No / The National Health Service (NHS) has historically undertaken initiatives to promote equality in employment as well programmes to develop and promote Black and Minority Ethnic (BME) staff. However, discrimination remains a feature of NHS employment practices and may help to explain the lack of BME staff at senior levels in the service. Despite having many initiatives BME staff are underrepresented in NHS senior management and at the top of each organisation, the management is almost always white. This paper will present findings from a case study on the experiences of corrective action by BME staff in senior/middle management positions. The paper will outline key messages and good practice to inform policy and practice.

No / Interest in third sector organisations (TSOs) is growing as their role in addressing social regeneration, especially in urban environments, is regarded as crucial by governmental and supra-governmental organisations. The challenge is increased in multicultural environments, where those from ethnic minorities may struggle to participate in the mainstream economy and society more broadly. There is an assumption that TSOs make a positive contribution to the social good of the diverse communities and client groups that they serve. However, although there have been many studies of ethicality in commercial and public sector organisations, few focus on TSOs. Furthermore, black and minority ethnic (BME) TSOs, in particular face specific pressures, caught between the high expectations of their capacity to engage with diverse communities where the public sector has failed and, in common with all TSOs, the struggle to secure the resources necessary to manage their organisations and deliver front-line services. In this article, we investigate how implicitly ethicality is constructed in TSOs, including those with a primary mission to provide support for and services to BME communities. Building on information obtained for 305 TSOs in a post-industrial city we develop a structural equation model (SEM) in order to evaluate the relationships between elements that we argue comprise ethicality. We then assess the manner in which TSOs generally, and BME TSOs specifically, vary in the manner in which they communicate their ethical purpose and the outcomes of their actions.

Rationale: This study was conducted to help improve mental health care for Black and Minority Ethnic (BME) clients as previous research carried out in non-western countries has suggested that western-developed psychotherapies often need to be culturally adapted to become more effective in treating this client group. The aim of this study was to explore how CBT therapists deliver manualised CBT with BME clients and if they make any adaptations, how and to what extent are they implemented. Method: Interpretative Phenomenological Analysis (IPA) guided the conduct and analysis of one-to-one, semi-structured interviews with six CBT therapists working in an Improving Access to Psychological Therapies (IAPT) service. The inclusion criteria for participants was accreditation with the BABCP, completion of an IAPT programme CBT diploma and to be currently working in an IAPT service, at least two years experience as a CBT therapist and at least four cases of completed therapy with BME clients. Findings: Four master themes emerged (1) CBT is based on western principles, (2) The complex nature of CBT, (3) Changing practice of manualised CBT and (4) The influence of therapist factors. Conclusion: The participants experienced many issues in their practice of manualised CBT with BME clients which led them to make changes including adaptations to manualised CBT. They described their current practice as being integrative as they incorporated therapeutic approaches other than pure manualised CBT, making them more flexible and adaptable. The adaptations involved altering the cognitive and behavioural interventions to better suit the individual needs of the client. The adaptations took into account the client’s culture, religion, language, psychological mindedness, acculturation to their host country, education and age. The participants’ confidence in CBT and their self-identity as therapists also influenced their overall practice of therapy. Recommendations for practice are discussed in relation to therapeutic practice, training of therapists, supervision and policy makers.