Social Inclusion and Mental Health: Understanding Poverty, Inequality and Social Exclusion PDF
Preview Social Inclusion and Mental Health: Understanding Poverty, Inequality and Social Exclusion
Social Inclusion and Mental Health Second Edition blih d li b C bid i i Iamdelightedtowelcomethisneweditionasessentialreadingforeveryoneworking/ involvedinhealthandsocialcare,notjustmentalhealthservices.Thetextexpandsour understanding of the means of social exclusion, its poisonous legacy on children and adults,andhowwemightchangethesingle,maindriverofmentalhealthconditions– poverty. The book goes beyond theoretical frameworks and the language of exclusion (inequalitiesanddisparitiesbelongtodifferentpoliticaltribes)–itbringsexclusioninto theworldofserviceusersandhealthprofessionals.Welearnthatexclusionisnotmerely economic,butraceanddisability(tonamejusttwo)compoundmultipledisadvantages.I wishIhadreadasocialscienceprimerlikethisbookatthestartofmycareer,andcan onlyhopeitwillbetakenupbythenextgenerations. PeterByrne,ConsultantLiaisonPsychiatrist,RoyalLondonHospital;Co-directorof RCPsychPublicMentalHealthImplementationCentre Withoutaction,thepoormaywell‘alwaysbewithus’.Butasthisbookmakessoclear, poverty(whetherdefinedintermsoflackingmaterialresources,accesstooccupational and leisure opportunities, civil participation, or even supportive social networks) is partlyaconsequenceofexclusionarisingfrompolitical,economic,andsocialstructures but all too often through deliberate actions of individual self-interest, prejudice, and discrimination. Thisbookprovidesacomprehensiveandpersuasiveaccountoftheforcesatplayand moreimportantlywhatwe,collectively,professionallyandindividuallycandototackle thesocialandeconomicbarriersthatpeoplewithmentalhealthconditionsfaceindaily life.Thisisanoutstandingbookthatshouldbereadbyallmentalhealthprofessionalsas afundamentaltextfortheirprofession. TomKJCraig,ProfessorEmeritusofSocialPsychiatry,King’sCollegeLondon Thesecondeditionofthisimpressivevolumeistimely,asintheUnitedKingdomand Europe we confront poverty, a conflict in Europe, and a major energy crisis, whereby morepeoplewillnoteatwellandusedrugsandalcoholandhighfatandsaltfoodswillgo up. We can anticipate greater levels of poor health and health crises. The central messages of this manifesto cut through political instability and poor health literacy, and give all policymakers and politicians an opportunity to improve the health of the nationandreducehealthinequalities.Iespeciallyenjoyedthenuancedexpositionofhow asasocietywefailtotacklesocialdeterminantsofpoorhealthatourperil.Povertyand socialadversity,especiallychildmaltreatment,leadtoprematuremortalityandpoorer life chances and quality of life, including the development of mental illnesses. Furthermore,thosewithmentalillnessencounterprejudice,stigma,anddiscrimination, allofwhichmeanpeoplewithmentalillnessesfaceprecarityandstructuralviolencethat deprivesthemofequalrightstobenefitfromsocietalopportunitiesandcaresystems.We need systemic preventive and care interventions. This book is a clarion call to all. We mustdobettertopreventmentalillness,tacklesocialdeterminants,reducestigmaand discrimination,and promote inclusivepublic caresystemsin whichthosewith mental illness realise their rights as citizens. Inclusive policy and practice are at the heart of actions that might transform dystopian complacency in mental healthcare and public mentalhealth. KamaldeepBhui,ProfessorofPsychiatry,UniversityofOxford blih d li b C bid i i Social Inclusion and Mental Health Second Edition Jed Boardman King’sCollegeLondon Helen Killaspy UniversityCollegeLondon Gill Mezey StGeorge’sHospitalMedicalSchool,UniversityofLondon blih d li b C bid i i UniversityPrintingHouse,CambridgeCB28BS,UnitedKingdom OneLibertyPlaza,20thFloor,NewYork,NY10006,USA 477WilliamstownRoad,PortMelbourne,VIC3207,Australia 314–321,3rdFloor,Plot3,SplendorForum,JasolaDistrictCentre, NewDelhi–110025,India 103PenangRoad,#05–06/07,VisioncrestCommercial,Singapore238467 CambridgeUniversityPressispartoftheUniversityofCambridge. ItfurtherstheUniversity’smissionbydisseminatingknowledgeinthepursuitof education,learning,andresearchatthehighestinternationallevelsofexcellence. www.cambridge.org Informationonthistitle:www.cambridge.org/9781911623595 DOI:10.1017/9781911623601 ©RoyalCollegeofPsychiatrists2010,2023 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithoutthewritten permissionofCambridgeUniversityPress. Firstpublished2010 Secondedition2023 AcataloguerecordforthispublicationisavailablefromtheBritishLibrary. ISBN978-1-911-62359-5Paperback CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracyof URLsforexternalorthird-partyinternetwebsitesreferredtointhispublication anddoesnotguaranteethatanycontentonsuchwebsitesis,orwillremain, accurateorappropriate. .................................................................................................... Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationthat isinaccordwithacceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesare drawnfromactualcases,everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved. Nevertheless,theauthors,editors,andpublisherscanmakenowarrantiesthattheinformation containedhereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantlychanging throughresearchandregulation.Theauthors,editors,andpublishersthereforedisclaimallliabilityfor directorconsequentialdamagesresultingfromtheuseofmaterialcontainedinthisbook.Readersare stronglyadvisedtopaycarefulattentiontoinformationprovidedbythemanufacturerofanydrugsor equipmentthattheyplantouse. blih d li b C bid i i Contents ForewordtoSecondEdition vii ForewordtoFirstEdition(2010) ix Preface xi Acknowledgements xiii 1 Introduction:Poor,Excluded,and 10 ExclusionfromMaterial Unequal 1 Resources 194 11 ExclusionfromSociallyValued Section 1 Social Exclusion, Activities 227 Poverty, and Inequality 12 ExclusionfromSocialRelationsand Neighbourhoods 249 2 SocialExclusion:BasicConcepts 21 13 ExclusionfromHealthandHealth 3 SocialExclusion:Applyingthe Services 274 ParadigmtoPeoplewithMental 14 ExclusionfromCivic HealthConditions–Key Participation 290 Aspects 35 15 SocialExclusioninSpecificSocial 4 PovertyandDeprivation:Getting GroupsandIndividualswithMental UndertheSkin 57 HealthConditions 299 5 Poverty,Deprivation,andSocial 16 SocialExclusionandPeoplewith ExclusionintheUnited MentalHealthConditions: Kingdom 87 DevelopingaClearerPicture 321 6 Poverty,Inequality,and Health 116 Section 3 Including People 7 SocialPolicy,theWelfareState,and 17 EnablingSocialInclusionforPeople SocialExclusion 141 withMentalHealthConditions:The 8 MentalHealthServicesandPolicyin RoleofMentalHealthServices 347 theUnitedKingdom 161 18 TheoryintoPractice 359 Section 2 Participation of 19 BroadeninganInclusive Approach 374 People with Mental Health Conditions 9 MentalHealthInequalitiesand Index 387 Exclusion 187 v blih d li b C bid i i blih d li b C bid i i Foreword to Second Edition Ihavelongarguedthatthehealthofasocietyprovidesinsightintohowwellthatsocietyis functioning.Thisistrueofphysicalhealthandlifeexpectancy,andperhapsevenmoresoof mental health conditions, to use the terminology adopted here. Social inclusion is one measureofthegoodsocietyandisvitaltohealth.Theevidenceonmentalhealthshowshow thatplaysout. Thereareatleastthreeimportantwaysinwhichsocietyisimportantformentalhealth conditions.Thefirstisthesocialdeterminantsofmentalhealth.Socialstructures,poverty, and inequality, acting through the life course, are important determinants of health. Psychosocialpathwaysareimportantforbothphysicalandmentalhealth,butparticularly for mental health. One example is adverse childhood experiences (ACEs). Children who experience four or more ACEs have increased risk of mental health conditions and, probably, physical ill-health. But the frequency of ACEs is strongly linked with level of deprivation: the greater the deprivation, the more common are most kinds of ACEs. We therefore have a potential causal chain from the structure of society and magnitude of inequalities in all the components that go to make up deprivation, to ACEs, to adverse outcomes. Asecondwaythenatureofsocietyiscrucialformentalillnessisinthedevelopmentof mental health services. When people with mental illness were treated as destitute and consigned to the workhouse, or locked away in asylums, it told us a great deal about society’s view of mental illness. Such inhumanity may now seem extreme, but vestiges of itarestillinoperation.Muchlipserviceisdevotedtoparityinprovisionofservicesbetween mental and physical health, but this is yet to be realised. At a more nuanced but no less importantlevel,therearemarkeddifferencesintheconceptionofwhatmentalillnessisand howitshouldbetreated.Itisnotdifficulttolinkthesebacktosocietalattitudes. Third is the experience of people with mental health conditions. In general, the social determinantsofhealthoperatemoretothedetrimentofpeoplewithmentalhealthcondi- tionsandthosewithdisabilitiesofvariouskinds.Housing,income,jobprospects,andsocial inclusionareallmoreproblematicforpeoplewithmentalhealthconditions. Thepresentvolumegivesarichanddetailedaccountofhowallthisworks.Ithasagrand historical sweep, pays detailed attention to each of the concepts with which it deals, and providesacomprehensivereviewoftheevidence.Thereissomuchthatisgoodhere,not justonmentalhealthconditionsbutalsoonsocialinclusion,poverty,socialcapital,welfare policy,capabilitytheory,humanrights,andallthefeaturesofsocialprocessesrelevantto mentalhealthconditions.Itdoesfeellikethedefinitivebookonthesubject. MichaelMarmot,UCLInstituteofHealthEquity vii h d i 0 0 9 8 9 62360 00 blih d li b C bid i i h d i 0 0 9 8 9 62360 00 blih d li b C bid i i Foreword to First Edition (2010) Beingpartofsociety,contributingtoitand,inreturn,beingrecognisedandacknowledged, is a core need of human beings. The impact of social factors, whether they be isolation, unemployment, poor housing, financial hardship or debt, in the aetiology of mental and physicalill-healthandtheirroleinitsmanagementcannotbeunderestimated.Whetheran individualisegocentricorsocio-centric,socialinclusionisofgreatsignificanceinensuring that an individual feels part of the larger community. Mentally ill individuals often seek employment, housing and social contacts as their key priorities and it is essential that cliniciansdonotforgetthesegoals.Thereislittledoubtthatsocialinclusionisoftenseenas apoliticalormoralconcept,butitismuchmorethanthat:itisaquintessentialbasicneed thateveryindividualhas,tobeacceptedandtohavetheself-esteemandtheself-confidence whichwillallowtheindividualtodealwithstress.Socialinclusionforindividualshasmany meanings, depending upon gender, age, sexual orientation, educational attainment or socio-economicstatus,amongotherthings.Thechallengeforcliniciansandpolicymakers is to make social inclusion work and not simply to rely on rhetoric. This book is doubly welcome for highlighting an important topic and for guiding practitioners and policy makerstoencouragesocialinclusion.Thebookoriginatesfromareportwhichwasdevel- oped by Jed Boardman, and for the book he has managed to attract many eminent contributors.Ihopethatitwillbeofinterestnotonlytocliniciansbutalsotostakeholders, includingpoliticiansandpolicymakers. DineshBhugraPresident,TheRoyalCollegeofPsychiatrists ix h d i 0 0 9 8 9 62360 002 blih d li b C bid i i
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