Sarah Carr
Honorary Senior Lecturer, University of Birmingham

Although adult social care works with some of the most disadvantaged and marginalised people in society, for various reasons mainstream services don’t always get it right for people. That’s why there are different forms and sources of care and support developing outside the mainstream. HSMC is currently doing some Economic and Social Research Council-funded research on the difference micro-providers can make in adult social care and the team wanted to know more about how very small providers could meet the needs of people who can be marginalised in large, mainstream services. So we reviewed some of the UK research on how small, local community organisations are already working with BME people, LGB people, people from different faith communities and refugees and asylum seekers. The review has been published as an HSMC Policy Paper 18.

Although we came up with some familiar findings about the difficulties associated with accessing the mainstream, it was very useful to get an overview of the commonalities across the different groups. Both Black and minority ethnic (BME) and lesbian, gay and bisexual (LGB) people perceived or experienced mainstream services as discriminatory. They encountered things like inappropriate support offers, cultural misunderstandings and assumptions and difficulties around communication. Using mainstream services could be stressful and make people feel powerless or even stigmatised. While language could be an issue for some BME people and refugees and asylum seekers, communicating identity, relationships and life history was experienced as problematic for older LGB people.

If BME and LGB people as well as refugees and asylum seekers and people from different faiths aren’t always getting the right support from mainstream sources, what happens? One positive finding was the extent to which communities have self-organised and established specific local support initiatives in order to compensate. People also draw on various social networks and peers for support. Faith and cultural tradition can be a positive factor for maintaining identity, resilience and well-being. Attachment to communities of culture and identity were also important.

The research highlighted the unique nature of small-scale, community based support and showed that grassroots and support network initiatives for marginalised people are multi-dimensional and can offer a mixture of practical, social and emotional support. Self-help and mutual support approaches can be particularly effective. Because they have grown up in response to specific needs, small community-based support initiatives can integrate non-conventional or broader support and activity sources for individuals and communities in a way mainstream services often cannot. Specialist community support initiatives can help access to and awareness of mainstream support and help with communication and cultural competence.

While it’s positive that communities are mobilising social capital and finding innovative ways to ensure marginalised people get the support they need, this type of compensatory activity needs recognition and investment if it’s to be sustainable. Its existence does not mean that mainstream services can abdicate responsibility for BME people, LGB people and refugees and asylum seekers. Rather its existence means that there is a real opportunity to invest in innovative community and specialist support as well as in mainstream services so marginalised people can make the choice that’s right for them.

Inevitably research generates as many questions as answers. We were left with an impression that there are distinct strengths within marginalised communities that could be nurtured but are often misunderstood. This led us to ask more questions like these – what do you think?

  • How can we address the perception that large mainstream services limit people’s control and stand in the way of them using their cultural and social capital for to mobilise support?
  • Is the nature of social support networks and communities more complex and diverse than the mainstream system currently conceives? Can the complexity and diversity be seen as strengths?
  • How can local sustainability be achieved without the ‘scaling up’ or absorption tendencies that can undermine the unique character of small community or specialist providers that makes them successful?

Dr Sarah Carr is an independent adult social care and mental health consultant specialising in personalisation, service user participation and diversity knowledge. She previously led the personalisation work programme at the Social Care Institute for Excellence. She is an Honorary Senior Lecturer at the School of Social Policy, University of Birmingham and an Honorary Visiting Fellow at the School of Social Policy and Social Work, University of York where she co-chairs the Lived Experience Advisory Panel at the International Centre for Mental Health Social Research.

You can send your responses to project leader Catherine Needham via Twitter @DrCNeedham or email