Working with Marginalised Groups

This book, aimed at health and social care students and practitioners, focuses on a range of practical topics which broadly – but not typically – fall within the remit of ‘diversity’. We explore examples and experiences of ‘diversity’ and highlight a range of individuals and groups in UK society who experience exclusion or marginalisation differently. Written by experts, including academics and practitioners working in health and social care settings, this book contextualises diversity and exclusion using a range of theoretical perspectives. The idea for the book arose from conversations between us and with our colleagues in the School of Nursing, Midwifery, Social Work and Social Sciences at the University of Salford, UK. Although we are located in a school with people from a diversity of academic disciplines and professional backgrounds – and this is reflected by the different ‘voices’ in subsequent chapters – we share a common value base as well as a strong commitment to addressing inequality through learning, teaching and in how we prepare students for professional practice. A key aim of the book, through its unique practice-based focus, is to encourage students as present and future practitioners to develop an enquiring mind in relation to diversity in UK society and to debunk myths about ‘the others’.

By focusing on the theoretical, legal and policy frameworks which underpin the debate about diversity and exclusion, this chapter serves as an introduction and as a backdrop to the book. Here we highlight that although the UK is a relatively tolerant society and home to a diverse population, it is still characterised by inequality and exclusion. For example, a substantially higher proportion of people who live in families with a disabled member live in poverty than households where no-one is disabled (DWP, 2014); people from minority ethnic communities are twice as likely to be unemployed than white people (DWP, 2014) and, in 2015, women who were working full-time earned just under 14 per cent less than men in full-time employment (ONS, 2015). This chapter explores some key concepts that help to understand these claims and these help to frame the subsequent chapters in the book. The concepts are: equality and diversity, discrimination, exclusion/inclusion and intersectionality. We argue that there is a need to problematise some of these concepts (such as diversity and intersectionality) in order to understand how they are applied and have meaning, and also to be clear about their limitations.

Public services generally within the UK have become increasingly aware that the population they serve is not homogenous. This is due to both demographic changes through migration and an increasing recognition that there are social category differences which impact on how people experience service delivery. Health and social care services in particular have made efforts to provide services that are responsive to the often different needs of groups that have found themselves marginalised and excluded by mainstream service construction and delivery. The Equality Act 2010 has led to further development of policies and processes to promote inclusion, for example through the creation of an Equality and Diversity Council for the NHS in England (NHS, undated) and the introduction of guiding principles for social care (Skills for Care, 2013). Social Work (our professional background) has developed anti-discriminatory practice and incorporated the notion of cultural competence in its core values, reflecting the commitment to address social injustice. This is usually articulated through the terminology of diversity and difference. The intentions motivating these initiatives are laudable and benign, recognising that serious injustice and harm has been done to those who have been marginalised and stigmatised through actions and inactions.

This chapter aims to explore the involvement of young users of mental health services and young carers in research, education and practice within the health and social care arenas. It is specifically focused on mental health and well-being with regard to these two groups of young people, as those who experience mental illness and/or those who are caring for someone with a mental illness continue to be stigmatised (Corrigan et al., 2012; Singleton and Fry, 2015). Stigma can be thought of as being personal, public and professional. There have been a number of initiatives such as Time To Change (TTC) (Mind, 2009) and its associated strategy aimed at reducing stigma, ‘Education Not Discrimination (END)’, a training programme aimed specifically to reduce mental health stigma among professionals, was also recently introduced in England. While such initiatives are aimed at reducing mental health stigma per se, young users of mental health services and those young people who are caring for a person diagnosed with mental illness are particularly vulnerable to marginalisation and exclusion (Office of Deputy Prime Minister (ODPM), 2004; Butler and Astbury, 2005; Child and Adolescent Mental Health Services (CAMHS) Review, 2008; Welsh Audit Office, 2009) impacting on their mental well-being, education, social interactions and future prospects (Banks et al., 2002; Patel et al., 2007).

Autism is a spectrum of developmental disorders characterised by deficits in verbal and emotional communication, social reciprocal interaction with stereotyped, repetitive, or unusual behaviours or interests (Inglese, 2009; Levy et al., 2010). Autism is referred to as a spectrum of disorders due to the way in which its manifestations can occur in a variety of combinations and be present in varying degrees of severity (Inglese, 2009). Although the term autism will be used in this chapter, it also refers to children and young people with Asperger’s Syndrome, Pervasive Developmental Disorder and learning disabilities as there appears to be a strong correlation between learning disability and co-morbidity occurring as autism. Although there is a dearth of specific data, it appears that children with learning disabilities may also have a reduced ability to understand new and complex information (DH, 2009). This inability to comprehend complex information is related to limited language skills which reduces the child’s ability to report their symptoms or distress, which may be manifested as challenging behaviours (MENCAP, 2004). Autism is an increasingly recognised condition and it is suggested that 1–2 per cent of the primary schoolaged population in the United Kingdom may be affected (Baron-Cohen et al., 2009).

Roma are recognised as one of the European Union’s (EU) largest minority ethnic groups, with estimates that there are more than 10 million Roma residing across the EU (Council of Europe (CoE), 2011; European Commission (EC), 2012). Despite a commitment at a European level to address the continuing disadvantage of Roma, and the development of a number of policy initiatives, entrenched disadvantage, discrimination, prejudice and exclusion remain defining features in the lives of many Roma (Amnesty International, 2011; CoE, 2011b; EC, 2011). Indeed, it is widely acknowledged that Roma are one of the most socially excluded communities across contemporary Europe (Amnesty International, 2011; Bartlett, Benini, and Gordon, 2011; CoE, 2011b; EC, 2011; ERIO, 2010). The chapter begins by defining and clarifying our use of the term Roma and the concept of social exclusion.

Trans is an emerging area of academic interest, and trans people are increasingly visible within our communities, but the social context of trans people’s lives is under-explored in academic literature (Rogers, 2013). Notwithstanding, there is a growing body of work which is gaining recognition for its interrogation of gendered life through the lens of trans subjectivity (Hines, 2007; Davy, 2011; Rogers, 2013, 2015). Some of the issues raised within this body of work demonstrate how structural factors (for example, political ideology, legal institutions) impact upon everyday experience (concerning, for example, intimate and familial relationships) and these structural issues will be drawn upon to illustrate the complex nature of trans people’s lives. This chapter focuses on the increasing recognition of trans people along with some of the social problems that affect them. Two of the enduring issues which affects trans communities are those of marginalisation and discrimination (Mitchell and Howarth, 2009; TGEU, 2015a). While the problem of marginalisation is one that is entrenched, over the years there have been advances in policy and legislation intended to increase trans people’s equality and rights.

This chapter will outline and explore how Deaf people’s marginalisation and difficulties in accessing health and social care are determined by historical and current institutional contexts. The chapter identifies how communication through spoken language is the fundamental platform to accessing family, education and quality healthcare provision. The chapter uses case studies to illustrate the impact of Deafness upon an individual’s life and highlights how the mitigating actions of healthcare practitioners can remove barriers and improve people’s experiences of services and quality of life. When using the term ‘Deaf’ (with a capital D) we are not referring to the 10 million people whose deafness is a result of old age or industrial injury or who are defined as ‘hard of hearing’. We are referring to the 60–70,000 people who are profoundly deaf and those who prefer to use a shared signed language and who live within the Deaf Community; although it must be fully acknowledged that all people with hearing loss and deafness (with a small d) may have similar experiences of social exclusion.

Dementia – a progressive illness of the brain, most commonly but not exclusively found in older people – has been identified as the biggest health and social care challenge facing society, due largely to an ageing population (All- Party Parliamentary Group on Dementia, 2013). At the 2011 Census, 16 per cent of the UK population were aged 65 and over, 14 per cent of whom were aged 85 and over, the population group that is growing fastest (ONS, 2013a). Migration patterns from the 1950 and 1960s mean that the UK is now home to an ageing Black and Minority Ethnic (BME) population (Ahmed, 2015a), and there are currently 25,000 people with dementia from BME communities in England and Wales (APPG, 2013). This figure is expected to rise to 50,000 by 2026 and 172,000 by 2051 (APPG, 2013). Yet little is known about the experiences of BME people with dementia, which in the UK includes people from a range of ethnic backgrounds. Although the National Dementia Strategy emphasises that health and social care staff should take account of BME dementia needs, service providers report challenges in including BME people (Williamson, 2012), and there is evidence that people from BME backgrounds are currently being ‘failed’ by the system (Moriarty et al., 2011).

Domestic violence and abuse (DVA) is a global problem and developing appropriate responses is a challenge for health and social care services (Lombard and McMillan, 2013). Not only is DVA entrenched and wide-reaching, it assumes many forms and has lasting impacts. There is no singular type of ‘perpetrator’, nor a homogenous group of ‘victims’ or ‘survivors’. DVA affects people of all ethnicities, cultures, religious communities, sexual orientations, genders, socioeconomic classes, geographies, mental capacities and physical abilities at any point during the life-course. However, it has been highlighted that the neglect of older women in DVA research and practice ‘has been a silent and unconscious one [as d]omestic violence institutions as well research on domestic violence often maintain a focus upon young and middle aged women’ (Goergen, 2011: 1). Inasmuch, older women constitute a ‘hidden group’ of victims/survivors (Turner et al., 2010). Indeed, in the UK one of the major surveys which is relied upon to collect statistical data on DVA does not include people aged 60 and over.