As an organisation, Imago understands, appreciates, and works with diversity and cultural differences amongst its staff, volunteers and, above all, amongst its clients and service users . We seek to be fully aware of our client’s needs regardless of differences in terms of the protected characteristics of age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. We recognise that our clients (including carers) can also come from a wide range of cultural heritages and traditions, which can vary in terms of, for example, differences in:

• Communication styles - for instance, in some cultures, direct communication is appreciated, while in others, indirect communication is preferred,
• greetings and gestures – for instance, in some cultures, a handshake is common, while in others, it's more common to bow or kiss on the cheek,
• personal space - what is considered appropriate can vary widely between cultures. In some cultures, standing close to others is considered normal, while in others, maintaining a greater distance is preferred.
• food and dining - the types of foods eaten and the way they are prepared and served can vary widely between cultures. Additionally, the way people eat and dine together can also differ,
• attitudes towards time - the way time is viewed and valued can differ significantly between cultures. For example, some cultures place a high value on punctuality, while others may have a more relaxed attitude towards time,
• beliefs and values – as some cultures, for example, place a high value on individualism, while others prioritise collectivism and group harmony,
• family structure – in some cultures, nuclear families consisting of parent(s) and their children are common, while in others extended families, including grandparents, aunts, uncles, and cousins, are the norm,
• gender roles - can also differ greatly with the mother seen as the primary caregiver and responsible for child-rearing, while in others, both parents share this responsibility more equally,
• respect for elders - highly valued in some cultures, with older family members holding a position of authority within the family. In other cultures, youth is highly valued, and older family members may not be accorded the same level of respect,
• religion and spirituality - can play a significant role in family life, and the way families practice their faith can vary greatly across cultures,
• the value placed on education – with some cultures emphasising academic achievement and the pursuit of higher education, while others place greater value on practical and vocational skills,
• parenting styles - with some cultures valuing strict discipline and obedience, while in others, a more permissive parenting style is favoured.

Within this context, we seek to understand and consider the unique position and attributes of all the people we support, investing in continuing learning, listening and feedback, to the benefit of all, enabling carers to achieve the best possible outcome from our support.

Providing culturally competent services also help us to prevent misunderstandings and miscommunications between carers, support staff, and other professionals, involved with providing care. Understanding and respecting the cultural background of carers helps ensure that they receive equitable care, that meets their unique needs. This approach also helps to reduce the likelihood of cultural biases and stereotypes that can lead to discrimination and marginalisation, including unconscious biases.

The following case study of our work with Sarika, a client of our Carers Support service illustrates how we supported her and her family:

Sarika was born and spent her early years growing up in West Bengal. She has been living in the United Kingdom for nearly 10 years and is currently working as a Systems Analyst at her local Council, as well as providing care to her mother and grandmother. The family consists of Sarika’s mother, father, grandmother, three older brothers and a young sister. They reside in a four-bedroom house close to other relatives who live in the same area.

Sarika became known to Imago’s service after she saw one of our leaflets explaining the services we provide in her local Civic Centre. Sarika made a self-referral via our website, as she and her father were struggling to cope at home with their caring responsibilities. Sarika thought this was a positive step for her and her father, as she wasn’t aware that someone in her situation was able to receive support.

Sarika’s mother had suffered a stroke six months ago and her grandmother was very frail, struggling to care for herself, and was often confused and forgetful. Sarika looked after her mother and grandmother’s personal care, getting them both up and dressed each day. Her father looked after their home, cooking, cleaning, and caring for his wife and mother-in-law during the day. He had retired early to look after them. Two of his sons took over the family business - a local corner shop nearby, another son worked as a local insurance broker and the young sister was studying at university.

The families first spoken language is Bengali. Although all siblings speak good English, they would always speak Bengali when at home. All family members practised Hinduism, except two brothers who practiced Sunni Islam. The family like to pray and have their own shrine in their living room where they pray daily. They visit their local ‘Mandir' temple with other family members and friends. It is a very cohesive community, and the family would be expected to reach out when in need.

Sarika’s father was reluctant at first to agree to the referral. He is a proud man and didn’t want to be seen as weak in seeking help for his family or having outsiders come into the family home. Sarika persuaded her father to at least make the referral and find out what support could be offered to them.

To ensure the best outcomes for Sarika and her father were achieved, the following was considered prior to the initial visit to the home:

• the need to understand and respect Sarika and her family’s freedom to express their beliefs and convictions in their own terms, which may be impacted by the support provided,
• respecting the convictions of others about food, dress and social etiquette and not behaving in ways which might cause needless offence but to adapt how our support offering could ensure a good response during the initial visit,
• not to underestimate how easily it is to offend when a full understanding of a carers cultural situation and circumstance are not taken into consideration,
• never comparing our own ideals with other people’s practices,
• preventing disagreement from leading to conflict - Sarika had only sought permission from her father as the elder and not any of the other family members. Hinduism views the needs of the individual in the greater context of family, culture, and environment,
• many Hindus hold strong astrological beliefs and believe the movement of the planets has a strong influence on health and wellbeing. The family may wish to schedule appointments according to these beliefs,
• the family may only wish to be supported by someone with the same religion and faith,
• to be seen as respectful, a specific piece of clothing may need to be worn. Shoes may be requested to be removed or plastic coverings applied,
• family dynamics - it is considered a family obligation to care for the elderly and the sick. Hinduism encourages family members to take a role in the care of family members, and emphasises respect for all older people, with children having a special responsibility towards their parents, mainly females within the family,
• the support plan may be received unfavourably by some of Sarika’s brothers and extended family members,
• fasting may be practiced on specific days of the week, during festivals or on holy days, or in conjunction with special prayers. Appointments will need to be flexible to meet the needs of the family,
• many Hindus attach a stigma to mental illness and cognitive dysfunction, therefore Sarika’s grandmother’s wellbeing needs needed to be discussed sensitively and respectfully.

After considering all these issues and remaining flexible, we were able to make a culturally competent assessment with Sarika, after which we were able to offer the following:

• access to the Sahayak Asianline telephone helpline. This service offers a culturally sensitive listening and information service for the Asian community in Kent and West Sussex. The service is for anyone affected by mental health issues - whether they are service users, carers or friends and people affected by domestic abuse. Callers can be spoken to in Asian languages (Gujarati, Punjabi, Hindu, and Urdu) or English. The services were able to offer advice on both Sarika’s mother’s and grandmother’s wellbeing, and an offer of a memory assessment for her grandmother. Sarika and her father were listened to, treated with dignity and respect, and given emotional support and were signposted to useful sources of information,
• referral to the Re-think Sahayak Services (Asian Mental Health), the health and wellbeing team and day-care services for people of 60+, at the Guru Nanak Darbar Gurdwara. We arranged for Sarika’s father to visit the centre with one of his elder sons to feel reassured that his wife and he would be able to come and interact with other like-minded Hindu’s with the same beliefs and values and receive a cooked meal, while having the opportunity to stay for the afternoon,
• referral to the Re-think Sahayak BAME Community Support service which provides a range of support to BAME communities across Kent,
• contact with the Hindu Cultural Society which comes together to support each other around ceremonies and celebrations, for all the family to attend.

Alongside this support we arranged a joint visit by Imago’s navigator with a social worker from the Adult Team at Social Services. We were able to create a care and support plan for the mother and grandmother, that considered and respected all the family’s values and beliefs on receiving support outside of the family network. Arrangements were made with other extended family members and members from their mosque to sit with the mother and grandmother to provide Sarika’s father with some respite to spend time with the males in his family and have more time to pray outside the home. Although a carers assessment was declined, at the time of offering, the family are now aware of how a carers assessment can help identify practical and financial support.

Initially, Sarika’s brothers were angry and felt shamed for seeking outside help. However, in recent months they have become more understanding of the stress and pressure Sarika was feeling and were more open to her needing support from her family. Continued support has been put in place for Sarika via our Carers Support service. She receives emotional and practical support and attends a local carers group as and when she is able. Her father has declined ongoing support, but his feedback shows his appreciation for the support offered to him and his family: