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Journal of Rural Studies 28 (2012) 406e411

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Journal of Rural Studies

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Promoting the mental well-being of older people from black and minority ethniccommunities in United Kingdom rural areas: Findings from an interview study

Jill Manthorpe a,*, Jo Moriarty a, Martin Stevens a, Shereen Hussein a, Nadira Sharif b

a Social Care Workforce Research Unit, King’s College London, Strand, London WC2R 2LS, United Kingdomb Social Care Institute for Excellence, Golding’s House, 2 Hay’s Lane, London SE1 2HB, United Kingdom

Keywords:EthnicityRuralityOlder peopleMental healthService developmentLink workersUser views

* Corresponding author. Tel.: þ44 207 848 1683; faE-mail address: jill.manthorpe@kcl.ac.uk (J. Manth

0743-0167/$ e see front matter � 2012 Elsevier Ltd.doi:10.1016/j.jrurstud.2012.01.006

a b s t r a c t

Drawing from 81 interviews with practitioners in social care and housing with care services in the UnitedKingdom, this paper explores practice issues in rural areas when supporting the mental health and well-being of older people from Black and minority ethnic groups. The paper begins with a review of theliterature which provides evidence that BME older people are likely to be increasingly part of thepopulations of rural areas. Next it presents interview data revealing that while practitioners are aware ofsuch demographic changes in general terms; some feel that they lack training and skills in adapting theirprofessional practice to support all older people. Others express feelings of professional isolation inseeking to support older people fromminority groups and are concerned that older people fromminoritygroups may be at risk of isolation and loneliness. The paper concludes with a discussion of the study’simplications for rural practice, policy and research.

� 2012 Elsevier Ltd. All rights reserved.

1. Introduction

This paper aims to explore efforts in rural areas to promotemental and well-being among older people from black andminority ethnic (BME) backgrounds using data collected frominterviews conducted between 2009 and 2010. The 81 interviewstook place in four sites in England and Northern Ireland. The papercommences with a synopsis of a preparatory literature reviewwhich precedes an outline of the study’s objectives and method-ology. The study findings follow, being reported under thematicheadings of demographic change; training and skills, and profes-sional isolation, concluding with a discussion of implications forpractice, policy and research in rural locations.

2. Background

In part-preparation for this study a systematic scoping review ofthe English language literature since 1990 (see Sharif et al., 2008)on depression among BME older people was undertaken. Thisnoted the scant evidence for mental health promotion among thisgroup and a concentration on clinical interventions when mentalhealth problems were acute. Other limitations included small andrestricted study samples, the most common ethnic groups studied

x: þ44 207 848 1866.orpe).

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being of Indian, Bangladeshi, Pakistani and Caribbean backgrounds,with little information about patterns of migration or geographicalsettlement in the United Kingdom (UK). The experiences of Viet-namese, Chinese and African (especially recently arrived groupssuch as Somali) individuals and families have not been investigatedextensively and those studies that are comparative often contrastone group to an apparently homogeneousWhite comparator group(thus neglecting variations among White populations, such asthose with Eastern European, Gypsy and Traveller, or Irish back-grounds). Moreover, there is poor reporting of intra-group differ-ences, for example, South Asian people are commonly aggregatedand variations in language, culture and religion are under-explored.Definitions of ‘old age’ in some studies are poorly articulated andsometimes spanmany decades with high levels of representation of‘younger’ cohorts. Other socio-demographic characteristics, such asincome, ownership of capital, and access to resources, are oftenunreported. Furthermore, the bulk of this research has beenundertaken in urban areas in which there is a high prevalence ofpeople from specific ethnic groups. From the perspective of prac-titioners working in rural areas, the messages from such researchmay appear to lack relevance to their own practice and this articlefocuses more on practitioners’ responses to these issues rather thanseeking to explicitly explore critiques of the current evidence.

Much of the research about BME older people in the UK islocalized in cities of primary settlement, such as London andBradford (where populations are often younger than the average

Box 1.

Interviews were undertaken with direct care workers (17);fieldworkers (e.g. social workers) e 5; and one ‘other’professional worker (occupational therapist), and onetrainer. Care home (nursing and residential) managers(including one deputy manager) numbered 15; othermanagers (e.g. heads of service) e 20; and commissionersor service managers in local authorities numbered 4. Asmall number of older people/service users (13) and carers(9) were interviewed and their views are reported on ingreater detail in Manthorpe et al. (2010b)

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UK population), although Bowes (2006) has addressed diversity incommunities of Scotland in particular. Areas with less ethnicallydiverse populations, especially rural areas, are infrequently studied,despite recent observations that they may be changing becauseBME populations, like others, are moving to such locations inretirement, or are ageing in place, leading to increasingly ethnicallydiverse communities (Askins, 2009; Wohland et al., 2010). There issurprisingly little research about older people from Gypsy andTraveller communities in rural areas, whose life expectancy is 10years lower than the national average and whose family groups areoften multi-generational (Cemlyn et al., 2009). Major healthinequalities have been found between Gypsy and Traveller pop-ulations and non-Gypsy counterparts, even when compared withother BME populations (Parry et al., 2007), relating to both mentaland physical long-term conditions.

Over the next 25 years the numbers of people aged over 75 yearswill increase by 90 percent in rural areas, compared to just 47percent in the urban areas of England (O’Brien, 2008), giving rise toconcern among policy makers and service providers that this willstretch resources. People may continue to move out of inner cities,especially London, in retirement (Catney and Simpson, 2009).These demographic changes are taking place across a number offacets, not just age, but also family composition, ethnicity, languageand cultural diversity. Lievesley (2010) estimates that by the year2051 the largest ethnic minority group in England and Wales willbe the diverse ‘Other White’ group (coming from several differentparts of the world) whose health may be good overall and whoseresources may be considerable, followed by Indian, Black Africanand Pakistani ethnic groups, among whom there may be wideninginequalities, possibly reflecting such divisions found internationally(Karlsen and Nazroo, 2002). Others factors influencing rural pop-ulation settlement will be the as yet unknown retirement choices ofcurrent migrant workers if they settle in the UK (Yeates, 2009),either in rural areas where they are employed, or if they choose tomove to such areas in later life. Internal migration within the UK isimportant to consider for health and social care practice (Pughet al., 2007), particularly when working with older people whoare not familiar with a locality, have weak social networks, orwhose plans for retirement do not seem to work out as individualswished. Such issues may be exacerbated for BME older people inrural areas, who, unlike their urban dwelling counterparts, aremore likely to be geographically dispersed and to lack the physicalinfrastructure of belonging, such as living near to a place of worshipor a purpose built community centre catering for their specificethnic group. In this sense, they may face extra challenges in termsof establishing rural citizenship, or: ‘rights to the symbolic,geographic and social spaces that make up rural England’ (Neal andAgyeman, 2006: 102). Such difficulties accentuate the particularand contested relationships between ethnicity, belonging andnational identity, identified more widely by Neal and Agyeman(2006).

Evidence about improving the accessibility, acceptability andeffectiveness of both health and social care provision is lacking forolder people from BME communities in all geographical areas of theUK (Age Concern, 2006; Milne et al., 2007). However, this isparticularly pertinent to rural services because of the additionalproblems faced by older BME people to become part of ruralcommunities identified above, which may well add to isolation andloneliness, increasing need for services. Furthermore, there are newimperatives for managers to review their performance because ofthe perennial questions about equalizing access to services in ruralcommunities (Manthorpe et al., 2008). These questions are raisedinternationally (see Keating, 2008), but because the nature of‘rurality’ is highly differentiated (Shucksmith et al., 2006), policyand practice transfer from one rural context to another may not

always be straightforward or beneficial (Manthorpe and Livsey,2009).

The diversity of needs among older BME individuals may besimilar across urban and rural areas but in relation to mental healthhave been described as constituting a ‘triple whammy’ based on theinteractions of advancing age, the difficulties of access and healthstatus associated with ethnicity, and the emergence of mentalhealth problems (Rait et al., 1996). Often mental health services areaccessed at crisis point. However, BME populations in rural areasmay experience greater difficulty getting the help that they require,particularly at the level of prevention (Watson, 2008). Fear ofracism and greater lack of trust in services (Askins, 2008) arethought to contribute to these barriers. These wider policy andresearch questions relating to rural diversity and citizenship, ageingof rural communities and mental health promotion contextualiseand inform the findings presented here.

3. Methods

In selecting areas to take part in this study we adopteda commonly used UK central government definition of ‘rural’. Thisdefinition consists of two parts:

e the settlement morphology comprising all places under 10,000population comprising small (‘rural’) towns, villages and scat-tered dwellings; and

e the wider geographic context in which individual settlementsare located i.e. whether the wider area is defined as being‘sparsely’ populated or not (DEFRA, 2004: p52)

In this paper we use interview data from 81 interview partici-pants based in four separate areas (three located in England andone in Northern Ireland), focusing on the rural dimensions of theirexperience of mental health and well-being among older peoplefrom BME backgrounds (although some participants in seniormanagerial positions had responsibilities for both rural and moreurban areas). We sought a wide range of participants, includingstaff working in a number of social care and housing agencies, andincluding those who were professionally qualified (social workersand community workers) and those undertaking housing andsocial care support. Interviews with participants e practitioners insocial care; voluntary or third sector groups and older people and/or family carers (see Box 1) e were designed following the litera-ture and policy review to: 1) chart the nature and type of social careinterventions available in different localities that help promote themental well-being and quality of life of BME older people; 2) toelicit evidence of innovative partnership working between socialcare and other public services, including health services, such astraining and the involvement of people using services and carers; toidentify any examples of apparently effective interventions; 3) to

J. Manthorpe et al. / Journal of Rural Studies 28 (2012) 406e411408

explore the range, nature and uptake of social care service provisionaddressing the mental well-being of BME older people; 4) to collectany examples of innovative organisational arrangements andapproaches that focus on mental well-being in BME older peopleand provide opportunities for wider learning; 5) to identify featuresof the recent and current social care policy and practice environ-ments that are perceived to support or inhibit the development ofsocial care services designed to address the mental well-being ofolder BME people; and 6) to explore BME older people’s and carers’perspectives on the accessibility, acceptability and effectiveness ofservices that are designed to promote their mental well-being. Thesemi-structured nature of the interview schedule designed for thisproject meant that not all participants provided information abouteach of these topics. Data were analysed thematically to elicitperceptions and experiences about the tri-partite areas of interest:practice with BME older people, who are living in rural areas, andthe promotion of their mental well-being. Findings have beengrouped around three key areas in this article (for further detailssee the study full report, Manthorpe et al., 2010a); those coveringawareness and understanding of demographic change; perceptionsof needs around training and skills development, and interventionsaddressing isolation and loneliness.

Interviewswere audio-recorded andmost were undertaken faceto face. Ethical permission was obtained from the King’s CollegeLondon and research governance permission was obtained in allfour study areas on the basis that neither the study areas, individualservices, nor participants would be identifiable in the final report(Manthorpe et al., 2010a), nor in any other outputs from the study.We have therefore not identified the local interviewers employedfor this study since this information might be used to makeassumptions about where the study sites were located. All sixinterviewers were White British/Irish; four were female and twowere male. Their ages ranged from 50 to 65 and all possessed socialcare professional experience.

All participants gave their informed consent, and were assuredof confidentiality about names and employing organisations.Identifying features, such as names of care homes, have beenpseudonymised in this article.

4. Findings

4.1. Demographic change and implications

While UK immigrants have traditionally chosen to relocate tourban areas, there is increasing evidence of relocation to rural areas(Jentsch and Simard, 2009). Many participants pointed to changesin the population make up of their communities and in their ownareas of employment. Some thought that this might well lead toa different ethnic profile among older populations, as this managerof a care home observed:

There are Polish people here [in the locality] and people fromthe Philippines. I can envisage if they decide to stay here theymay be would want to go to a home when they are older e theywould need to feel comfortable [with their care].

(Manager: Hester James Care Home)Other ways in which older people’s diversity might be respon-

ded to or addressed appropriately included the comments made byseveral participants that the growing numbers of migrant careworkers might assist in making local services more culturallysensitive. Many of those interviewed spoke of the increasingnumbers of migrant care workers working in older people’sservices, for example, who were generally reported to be of a verywide range of nationalities or origins, described particularly asbeing from West Africa, the Philippines and Eastern Europe. In

some care homes, care assistants were being encouraged to learnfrom each other and tomake themost of staff diversity, with eventsbeing arranged to celebrate international nursing, for example.

A smaller number of participants pointed out that rural localitieswere long-standing areas of diversity because many already con-tained minority groups, such as Gypsies and Travellers. Finulla,a liaison worker with Gypsies and Travellers, outlined some of thedifferent cultural traditions that existed among this group andnoted that members of this community trusted their own familyrather than social care or health services. Some of the Travellersinterviewed confirmed this directly, saying that social care practi-tioners did not understand their culture and therefore could notmeet or even establish their needs. They believed that social carepractitioners, like other forms of officialdom, were trying to push‘their way of life’ and ‘ways of doing things’. Participants spoke oftrying to keep secret aspects of their culture or ‘certain customs’ tomaintain their self-esteem andwell-being. They felt that social careservices were not for them, and that care and support would beprovided by family members, possibly with the help of sometrusted professionals. Mrs Smith, a former carer, added:

The problem is that we like to care for our own. We don’t likeoutsiders coming in. We like to care for them because weunderstand the Traveller’s way of life, because we’ve lived it. Ifwe get a strange carer (care worker) coming in, they don’tunderstand what the needs are of the Travelling people, likeTravelling people do themselves. We are prepared to care for ourown and not have outsiders care for them. Our elderly, weusually don’t like them going into care homes. We usually lookafter them ourselves.

(Mrs Smith e former carer e Traveller)Finulla described some of the cultural tensions that might exist

between the views of some professionals who wanted to moveolder Travellers to care services, in what they perceived to be their‘best interests’, and the culture of this community:

I think that when care providers actually go on to the sites, theirfirst thing they want to do is get them people off the site,because it’s not a very nice place. The conditions of the sites arenot good. Living in a caravanwhere the toilet is external and youwalk across your pitch and go to awash house, which is basicallylike a garden shed with a toilet in. It’s not very nice.

(Finulla e Gypsies and Travellers liaison worker)In her experience, what worked best was a system whereby

social care and other statutory staff were introduced by a trustedintermediary to the community and if possible, named staff wereassigned to Traveller sites to support older and disabled members.Finulla proposed that the emphasis should be on helping familymembers to care well and she thought that training could bebeneficial, particularly around care and support for people whohave had a stroke who are also often at risk of depression. AnotherGypsy and Traveller liaison worker, Elaine, also noted that literacymight be a problem when working with such groups and thissuggests the importance of providing information in non-writtenformats (often required by other older people who may not beliterate in their own or other languages). Literacy has also beenidentified as a key factor in access to services for some groups fromother communities such as Asian backgrounds (Ahmad andWalker,1997).

Elsewhere, Kathy, an occupational therapist working for a localauthority, said that she was not allowed to ask family members tointerpret for their older relatives because of the risk of themcontrolling the conversation and the information that was beingprovided. While she appreciated these risks, Kathy felt that thisthenmight delay matters for the older person, because interpreters

J. Manthorpe et al. / Journal of Rural Studies 28 (2012) 406e411 409

‘were not on hand at a moment’s notice’ in her area. A seniormanager in the same area, Tom, confirmed that it was localauthority policy to avoid using family interpreters, and saw thisas important for protecting the best interests of older people. Inrural areas, however, there were general complaints that access tointerpreters and translators was poor, compared to more urbansettings.

4.2. Training and skills development

Karen, manager of a care home in a rural area with few BMEcommunities, explained that all direct care workers in her homeparticipated in training about caring for people of different faithsand cultures, through distance learning packages, study books, andgroup sessions. The scope of this training covered care plans andreviews, as well as communication with relatives. Her colleague,Shamine, outlined an example of practice after a new resident froman Indian background moved in to the home:

We were trying to fulfil her needs and we did fulfil her needs.We had a meeting with our kitchen staff, the chef, about specificfood and dietary needs. She (the resident) used to speak fluentEnglish but with dementia she completely forgot and couldn’tsay much in English. With her family’s help and my own Urdubackground I could understand her. We made some signs andsome simple sentences to help the rest of the staff. I think thathelped to give quality of care to that particular resident.

(Shamine e care home deputy manager)Shamine also talked of the importance of working with this

resident’s adult children to find out ways to support their mother.The family had described to staff how their mother would alwaysmake sure that the children were fed before she would eat herselfand together they worked out that this might lie behind some ofthe problems that were arising for staff when helping her to eat.Once staff started eating food in the company of this older person,then she seemed more willing to be helped to eat. The family hadalso expressed a preference that their mother’s personal careshould be provided by female rather than male care workers andthe managers were able to accommodate this through adjustingshifts. As Karen acknowledged, it is important to be clear aboutwhat is possible and not, and to reach accommodation:

We always like to try and match staff with the resident. On pre-admission assessment, for example, if I felt that we couldn’tmeet that resident’s needs, we would make that clear to themand their family. If they are willing to teach us, and to carry thatthrough, that works.

(Karen e care home manager)However, such reports of embedded training and good practice

examples were uncommon. This was confirmed by the morefrequent reports from practitioners of the possible frustrations ofinterpersonal communication difficulties. Many reported usingtheir training and experience from other areas of practice, such ascommunication skills, in their work and general hopes that thiswould suffice. Tina, manager of a sheltered housing (assisted living)scheme, described her practice when talking to one tenant, Mrs M,who had lived in England for many decades but whose family onlyspoke English:

Mrs M still speaks with a very heavy accent and sometimes thatcan be a problem for people to understand, I always make surethat I give enough time to sit and then I can ask questions if Idon’t understand. She can speak to me again. There is nothingworse if you want to say something and you are upset aboutsomething, you’re angry and then you’re trying e the more

angry you are or themore upset you are, the harder you find it toget the right words, don’t you? And she finds it even more so.

(Tina e housing manager)

4.3. Isolation and loneliness

Isolation and loneliness were identified by many of the profes-sional participants as important signs to notice because theypotentially placed people at risk of depression. As we noted above,this may be a particular issue for older BME people living inrural communities, where they may face particular exclusion. Forexample, Magda, a worker in a specialist counselling organization,had experience of some older people’s family and supportnetworks becoming fragile, even if the person was living withintheir immediate family:

Older people, I mean our older people, are getting isolated. Andeven when some of these older people appear to have familyaround them, they actually feel very isolated, because if theywere at home they’d have had a huge extended family around,immediately around them. So, even though they’ve got a wife,and two or three children, for him (that individual) that is veryisolated.

There were balances to be struck between older people wantingto be independent, or feeling outsiders in service settings, whichmight lead to their isolation and increase their loneliness. Owneroccupiers and tenants who had moved to housing with careservices (assisted living) from their own homes or had previouslybeen living with family members were given as examples of peoplewith declining health and mood:

People get to a stage where they think, well my sight has gone,my hearing has gone, and this and that have gone, and thereforeI can’t do anymore, I might as well give up.When they do realisethat there are things out there that can help them and thenwhen you domanage to get one side of a person’s life moving upa little bit then often other areas follow, because people get veryinsular within their own problems.

(Tina e housing manager)Tina felt that some of these risks were compounded if older

people were first generation immigrants:

Sometimes people when they move into a different culture andcountry then they are very worried and frightened and don’twant to step on people’s toes and say the wrong thing, so it isvery important to get to know them and get to understand themso they feel safe and able in their environment to talk and saywhen they need and what they want.

Consequently, early intervention and prevention, particularly ifthese were focused on identifying and reducing isolation andloneliness, were important parts of her practice and that of others.A housing support worker, Trudy, spoke of the ways in whichregular contact with people in sheltered housing (assisted living)schemes meant that support workers were likely to notice anydeterioration. Such regular contact fostered trust not only witholder tenants but also with members of their family, even if theywere living at a distance. Specific approaches to prevention, basedaround housing and social care services working closely together,were reported by some service managers as well as specialist careservices. For the voluntary and community sectors, prevention wasmore often described in terms of part of their efforts to involveolder people as volunteers, or as members of social groups, and sostress their role and contribution to their communities and locali-ties (Institute for Volunteering Research, 2004).

J. Manthorpe et al. / Journal of Rural Studies 28 (2012) 406e411410

A second theme of isolation emerged from the data when ana-lysing practitioners’ discussion of managing relationships, betweenpeople using their services, with family members of service users,and with practitioners based in other local services. There wereseveral references to working alone and having to rely on oneself orgeneral common sense and experience. As indicated earlier, whilesome practitioners hadworked directly with Gypsies and Travellersthey did not refer to this as part of their experience of working withpeople of diverse cultures. There also seemed to be few opportu-nities for practitioners to discuss working with families overall,especially if relatives were not living nearby. Very few practitionersspoke in ways that drew on practice wisdom or training abouthandling difficulties in relationships with family members ormembers of social networks, such as fellow tenants or service users.If there were family therapists, or consultants available to frontlinestaff who were working in situations in which family and inter-personal dynamics were an issue, they were not known to thepeople we interviewed. Staff sometimes faced complex, possiblyentrenched patterns of behaviour and interdependencies, such asthe isolation of older people or behaviour that might be racist orbullying, that might be culturally rooted or expressions of distress,but they felt largely on their own. Debates about access andappropriateness hardly touched upon these challenges. There wereseemingly few opportunities to discuss this in supervision and howto manage manifestations of racism and interpersonal disputes.Instead, there were many references to the need to be sensitive tocultural practices, and about conflicts that might arise in relation todifferent cultural beliefs and practices. However, in contrast to theevidence on the negative contribution of racism upon mental well-being (Karlsen and Nazroo, 2002; Karlsen, 2007) there was verylittle direct identification of racism as an explanation of conflict andthe exclusion of certain groups from services. Future studies maywish to explore this directly, adding to recent research that hasexplored aspects of racismwhen experienced by older BME people(Bajekal et al., 2004; Moriarty and Butt, 2004), and among BMEmigrant workers (Stevens et al., 2012; Cangiano et al., 2009).

5. Discussion

The findings presented here need to be seen in the context of thestudy’s aims. The study provided an opportunity to explore a hith-erto uncharted area and while reports of practice may not be thesame as actual practice there is no reason to believe that theparticipants were over confident in their experiences or knowl-edge. The independence of the research team may have assistedhere. The professional background of the interviewers may havereassured participants that they were talking to researchers whowould understand their professionalism and the service context.The study was limited in its number of sites and participants, andmore research is needed across different service configurations andto assess the outcomes of interventions.

One key message of this study is that practitioners feel thattalking to BME older people is an important way of finding out whatthey want and what they might choose to support their mentalwell-being. This resolves for them some feelings of a lack experi-ence and confidence in working with people from diverse cultures.Emphasis on person-centred support could be the centre of trainingand of supervision or mentoring. There is also a deficit of guidanceor professional support materials on subject of difficult issues suchas tackling racism or conflict (Neal, 2002).

Many participants were cognisant, in general terms, of changesin their areas’ population composition; particularly because thecare sector has been so often the first stop for migrant workersseeking employment (Hussein et al., 2011) and they were wellaware that more recent arrivals to the UK had different countries of

origin to those of counterparts arriving 1960e1980 and previously.Few were confident that new community languages requiringa greater range of interpreters (e.g. in Pashtun, Somali or Arabic)and links with different faith and cultural groups were available tothose working in older people’s services in their areas.

Training was regarded as welcome but as needing to recognisethe local context, the diversity of migration to rural parts of the UK,and the reality of social care practice which is increasingly workingin partnership with colleagues from medical and nursing profes-sions but also with those from housing sectors. Practitioners oftenexpressed a lack of confidence in working with BME older peoplein rural areas. Interestingly, as noted above, none spoke of learningfrom their prior experiences of working with Gypsies and Travel-lers and whether investment in community workers and liaisonschemes for these groups might be an approach that couldbe replicated. This may be a missed opportunity for practicedevelopment.

Many of the practitioners working in social care and alliedservices in this study were working on their own, despite therhetoric of partnership or teamwork in services. There was a strongsense of this among those working in housing services, run bydifferent agencies across the study sites (Manthorpe et al., 2010b).There seem to be very few opportunities for these practitioners todiscuss working with families or social networks overall when theyencountered any problems. Some find themselves managing rela-tionships and thinking about mental health risks largely in isola-tion. They build up their experiences in this way rather than havingaccess to skilled support. The implications for practice and researchin rural locations are that multi-disciplinary service developmentmay be lead to better outcomes but establishing what works is farfrom evident.

Older people often play their own part in reducing risks ofdepression by acting as volunteers or being involved in peeractivities and exercise (Cattan et al., 2005). These could be furtherencouraged by practitioners in rural areas, especially where suchopportunities may be linked to groups that do not have a specific orevident welfare role, such as the Women’s Institute or village hallcommittees. However, as Askins (2008) has noted, the Englishcountryside consists of webs of social networks some of which maybe impermeable for older BME people, because of commonconstructions of BME people as a fixed ‘other’, and reactions eitherof fear or awe of the local community. The importance of socialnetworks to mental well-being is now well-established and can befostered by practitioners, although work with local communitygroups, beyond promotion of ‘cheerful diversity’ (Askins, 2008: 5)will also be necessary to break down some of the barriers.Researchers may wish to investigate which models of recruitment;volunteer support and co-ordination suit such developments and, ifsome are more accessible than others, how such barriers may beovercome.

6. Conclusions

Growing old in rural communities is diverse, different andchanging (Manthorpe and Livsey, 2009). Factors over and above therurality of a setting influence the provision and the experiences ofservice care. There are several demographic changes at play notsimply the expected increase in BME older people in rural areas butalso the increasing numbers of migrants working in social careservices. This means that training activities addressing culture,equalities and diversity will need to engage with greater diversityamong care professionals. This study has also raised the potentialfor making greater connections between practice with BME olderpeople living in rural areas, notably what works with people fromGypsy and Traveller communities, so that patterns of disadvantage

J. Manthorpe et al. / Journal of Rural Studies 28 (2012) 406e411 411

are not sustained or repeated. This study also raises the potentialfor efforts to relieve isolation and loneliness to be seen as importantto all older people; and that skills which can promote social well-being should be valued and disseminated. Isolation and feelings oflack of confidence were commonly expressed by professionals inthis study on the basis that they knew they lacked experience ofworking with BME communities. Support for them would seema sensible investment by employers, educational and improvementagencies, with those working in rural areas possibly being bettersuited to access on-line information, supervision and mentoring,and web-based communities of practice than attending events.

Acknowledgements

We thank the participants in this study and those who con-ducted the interviews. The views expressed in this article are thoseof the authors alone and should not necessarily be interpreted asthose of the Social Care Institute for Excellence or the Departmentof Health.

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