Addressing the gender challenge in cognitive rehabilitation

By Natalie Mackenzie, founder and director, BIS Services

In the last six months, I’ve watched as what was once a manageable challenge has evolved into a critical workforce crisis that’s directly impacting our ability to provide timely cognitive rehabilitation services to our clients.

For years, we’ve faced the reality that finding male psychology graduates to work as cognitive rehabilitation assistants (CRAs) was difficult.

But recently, given the speed at which people expect us to turn around referrals, we’re finding ourselves under unprecedented pressure to find qualified male professionals who can work with our clients.

We used to have more flexibility, and our approach wasn’t quite so prescriptive.

When a client requested a male CRA, I could confidently say, “We’ll try our best. It might take some time, but we also have a highly skilled female professional with these particular competencies who would be worth considering.”

More often than not, that consideration was welcomed.

But something has shifted dramatically in the past six months. That flexibility, that willingness to consider alternatives, has largely disappeared.

The rigidity we’re seeing from clients is directly impacting how quickly we can deploy male CRAs to those who need them most.

What’s driving this change?

I believe we’re working with increasingly challenging clients who present with more severe behavioural issues.

The rigidity and concrete thinking patterns that are classic hallmarks of frontal lobe brain injuries are becoming more apparent in our client base.

These neurological changes result in reduced flexibility and decreased willingness to adapt or try new approaches.

While we remain steadfastly client-focused and person-centered in our approach, I’ve observed that multidisciplinary teams (MDTs) can sometimes inadvertently reinforce this inflexibility rather than exploring alternative options and outcomes.

The challenge is particularly acute in the early stages of a rehabilitation package, where there might not yet be an MDT actively working to address these rigid thought patterns, which is often precisely when we’re brought in to help.

Despite these challenges, we continue to advocate for our female staff members.

I regularly present cases where I’ll say, “I know this person is female, but she has the exact skill base and robustness you’re looking for, and she meets all the criteria except for gender.”

When we have strong relationships with MDTs, we can sometimes work collaboratively with clients to create opportunities.

Sometimes, simply arranging a meet-and-greet can completely change the dynamic.

But this requires confidence and collaboration from case managers and MDTs who must be willing to challenge preconceptions and work in partnership with clients to explore alternatives.

However, when that collaboration isn’t forthcoming, we hit a wall. And this impacts us significantly from an employment perspective, creating complex legal considerations around advertising and recruitment.

The legal landscape around gender-based hiring in our field is particularly nuanced.

We’ve had to work closely with external providers who handle our advertising to ensure we’re using appropriate wording.

Since we don’t provide intimate personal care (rather prompting & supervision), we must be extremely careful about how we phrase our requirements.

This creates a delicate balance during interviews and application processes.

We must be cautious with candidates throughout the selection process, and when someone isn’t successful, we can’t explicitly state that their gender was a determining factor.

It’s a complex dance that adds another layer of difficulty to an already challenging recruitment landscape.

The root of our workforce challenge lies in the broader demographics of psychology education.

Today, only about 20 per cent of psychology graduates are male.

This figure hasn’t changed significantly since I completed my own degree decades ago, when there were only three males in my entire cohort.

Interestingly, our workforce actually mirrors these national statistics perfectly: 20 per cent of our total staff are male.

However, this figure includes our senior management team, where male representation is higher.

When I look specifically at our CRA population, the percentage drops to around 15 per cent.

This makes every qualified male candidate incredibly valuable. When we identify a promising male psychology graduate, we move quickly to bring them on board.

What’s particularly striking is the disparity between different levels of care provision.

We see many males working as carers, but significantly fewer working in specialist provision requiring psychology degrees.

There’s a substantial drop-off between carer-level provision and clinical rehabilitation provision when it comes to male professionals.

This specialist provision gap is critical because we’re seeing increased demand, particularly in neuro-rehab with more forensic and behavioural needs.

Having male psychologists in these roles isn’t just preferable. It’s becoming essential.

The implications extend far beyond our immediate staffing challenges.

We know we’re facing increased demand for mental health professionals, psychologists, therapists and counselors.

Given the growing awareness around male mental health issues, it’s crucial that we have male professionals who can bring different perspectives to treatment approaches.

In our sector, we’ve traditionally seen a higher proportion of male clients due to demographic patterns and prevalence rates, though we’re seeing more female clients over the past five to six years.

However, the need for specialist male provision continues to grow while our ability to meet that need diminishes.

The solution requires action at multiple levels.

We need grassroots education starting in schools, encouraging young men to consider careers in psychology, counselling and therapeutic professions.

Universities need to make these programmes more appealing to male students, and we need to actively work to dispel outdated stereotypes about who belongs in caring professions.

At the service delivery level, we must continue our collaborative approach with MDTs and case managers to increase flexibility in client expectations.

The reality is stark: when female professionals are available within a few weeks, finding qualified male professionals can take several months.

In rehabilitation, timing is crucial. That golden opportunity for intervention can be lost during extended delays.

This isn’t just a staffing challenge – it’s a systemic issue that affects the quality and timeliness of care we can provide to those who need it most.

We need male psychology graduates not just to fill quotas, but because diverse teams provide better outcomes for clients with complex neurological and behavioural needs.

The path forward requires commitment from educational institutions, professional bodies, employers and society as a whole to break down the barriers that prevent qualified people from entering this crucial field, regardless of gender.

Only then can we ensure that every client receives the specialised care they need, when they need it most.

Learn more about BIS Services at thebiss.co.uk