Equality and diversity in the workplace
In 2004 five researchers, measured the impact of the Human Rights Act 1998 on NHS provision. They investigated the extent to which patients from diverse religious backgrounds had access to appropriate spiritual support. Responses from 72 hospitals chaplaincies indicated "considerable disadvantage to non-Christians in relation to access to space for worship, chaplaincy staff and quality of chaplaincy care" [Sheikh et al, 2004]. Earlier research [Weller, Feldman and Purdham 2001] for all religious groups in England and Wales revealed that around two thirds of Sikh organisations and over half of Muslim organisations recorded unfair treatment from NHS staff. A majority of the small number of responses from New Religious Movements [NRM's], Pagan, Zoroastrian and inter-faith organisations did the same. Muslims were the most likely to say that the unfairness was 'frequent' rather than 'occasional'. Little or no unfair treatment in any aspect of NHS health care was reported by Buddhist organisations.
Specific examples of unfair treatment were:
"Chaplaincy and facilities for worship (Muslims, NRM's,
Pagans and inter-faith)
Dietary needs (Jains, Muslims, Sikhs, and inter-faith)
Language barriers (Sikhs, inter-faith)
Medical techniques (Jains, Muslims, Christians)." [op cit]
The aim of this assignment therefore is to explore the extent to which mental-health service users and colleagues within my workplace of South Staffordshire and Shropshire NHS Foundation Trust [SSSFT] experience religious equality, particularly within its Shropshire and Telford & Wrekin [STW] areas.
Firstly, I will survey the aspirational [i.e. international declarations or conventions], legislative, and theoretical framework for religious equality and diversity. I will explore how definitions of belief and new thinking on spirituality encourage us to go well beyond what those researchers had in mind. Then I will comment on progress within SSSFT concluding with some outstanding issues for the future.
Of the six equality and diversity strands [the others being race and ethnicity, sex and gender, sexual identity, disability, and age] religion or belief is for me the most complex given that it has proved difficult to define as reflected in the various declarations and pieces of legislation.
The overarching framework is the aspirational United Nations Declaration of Human Rights 1948. Article 18 states that:
"Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance."
Article 9 of our own Human Rights Act 2000 protected a person's rights in relation to a broad range of views, beliefs, thoughts and positions of conscience as well as to faith in a particular religion.
Significantly, "religion" was becoming a loose concept which included "positions of conscience". However, there was an important restriction, whereby the state could "interfere with a particular religion or view, if necessary to protect public safety, order, health, morals, or the protection of the rights and freedoms of others." [Articles 9.3.80 to 9.3.82]
The Employment Equality [religion or belief] Regulations 2003, included discrimination on the grounds of religion or belief in employment, training and further or higher education. However, the Act offered no fixed definition of religion, leaving it to the courts and tribunals in cases of dispute.
The Equality Act 2006 Part 2, in force in 2007, dealt specifically with religious or belief discrimination. It stated that a religion or belief must be generally recognised as "cogent, serious, cohesive and compatible with human dignity" [Barrow 2008]. This would, as Barrow points out, exclude allegiance to or belief in, for example the Jedi Knights. The Act named Bahai, Buddhism, Christianity, Hinduism, Islam, Jainism, Judaism, Rastafariansim, Sikhism, and Zoroastrianism. However, it also provided for other "philosophically-based beliefs" [without the 2003 Act rider of "similar to a religion"] as well as the right to have no religion or no belief at all.
This has led not only to the protection of humanism or atheism, but also to Scientology, which, despite previous support from the European Court of Human Rights, has now been successfully prosecuted in France for preying on "vulnerable" and "fragile" adults [Sage and Ayers, 28th October 2009]. The criterion of vulnerability has implications for mental health as we shall see later.
Nevertheless, the Equality Act 2006 Parts 1and 2, made it unlawful for anyone to be discriminated against because of their religion or belief, in terms of any aspect of employment, the provision of goods and services, education, using or disposing of premises or exercising public functions. It is the provision of goods and services which is the concern of this assignment.
The purpose of the acts was to outlaw instances of discrimination, either direct, indirect, or through harassment or victimisation. But what does "discrimination" actually mean? Thompson explains that whilst discrimination itself is a neutral concept identifying differences, it becomes negative and therefore unacceptable when "attaching a negative or detrimental label or connotation to the person group or entity concerned." [Thompson 2003:10].
In essence therefore the Acts were attempting to ensure that every person was treated equally within the workplace and that their human rights were protected. Whilst mostly framed in terms of employment, it is easy to see the implications for the provision of goods and services.
Thompson has provided us with a theoretical framework to underpin all of this in his PCS model [see below]. He first shows how negative discrimination generally is experienced as oppression, which he defines as "Inhuman or degrading treatment of individuals or groups, hardship and injustice brought about by the dominance of one group over another; the negative and demeaning exercise of power" [Thompson 2003:10]
Then he identifies three levels of discrimination and oppression:
Personal - our own covert or explicit perceptions or prejudices e.g. Islamophobia because of recent terrorist acts;
Cultural - quoting Berger and Luckman, "The social Construction of Reality" 1967 the "taken-for-grantedness" [Thompson:15] of everyday life that for example, one culture is superior to another;
Structural - the social, political and economic factors which, if unchallenged will seek to keep things as they are.
Thompson quotes from Foucault's "discourses of madness" where in the early medieval period, socially "the mad were not seen as threatening, but almost possessing an inner wisdom", whereas later discourses regarded madness as "an illness in need of treatment" [Thompson 2003: 22]. He expands on this to describe how oppressive it can be to be labelled as mentally ill. He cites Ussher's [Thompson 2003:132] exploration of women's madness as more to do with misogyny than mental illness; or how mental illness results in a power-transfer away from the patient to the expert doctors. [Thompson 2003: 133].
So, all three PCS factors, says Thompson, interact to produce our own particular discriminatory practices. Moss  however, offers a fourth factor:
Spiritual. Whilst recognising the negative oppressive potential of religion, Moss suggests that re-discovering the deeper spirituality within all faiths would enrich the PCS dimensions becoming "the very heart of the struggle for justice and emancipation" [Moss 2005: 71]. At its best, spirituality challenges us to ask what our world view is or should be and can therefore aid our emancipatory practice by motivating us to challenge essentialism [Thompson 2003: 28] whereby our biology, personality or destiny are regarded as fixed rather than fluid or diverse.
There is therefore a developing emphasis, not just on legal constraints, nor even on challenging essentialism, but of celebrating the potential of diversity as "a sort of benchmark in contemporary human services" [Moss 2005: 69.]
NHS Trusts were often at the forefront of this approach. For example the Devon Partnership Staff Handbook on Culture and Religion 2003 states:
Those who have reason to access the Trust will receive:
"the right not to be discriminated against on the grounds of gender, sexual orientation, social, cultural or religious beliefs." [Harrison 2001: 1]
These values are reflected in the most recent DOH Practical Guide on Religion or Belief stating that "A holistic approach to the patient, which takes account of their physical, cultural, social, mental and spiritual needs, would seem to have a particular significance within mental health services." [Religion or Belief: 2009: 32]
As well as dealing with diet, dress, surgical procedures and privacy, the Guide deals specifically with mental illness drawing attention to the variety of spiritual interpretations of mental illness and differing attitudes to the use of psychotropic drugs, though it is factually wrong in asserting that "All the major world religions condemn suicide unequivocally." [Religion or Belief 2009: 34] The Church of England does not.
So how is all of this working out in SSSFT? At policy level it has some way to go. Published in 2005, its review date  has expired. It acknowledges its obligations in its preamble:
"Staff and users of our service are treated equitably, with dignity and respect, involved and considered in every aspect of changes affecting their employment or health care within the Trust." [SSSFT 2005: 1]
There is however no further consideration of service delivery concentrating solely on employment aspects of equality and diversity.
Despite this, there are several instances of good practice locally. The number of other-faith groups in the area is very small. Within STW, [population 445000, and 99.1% white], Telford and Wrekin, [population 160,000], has the most diverse religious mix with 74.3% Christian and 2.5% Muslim and Sikh. [2005 National Census].
Nevertheless, Shelton Hospital set up a multifaith room with sacred texts and artifacts of six world faiths and a monthly multi-faith calendar. Patient leaflets alert new arrivals to the existence of the room which has become well used. A Hindu patient has used it recently for meditation and Muslim staff use it for prayer-times. Space has been created in the planned new hospital for religion and spirituality, including en suite wuzu [washing] facilities. In the case of a long-term Muslim patient, arrangements have been made for him to visit the nearest mosque 12 miles away for worship.
In the community however, a Muslim consultant colleague observes that take-up of our services are lower than would be expected. Therefore a Sikh female cross-cultural community worker has been appointed to address this in her own and the nearby Muslim community, but clearly more needs to be done on the lines perhaps of best practice in Newham featured in "Hard to Believe" [Croydon Mind: 2007]
Former service-users were asked recently to describe their experiences of hospital care. All unwittingly mentioned their own experience of Thompson's PCS model. Having already endured the cultural stigma of mental ill-health, they experienced a structural factor as well, given that their consultants believed their spirituality was delusional and therefore pathological at worst or at best irrelevant to their well-being. Recognising how powerful their psychiatrists were for their future, they learned to hide their faith.
Since 2005 however there has been a remarkable sea-change with 12% of psychiatrists now belonging to the Spirituality Interest Group of the Royal College of Psychiatry. Sims and Cook call for a much more positive attitude amongst their colleagues, and this has impacted locally. Regular Christian worship has been established around the hospital making it easier for demented or vulnerable older patients also to participate.
Within the broader spirituality agenda, "Exploring your Spirituality" groups with clear anti-discriminatory ground- rules [Potter 2008] have given patients opportunities to learn from others and to celebrate their diversity, encouraged by Hindu, Christian and non-faith facilitators.
Members of staff too have been given local training and handbooks on religion, spirituality and culture over the past two years leading to much more acceptance and celebration of diversity.
In summary therefore local practice is ahead of policy development.
Other challenges are now emerging. Firstly a colleague recently requested that, as a matter of equality the Multi-faith Room should contain books for those with no faith, so that patients could read about faith as a delusion, or scientific explanations of life. The request has raised issues relating to vulnerable adults and proselytizing literature. The Scientology case mentioned earlier together with two cases in the Greek courts described by Evans [Edge & Harvey 2000: 185] have all used the criteria of "vulnerability" to settle the matter and it remains to be seen what our own conclusion will be.
Secondly, the human rights declarations together with the broader spirituality agenda beg questions about the limits to diversity in a mental health setting. It is one thing to limit diversity if someone's faith is at risk of damaging society or others; it is another to actively support a patient in pursuing beliefs however bizarre which, though causing no harm to others, could be judged as harming the patient's well-being.
Lastly there is the challenge of funding. Although emancipatory practice is everyone's responsibility, the appointment of Equality Champions, including chaplains, in SSSFT is recognition of the need to encourage implementation. However, SSSFT chaplaincy is under-resourced, particularly in the area of other- faith chaplains or spirituality co-coordinators which could lead to delayed full celebration of diversity.
Perhaps therefore it is time to carry out our own research in order to secure funding for best equality practice.
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Employment Equality [Religion or Belief] Amendment Office of Public Sector Information.http://www.opsi.gov.uk/SI/si2003/2003
Equality Act 2006 Part 2, Office of Public Sector Information http://www.opsi.gov.uk/Acts/acts2006
Evans M.D. Chapter 9 Religion, Law and Human Rights: "Locating the Debate: Law and Religion in Contemporary Society" Edge & Harvey [ed] 2000 reprinted 2002, Ashgate.
Hard to Believe: DVD presentation exploration of Spirituality in Practice: Mind Croydon 2007
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Sage and Ayers, 28th October 2009, "Scientology found guilty of Fraud in historic ruling. The Times
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