you can have these things, and you're allowed to have these things. And you don't have to feel guilty for having them.

Peter Markham  31:04

I suppose there's an argument that each, each generation is different from the previous one in some way. And this next generation joining the workforce may be different to those that have gone before them in the way that you're talking about there. We shall see. What advice would you give to someone starting their career in psychiatry now?

Trudi Seneviratne  31:30

Yeah, that's lovely. You're absolutely right. There are generational changes, aren't there? And we would like to hope that each generation nudges positively in the direction of gender equity. I think the advice I would give is that, you know, when you're when starting in psychiatry, wherever you are, in the world, whatever the sort of social, geopolitical, cultural context is, and all of that matters, because all of that contributes to how somebody achieves the maximum of themselves.

I would advise it always, always ask for what you want. Just ask for as you progress forwards in your career, obviously, have a dream, pursue that dream, whichever area of psychiatry you want to go to, and go into. But also, be brave enough always to ask for all the tools that you need to be able to progress to the next level. Be brave enough to ask for, and unashamedly be brave enough to ask for, for everything, whether that's, you know, a clinical role or an educational role or if it's a mentor, within a race, within a research area, or it's, you know, it's additional support because you happen to be a parent or you happen to be a carer.

Just ask for all the support that that you need. And hopefully that will, you know, fuel a fantastic career in whatever it is that you're going to be doing. Don't be, you know, don't be frightened to ask for anything that you need to boost your career.

Peter Markham  33:26

Some great thoughts, their trading, and some great advice. Thank you very much for joining us on International Women's Day.

Trudi Seneviratne  33:33

Thank you so much, Peter.