Explaining what social inclusion has to do with mental health

Social exclusion is seen as both one of the drivers and one as the consequences of mental health problems, logically leading to vicious spirals. As a crude example, say someone has a relationship breakdown. They could be depressed and anxious as a result and lose their job, leading to debt, leading to housing problems, leading to low self-esteem and anxiety as well as the obvious perks of being homeless.

I have to catch up on a report for the internship I did between August and December last year for MindWise Mental Health. The main question of the report is what could be done to involve mentally ill people, or "service users" in MindWise terminology, in political decision-making. I'll keep track of my progress here as it's an opportunity to start writing and to break the question down in small pieces - I'm already really noticing the difference to my writing habits. In this post then I will further elaborate on social exclusion, in a/the next one perhaps on political in- and exclusion which is related but more narrowed down.

What makes the link between social inclusion and mental health problems really interesting is that it may be the key to understanding how come mental illness occurs much more in more deprived parts of society. (I think John Read makes the case for this really well in the book he wrote with Loren Mosher and Richard Bentall but I can't find it online to link it here. Here's a review though)

The definition of social exclusion seems pretty clear-cut to me but as with all things in Politics, really, it is an essentially contested concept (because politicians tend to bend and stretch language so it justifies their political decisions. Often intentionally. In this case, some argue talking about social exclusion became popular in politics because it was more acceptable, less inciting than talking about poverty.)

The definition in this report seems to take the contestedness of the concept into account:

The Social Exclusion Unit has always adopted a flexible and pragmatic definition of social exclusion as "what can happen when people or areas suffer from a combination of linked and mutually reinforcing problems".

The definition in the Wikipedia summary for Social Exclusion is perhaps less flexible but easier to understand:

Social exclusion refers to processes in which individuals or entire communities of people are systematically blocked from rights, opportunities and resources (e.g. housing, employment, healthcare, civic engagement, democratic participation and due process) that are normally available to members of society and which are key to social integration.

 I wanted to explain why mentally ill people especially have problems with social exclusion and what further consequences it can have for the people themselves and I have a number of tabs open with reports to read that will help me say it, but I think I explained at least part of that pretty well in the first paragraph; there is a cycle of opportunities that you can only grasp if you have certain other things sorted in your life, for which yet other things need to be in place.

Another big part of it is the stigma associated with mental health. At one hand actual discrimination from potential employers and from the community altogether will stop a person with mental health problems from reintegrating, at the other hand the fear of these things happening will make a service user want to stay in the relative comfort of the service. It will also serve as an obstacle to building up trust and self-esteem. Media contribute to the stigma as mental illness is often only mentioned in relation to crime, e.g. after a murder people will try to prove that the suspect was delusional.

This report further says that lack of clear responsibility and bad cooperation between different mental health organisations also don't help to prevent social exclusion.