Inequalities in mental health care for black communities transcript

Helen Beddow:

This week I am joined by Karen Carberry and Dr. Ted Ransaw to talk about inequalities in mental healthcare for black communities.

Karen is a Black British Family and systems Psychotherapist and is a Consultant Family Therapist at Orri, which provides Specialist Day Treatment for Eating Disorders. Dr Ted Ransaw is a curriculum development specialist at Michigan State University.  Ted’s research explores masculinity and black male identity in educational contexts. 

Ted and Karen, alongside Richard Majors, are co-editors of the recently published International Handbook of Black Community Mental Health.

Welcome to the podcast and thank you very much for joining us.

Karen Carberry: Thank you

Ted Ransaw:  Nice to be here.

Helen Beddow: To start with, I just like to ask you about the motivation behind the handbook. What does it do that's different from what was out there what was what was kind of missing?

Karen Carberry:

Our book really looked at the lived experience, I mean a lot of information that we have out there about the experience is in some reviews, statistics, but not really getting behind the real lived experience of people. And it was very important that when people read our book, they got a sense of exactly what's happening to the black community in the mental health system, not just the, the percentages and the statistics about the disparities in treatment, the disparities in pay for workers in the NHS system, the racism that they have been experiencing. And then we know from Roger Kline’s report, "Snowy White Peaks", he talks about the level of black people in lower grades, I know some of that started to change, but not enough. In terms of some of the treatment models and how I guess distress, how that's exhibited is not normalised for people of black, and minority ethnic because there's - in parentheses - the normative state of how practitioners expect people to express their distress, coming from really a white middle class background. in terms of research., I think it was really important that we showcased a lot of the work out there where we are doing really well in terms of engaging in treatment models. And also, sharing some of the ways we work that can actually provide a successful outcome as well. So that was really important and we had such a large contingent of very able scholars, practitioners, who talked across, not just the NHS, but also in terms of education. that we're able to share, sort of a more global holistic way of seeing what's actually happening there and I guess with the recent dreadful experience of people, observing the killing of George Floyd, that just really bought home for many people, the pain, in which people of colour globally have been going through to through the criminal justice system centred education system. Just about in every system, I guess, really, some of the different types of racial experiences they've had that really contributes to their mental well-being. And, you know, recently we've been very pleased to see that people have all come on board in terms of the Black Lives Matter. People from all racial backgrounds are now seeing and acknowledging, I guess, what really is happening s so in a sense of books sort of highlights some of that across the generations, but also provides solutions to that as well.

Ted Ransaw:

Richard majors and I - the gentleman that is not here today thought about maybe doing something a little bit different and going more in depth with community health and mental health challenges. So motivation was to take some of the ideas that we've had, and do things in a way that reach the people who really need it. And to have more global impact. And Richard had a really good relationship with Karen. Karen came aboard and kind of changed the dynamics and definitely added the black magic touch to things that we've done. And as you can see from the book that we've really tapped into the heart of what's going on and tapped into the pulse of what's happening today. And the motivation one was trying to do something that reached people especially those of the diaspora - that touched them in a personal way that had more of a direct impact by being more accessible globally.

Helen Beddow: So what are some of their main challenges, going through this healthcare system that has a white normative approach, what are some of the challenges that black patients experience and, and how did that show up in the lived experience within the handbook?

Karen Carberry:

I guess one of the things even if we just sort of looked at Sharon Walker's chapter systemic racism: being black, mad and dangerous in the criminal justice system you can see how black men are stereotyped. And as we know disproportionately diagnose with mental illnesses. It was really important that we could see such a long history of endemic racism, I guess, in terms of the criminal justice system. And, you know, even under the COVID-19 targets of stop and search, You see a disproportionate number of young black men being stopped and victimised, in a sense, really. So, this worry about black men, and you know to some extent and just in terms of stereotypes of being bad and dangerous. And then there's a fear about how to treat them.

Ted Ransaw:

Here in the US, those things are the same thing here, a lot of those stigmas and representation, black males, and how that applies to not necessarily interactions with the police, but also the interactions with the healthcare system but especially the mental health care. A lot of black males for various reasons are under different types of stress, have different types of experiences. And so when you're interacting with folks that may not necessarily look like you, if you're a male of colour especially black male, then there can be extended reasons with disconnect. but I think maybe one thing that might be slightly different in the US for black males, is that there's been a different type of perception with regards to aggressiveness, and stability and how African American males in the United States have been handling things. it's been something that's been called the cool pose, and having a stone face and try to eliminate internal - actually a better way to say it is to project some type of screen, and some kind of coping strategies, and sometimes that gets inflated to mean, to thinking of Black males have been aggressive. And also is reflective that young black males, even as early as preschool, are seen to be three to four years older than what they actually are and so that plays a role in them being  excluded, and suspended and expelled at school, even in preschool. almost, from the very beginning And here in the US, which I think similar to the things in the UK, is that once you get tracked in the system and something happens at the very beginning, now you labelled as a troublemaker or what some may call the lad, right, and that has ripple- repercussions for the rest of your life as a Black Male so it's the same exact thing in the US

Karen Carberry:

The men in, in this country, you know, they've learned how to, in the sense not to present in parantheses as “threatening”, because, you know, they know that they could end up dead, you know, essentially, if we if we look at some of these men who have, you know, have needed some mental health treatment and have, sort of, ended up deceased, either through the mental health system  or - we've got in here Sharon's chapter about the Bennett inquiry, where black patients, there needs weren’t adequately met. And, you know, there's a long litany of peoples names – Orville Blackwood, Mark Fletcher, Munir Yusef Mojothi, Jerome Scott this is going back to sort of 94 - and Rocky Bennett, because we know he was restrained by four nurses for over 30 minutes and this whole concern about, you know, you've just been stopped and asked to get out of your car.

We’ve heard recently about a couple of athletes who were asked to get out the car who had their little baby with them, and are being handcuffed while there searching for suspicion of drugs. This is something that we’ve seen on a regular basis. And now I think because of what's happened in the media highlighting the plight of black men and black women in terms of the stop and search, or even just the microaggressions then actually having to find some coping mechanism to not present as threatening, in a sense, then taps into their, their own sense of self having not been able to present, who they are - not threatening but just in terms of assertive, an assertive black woman is looked at as an angry and threatening woman, whereas a white woman would be just looked at as assertive. I think we had one of our authors who talked about black women in leadership, who again was suggested that she was unusually assertive, again, looking at stereotypes. So, you know, it is a very hard road to come out of your door each day knowing that you're going to be meeting some sort of microagression every day and as with any types of stress, whether it's work related stress, whether it's bereavement, you know, all those types of stresses that provide a real distress state, when you think about all of those things that are compounded – and then your going into work, you're going on the train somebody might spit at you, some might say something abusive, etc etc there's something – these microaggressions or overt acts of racism every day, and then trying to hold a job down, or even find a job, and the way in which people, then may want to get some help. So, stress management or something – they may ask to see somebody referred for some therapeutic support. And that isn't always forthcoming. And I know that one of the College of psychiatrists, one of their new senior members of staff talked about, referring a chap for therapeutic support and she'd already assessed him, thought he was to be a good fit. And he was not offered, he was deemed not appropriate. She sent a second person, another black male, who was somebody who was on high intelligence and would meet all the criteria. And again, he was deemed as not appropriate. So these are things, these systemic acts of microaggression, and racism that take place in the mental health system have a wider effect, not just on the individual, but also in terms of the families, you may want to be supporting and the ones inside the system. And this has gone on, as we've seen in our book for, you know, to past 30 years of overrepresentation and 40 years in the psychiatric system but we know it goes much further than that. And so we'll talk about sort of institutional racism. It is something that's embedded within the fabric, not just in terms of building, but in terms of people who are making policies and developing services. And people have to start taking responsibility for changing those services so that they are culturally competent and practitioners as well.

Helen Beddow: So I guess what do mental health professionals need to be aware of and to acknowledge that the story is different for black communities?

Ted Ransaw:

So I think to add just a little bit of context so when it comes microagression – so if you're not familiar with these microaggressions is that someone's referred that to as - just a cut. Just a couple small like little paper cuts here little paper cut there, but over a series of small period of time, you can have 1000 cuts. Right. So within a week or in a month you can literally have 1000 cuts and you bleeding from all different places. So it's death by 1000 cuts right something that happens that accumulates over a period of time. And then here in the, in the US, one of the things that's happened is that, especially for black women, if you look at how interactions are between blacks and whites I think overall, but especially when interactions and being in rooms around white women. It's that the concept of white femininity has to do with being pious, quiet demur,  And being, maybe, maybe having just a little bit of emotion, you know, showing, you know, showing empathy and so in interactions between white women and white healthcare, people having conversations with Black women. Then, if a black person is faced with racism and is quiet in the face of racism lets say because they are angry, because they are upset, or because they are trying to have control - they're trying to not cause a problem because having extreme physical reactions or facial expressions your in a white audience and you're the only black person makes you highly identified, right, and so if a white woman is being quiet. Let's say she makes an extra accusation, or is responding to something where she's been talked about in terms of there being something in the system, or insurance policy or interaction between the patient and their saying well there may be some things that are some systematic racism she responds and says, I'm not racist and gets upset. The black person being calm still gets the impression they're being indifferent, not being empathic, they’re not caring. And that's led to conceptions in the united states that black women may not necessarily feel pain the same way. So they're not giving the same type of medications for pain relief. Right, so it has ripple effects that applies in big ways, but talking about the school system with regards to health care so, if you look at health care, mental health care and health care in general but you also look at the school system, look at housing and inequalities. Then, one way to think about - those aren’t different systems, those are the same systems, because each one of those plays a role in something else. If you're a person of the Diaspora right so if you're a black person, all of those systems are systematic systems that oppress and restrict you from having or living your best life and having a full potential.

Helen Beddow: Do you think that the mental health profession has, has acknowledged the existence of structural racism in the system. Is that accepted universally throughout the mental health profession?

Ted Ransaw:

There's been conversations about them with regards to specifically, mental health, there's two schools of thought – one school of thought that we're all the same people, and the processes are the same. But then, if you're a person of colour, and you've lived your life experience around other folks who may not necessarily look like you think like you then the norm becomes that norm anything out of the norm, that is perceived as the norm, winds up being . Right. So for example, I'm a professor at a university here in the united states, and I've had a student is a female. And she's from Detroit and Detroit is a distressed area distressed situation housing schooling, all types of things are not going well for people of colour in Detroit. And so she was having a really bad day, because of racism. And then, there were saying this young ladies having problems, and they took her to get tested for, you know, for mental capacity, and the short version of the story is she says she is in a situation where she hates white people, because she's tired of all the things that have happened to her being pulled over by the police. She was having a really bad day, she was institutionalised for two weeks, because she says she hates white people. Now, hate is a bad word. Maybe she shouldn't say she hates white people. But I don't necessarily think that if you're a black young woman who is distressed in Detroit, who feels oppression, and she's reacted to that – not physically but just saying, I hate white people, I need a moment to myself. I don't necessarily think that she should be institutionalised, because if you look at the normative right, look the normative right, then that is not considered appropriate. But if you look at a person that’s black, a black person walks in the room said you know what these situations right now I’m not feeling white people right now. I don't think any black people would consider that atypical.

Helen Beddow: In terms of the mental health professionals themselves, and people of colour working in the mental health profession, what kind of microaggressions and issues around race do they experience working in mental health practices?

Karen Carberry:

Something that was put in the Metro by Faima Bakar a lifestyle reporter for the Metro. And she talks about an incident that happened last year, maybe you might remember it. So Dr. SHAN Pak who sort of made headlines when a patient asked if he could have a white doctor, instead of him

Helen Beddow: I do remember that. Yeah.

Karen Carberry:

And this very powerful interview he sort of said that the National Health Service is a jewel in the crown but one that needs to take appropriate action to stop the jewel from being tarnished. And also he was exposing something that happens on a regular basis I would probably say as a worker in the field. And you may have even people who ring up and ask for a referral to a therapist, but they don't want a black therapists they want to have a white therapist. And if you think about that, just in terms of psychotherapy. Well, you know, the predominance of white psychotherapists juxtaposed to psychotherapists of black and minority ethnic is very small, is inevitable really that as a black psychotherapist I work with a lot of white families, a lot of white clients. And so when you go into training, you're being trained to work with white clients you know that is kind of the norm, if you like. And so then, if you have a Black client who's gone through a lot of these everyday racism and microaggression that has caused extreme distress and depression, and they may only want to speak to a black therapist, somebody who looks like them, who’d understand their experience. It can cause a few problems I guess for white therapists saying that they might feel that that's racist. But there's something about as we talked about cultural competence really, in terms of understanding that these existing theories and interventions that we have for depression are really constructed by specific groups as I said before, they're mainly middle class white professionals working primarily with middle class white clients. So theories and interventions tend to be just uncritically transferred really to other affected groups, without the basis of having the cultural translation. And that's what needs to take place, the training needs to make a change. there's a lot of people calling out for decolonizing of the curriculum, so that the theories being taught are in more line with a sort of multicultural and reflective way and able to engage and work, a culturally competent and safe way, because there are professionals who experience, sort of that type of racism with the patients, and sometimes the clients who go to see also experience a level of racism but for the practitioner, they haven't seen it, I think you could perhaps term it as unconscious bias because it's something that they haven't raised their level of awareness, or they could be racist, I don’t know.

So, to be real out there, and it's really important that staff who are employed, working in the mental health service are properly supported, you know, and talk about that term institutional racism or systemic racism, you know, we know it's a form of racism that is embodied in normal practice. And it does lead to discrimination so it does manifest its way in so many different ways not just in terms of criminal justice, but also that the pay gap as well between black people and white people as well. In the positions. And with the constant, as Ted has mentioned, the microagressions, the thousand cuts that something else then does contribute to their mental well being, as well.  it's a lot to take these slights every day. And as particularly as you said as a practitioner, working with different types of fields I guess in the mental health service and having the type of response that Dr Sham had shared This is the level of everyday racism that we talk about that, that Philomena Essed coined as everyday racism that takes a lot of the well being away from people who's trying to live a perfectly happy life. And so, the personal level of racism that you talked about before. There has to be some accountability and they have to be able to correct that action, things need to take place within the workplace, in terms of accountability for some of these personal level racism that is increasingly damaging.

Helen Beddow: I think you're right that that applies to so many different sectors and taking accountability I think that, you know, many, many white people will will categorically say that racism is wrong and that they're not racist but being able to understand themselves in that model and understand themselves – how they also contribute to that system and and to perpetuating personal level racism is I guess what's missing.

Karen Carberry:

Yes you're quite right in terms of that understanding, particularly when we think about sort of our levels of consciousness around our experiences so sometimes, when something happens in front of people, it might be a shock. And it happens for both black and white people when there's a initial slight or microaggression or outright racism, sometimes people are silent because nobody is coming forward and standing up. And as a white person they're not saying they're just sort of in shock but they feel a bit ashamed about what's happened. And then they as you said as people start to sort of understand themselves and understand what racism is and and the impact on people and also themselves, they start then to look at, they're looking at their level of awareness that really forces them to look at that they are white and whiteness means terms of privilege. In terms of whether or not they shy away from the struggle of black people, or whether they come alongside, and you know it's not a linear process it's sort of a moving up and down process or immersing themselves into different cultures, and also coming out and understanding what the impact of that is on them and sort of reorientating really rather than having that sort of intellectual curiosity about black people in black and white relationships is more about how they then reject what in parenthesis bad racist white people and identify with a good white people as well. So it's a stage that people go through when they start to develop sort of an anti-racist approach, and likewise for people of black identity status again these when these things happen to them, because of the way in which I'm just thinking in terms of this country, how we're brought up, we've got this Eurocentric white worldview, unless you then start to do some work yourself and start to understand, you know exactly who you are as a black person and also your history and then realise that if you think that you'll be tall isn't quite right, isn’t quite correct and I remember again reading something about a group of students who were taken to the slave museum I can't remember where it is – they taken for a history lesson. And so they went too long, and then they when they came back they said everything that we've been taught is incorrect. And so, the head said what do you want to do and they said, our history teachers need to go, because all our history teachers are white, and they need to go to the Slave Museum. And so, they did a couple of days later, they flew to the museum. And by the time they returned, they started to change, they said we need to change the curriculum. We know now, people know is there in your face there's been this big movement what are you going to do to change, to do to decolonise, the curriculum and decolonise, the theories. And also, the assessments and the treatment process.

Helen Beddow: So we know that COVID-19 is affecting mental health and that there's been a lot of talk around the impact of COVID-19 on mental health. Are there ways that this might play out differently for black communities?

Ted Ransaw:

And one of the ways that affects black communities – if you look at communities of colour and I know we're specifically talking about black communities, but looking at communities of colour – When you go from one place to another, you normally have to go from your community, to somewhere else. And so, what I mean by that is that if you're a black person. Most black people especially the United States, usually typically live in areas, other people's covered, right, because of all types of institutional things that have happened with regards to housings segregation, housing discrimination of not being able to get that quick loans when you apply for a loan - redlining all these different things. So when a black person when they go from where they live, to whether it usually has to go through a different area. Right, and outside of their community one. The second thing is that people of colour but especially Blacks in the US here, they normally have to go to a job outside their community. but also living in a distressed place, lets say Detroit I mentioned, there's not that many grocery stores in the inner cities where most people of – African Americans live. So, you have to go from outside the community where you live to a grocery store, to where you work. So, it's the trans, is to transition from where you are so we look at containing things, especially with regards to viruses in close community. If you have a tight knit close community that’s contained to one area, but if you are a person of colour, you have to work somewhere else and come back. You are one always around other people – you're more likely to be in the service industry job, you're more likely to be a person that’s not in the office, or not, the upper floor so your normally around other people, normally the front line. two because of the communities that they live in, and being tight nit also being around other folks that look like you – they're also service workers so your in contact with more people at a larger volume.

Helen Beddow: And will there be some long-term repercussions for that communities in terms of mental health from COVID-19?

Karen Carberry:

So one of the things, as we know, the percentage of black people admitted to critical care was, like 34%.

In the UK, they count for 4% of the population so it was huge. And people of colour black and minority ethnic people how they grieve, their loved ones when they pass has had to have a huge change for everybody, for everybody, but whether it's black or white, but there are specific processes, and the way culturally, the way the people are able to bury their dead and grieve their dead in a collective, but hasn't been able to take place, obviously, so I think that has been something that's been very, very difficult in terms of being isolated. The other thing I'm going to talk about was also the fact that again how people have been treated through the COVID-19 I'm just thinking about globally in China, we heard about how some of the Africans had been thrown out of their homes and had to take their families and live on the street, because there was this discussion around how coronavirus is predominantly affecting people of colour. And so out of fear they were thrown out of their accommodation thrown out of their jobs. So that will have a knock on effect on families extended family system in which they would be earning money and sending back to their countries of origin. And the other thing I think in terms of around COVID, how we've seen - masks obviously had to be used for protection - and stories of black men going to the supermarket to buy food for their families, haven't been followed around and ejected without being able to buy food. I mean, that sense of humiliation of not being able to provide for their families or buy food for their families really demasulclates, brings us back to another time doesn’t it where black men were unable to look after their families. And we're also hearing about who's getting fired from their jobs so we know that a lot of people are losing their jobs, the downturn in the economy, across lots of countries. We are seeing a high level of people of colour, who are being let go. So, you know, the long-term effect we know globally is going to have an effect on people of all cultures and races. But in particularly when we talk about black people people of colour who haven't been able to access talking therapy anyway, or in a way that they connect to the way in which they think and exhibit distress in a safe way without feeling stereotyped or without fear that they're going to be on psychotropic drugs. So, you know, I think there will be a lot of concern about people's mental health. but at the same time I would say that the black community has been coming together in providing support as well and I think that's important to say, but as a collective, they are seeking answers to why there has been this disproportionate numbers of people of colour with coronavirus.

Helen Beddow: And is a conversation about this within the mental health profession, mental health professionals and platforms where mental health professionals talk about their work, are they thinking about the ways this is playing out differently for black communities and are they thinking about how they might mitigate against some of these long term repercussions for the black community?

Karen Carberry:

I think when we had our launch the organisation, hosted our launch, right at the beginning of COVID did a call for action for people to come together and talk about what's happening when we heard you know the first 10 professionals, or first 10 doctors who had died, were from the black and minority ethnic community, and some of the later discussions about why it's black and minority because they are higher risk because they're overweight. They have high blood pressure, there obese, you know, those sort of things. And so there have been forums where they said, Well, actually, I've worked with this, this, this I've worked with these, this, this particular colleague, and this person was not obese they weren't overweight or they weren't poor, that's was the other thing, poverty, these people are people who are middle class who don't fit what they say so something else is afoot here.. So in terms of the professionals, you've got a lot of people who have been offering free counselling, to the bereaved. So there has been a lot of fundraising, a lot of discussions about working collaboratively. In order to help the community.

Helen Beddow: And is that similar in the US Ted, are there our conversations within the mental health professionals going on about COVID-19 and the ways it might impact on black communities?

There's been lots of conversation about that to echo what Karen was saying, there's been a couple of conversations about the bill gates, and some other folks, wanting to try, or do trial test with people of colour in black communities and getting them to do trial drugs first. And what may not know across the pond. There's a big distrust within the black community with medical professionals for a few different reasons. One, mostly gynaecological experiments that were done United States were tested on black women. We also have something called the Tuskegee experiment where African American males in the service were given syphilis without being told explicitly over a large period of time. So there's been a few different things that have happened to African Americans so there's a large distrust between the black community, and the medical profession in general, and then now's the time to come to your community we have this experimental drug for covid, you know, let's take it doesn't necessarily go very well, but one of the other conversations with regards to black Mental Health not just covid, but going along with COVID-19 is that because of the diaspora, right. So for those of you that are familiar with the diaspora is has a lot to do with the slave trade folks taken from Africa, going to other places around the globe, but because of Diaz Group, a large percentage of those who survived the Middle Passage were because of their blood type, right, and some memory something called sickle cell anaemia. And there's haemoglobin right so there's this actually slightly different distribution in blood folks of African descent. And that's how we made it across the Middle Passage. Because of that, blood, it might be slightly different than taking anti-depressant medications for African Americans may not work as effectively, because our blood type is different. And then now we're getting into designer drugs, based on ethnicity and race and that gets into a whole, whole nother ball of wax So, short version Yes,. There is a lot of mental health conversations going on about how to best provide for those of African Americans in the united states.

Helen Beddow: Are these issues around education around community, all of these different aspects that affect the black lived experience, are they bought into mental health training for professionals, or is that something that's really missing?

Karen Carberry:

one of the chapters that we have is we have a couple of chapters on ASD and mental health. One of the important things to think about is already your children are stigmatising right you know we already know that as children grow up, they're going to be stigmatised and so it's very important that they have a strong protective factor in terms of their sense of sense of their identity sense of self. So one of the things I think sometimes black communities would be that don't want to see their child sort of diagnosed with a education deficit, even, you know, even if I think about physical deficits, you know if people need a hearing aid or something like that, you know, I think there probably needs to be a lot more research around that area but in terms of being told that you're, you know your child isn't working to the best of their ability or is not on par with the rest of the class, you know, again, sort of sets up the children in terms of impacting their sense of identity and their sense of self esteem. Cheron Byfield and Tony Talburt talks about targeted intervention in education and employment of emotional well-being of boys,  but it's really important that the young people have a sense of what they can achieve even more so than just yes you can do that but you know that they have a sense, they can see people who look like them, who have achieved. I think that's very important if you're if you've got a teacher that looks like you when I think about - I do a lot of work in the Caribbean, and the level of attainment is phenomenal in the Caribbean, and not enough of that it's talked about. Although, everybody, whichever country you're in, they will suffer some degree of mental health the level of mental health in the Caribbean is much lower than it is in Europe. So, in terms of the Caribbean, I'm just thinking about Jamaica, the work I do in Jamaica In Jamaica, you have teachers who look like the pupils. There's a sense of expectation that they will achieve and how education is really important for black families, and black parents, and they do achieve, because that's the expectation, whereas when you're in a school whereby you are not expected to achieve. and that's going to affect your mental health well being and also your confidence. So, when Cheron Byfield and Tony Talburt talk about the word targeted intervention in education, that's so important and key that these boys and girls can develop training, to develop their skills and confidence, and address any negative impact that might come against them so that they can move through that, as Tony said, you know, a lot of things, young people they’ve worked with have gone on to Oxford and Cambridge. You know those things are really important that we put that training in, I would say every school very where there are black children are and you could say, well, that should be for everybody, but when you have statistics that say well you know there's underachievement both in school or in university that black people drop out, Black people drop out of university, and, you know, we have to really attack that fabric where they feel that they're not Don't feel valued and that is in the curriculum, I believe, really, as well.

Karen Carberry:

one of the things I would like to sort of say, you know, Jennifer McCall the senior publisher at our book launch she says that our handbook is one of the most important handbooks that we published by Emerald all this year. And for me that was really really encouraging, and that you know we published at such time as this with solutions that can meet so many different needs transgenerationally across the family lifecycle, but also a guide, really, in terms of teaching for mental health, teachers and other practitioners, who’ll be able to read this and say, Okay, this is what I need to work on. This is what I need to be able to open my mind and raise my level of awareness. And one of the things that I am seeing as a result of the Black Lives Matter movement as and as a result of the global response to George Floyd, is that companies are taking there, they're not only just making statements, but they're also making changes, and you know that's a big deal. It is a fragile state if you like When you are, you know you need to respond to do something, but how do we do that. So I think in terms of being able to have a deeper understanding across the whole socio-political aspect of society, being able to raise your level awareness and be able to make a change is only going to have good effect for all.

Helen Beddow: Absolutely.

Ted Ransaw:

Wow that was pretty Impressive Karen. I do want to say that as a black male, as a professor at a predominately white institution is actually have a lot of good days, I actually go to work. Everything is, you know, actually I have a fairly pleasant life Right. I do a lot of work with issues with regard to mental health and cognition, but also to work with regards to supporting black males right, and I work with a lot of folks from a lot of different races I have a few white colleagues that I work with, they send me articles and do research on black males, and they show me and bring me stuff all the time, stuff that I didn't even know about right. So I have a lot of really good pleasant relationships. Right. But sometimes I go to work, and some stuff happens or someone said something, or have a student come to my office, talks about their interactions. And I really just am quiet for a long period of time because I really don't want to be labelled angry black guy although a lot of times I am most of the time I’m not. I get that a lot.  But what I’m getting at is that for the colleagues that I do work with then and great relationships that I have students even some black, some white – great relationships with students. I think one of the challenges is the really good, great relationship that is fostered with white colleagues, very satisfied very good long great, but I couldn’t tell or I wouldn’t have been able to predict that I would have these great relationships with these folks by looking at them. And I think that's the key is being open and be able to, you know, be patient, but being open and and focus on being aware and establishing relationships. And so what I guess what I'm talking about what I'm getting to is you probably can't judge a book by its cover. And that's kind of getting into the essence you know making assumptions about people, or what they look like. There are so many folks who have come out of the woodwork who are now allies of all different colours of all different races, and now everyone seems to be aware. So this is the time this is what Karen talks about what, where people are doing some phenomenal things. And so we're making large, broad changes so that's a good focus, but focusing on the every day, and being able to say hey you know what I don't necessarily think that's the right thing to say. Or maybe we should handle this a little bit different. Everyone can contribute to making a positive difference. And if we can focus on everyone pushing a little harder or pushing a little bit further, we can push through racism and get to the next level.

Helen Beddow: Thank you both for a really engaging and eye- opening conversation that was that was brilliant. Thank you.

Ted Ransaw:

Well I appreciate you and I appreciate Emerald press, thank you for everything you've done this far and look forward to the very near future.

Karen Carberry:

Yeah, thank you ever so much. I did enjoy it actually.