Understanding culture and belief: an essential ingredient of good advocacy

The heart of good advocacy is understanding what is important to a person – and that includes understanding people’s cultural experiences and beliefs such as diet, language, community or religion. This is about more than just awareness. It is about having knowledge about someone else’s culture and the skills to put this into practice to ensure that they are supported in a way that works best for them. It is about understanding their sense of community and belonging and what the person needs to feel safe and happy. And it is about knowing that you as someone of perhaps a different culture will not understand fully - so it is about being comfortable asking questions to deepen your own understanding and enable you to better support people who might have a different cultural background to you. When we get this right, it makes a huge difference.

A great example is our work with Rania, a woman in her thirties. Rania had moved from Pakistan to the UK to marry, and since then had only ever lived with her extended family, never leaving the house except when accompanied by another family member. She spoke some English, but to communicate fully she needed to speak her mother tongue, Urdu. When Rania was in hospital, detained under the Mental Health Act, she met a VoiceAbility advocate who made sure Rania got the translation in Urdu that she needed to understand her rights and have her voice heard. But when it came to discharge, the staff on the ward had planned for Rania to live independently in a block of flats.

Rania was distraught and the advocate saw that the impact would be considerable. But this impact was not being recognised because of a lack of cultural understanding of Rania’s experience. Rania had never lived on her own in this country and did not have confidence to even go out for food shopping alone. The advocate was able to raise these concerns on Rania’s behalf. The housing officer said that Rania’s cultural needs were not a priority for them as their aim was to get a roof over her head. However, the roof on offer would have been very detrimental to Rania’s emotional wellbeing and would almost certainly have led to another hospital admission.

The advocate continued to raise concerns on Rania’s behalf and was able to get her accommodation with a supported living provider. Rania was offered a safer living environment and was supported to learn independent living skills to build her independence and confidence. Without the advocate’s cultural sensitivity, understanding and support, Rania would not have had a positive discharge.

We also provided an advocate for Amira, a young Muslim woman detained under the Mental Health Act. The advocate saw there were areas in which Amira’s care and treatment from staff on the ward was not culturally sensitive. For example, when Amira was in the middle of her prayers, staff came into her room and began to give her an injection before she had finished. Amira felt violated as she was not able to finish this prayer in an acceptable way. The ward staff denied that this had happened. The advocate understood the patterns for Muslim prayer and how important they would be to Amira, so she spoke to the ward staff and explained that there is a certain part of the prayer when a Muslim can end the prayer. The advocate supported Amira to raise this at the ward round and Amira’s consultant supported the view that Amira’s religious and cultural needs were paramount. After this, the ward staff did not interrupt her prayers and she was given a plastic jug so that she was able to carry out Wudu (ablution) for herself in line with her religious practice before her prayers.

Supporting people in a way that considers their cultural needs is crucial to good advocacy. We want to see this embedded in mainstream advocacy and the ongoing plans for reform of the Mental Health Act. Advocacy providers have a role too: to recruit advocates who have the knowledge and skills to consider people’s cultural background and how it impacts the person and their needs. Having an advocate who understands your culture has a massive impact for mental health and recovery, reducing the chance of readmission and relapse.