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Social Inclusion – is it up to you?

Now that the large asylums have been shut down and the majority of mental health service users live in the community, it is declared government policy that stigma and discrimination that society aims against service users should become a thing of the past. It is the government's stated intention that people with mental health problems should be socially included instead of being locked away in the virtual asylum that has erected barriers to their social participation in the mainstream of society.

The government is particularly interested in enabling more adults with mental health problems to enter and retain paid employment which they feel is the key to social inclusion. However the Department of Work and Pensions found that less than 40% of employers want to recruit people with mental health problems, whereas 62% are pleased to recruit those with physical disabilities. The DWP also found that less that a quarter of people with mental health problems are in work. The main barriers to service users entering work is this attitude of employers as well as fear of losing benefits, the fluctuating nature of a mental illness and the low expectation of health professionals who do not encourage the service user to seek employment.

There is exclusion in other areas of society: people with mental health problems are not eligible to be a juror or school governor; there are low levels of participation in further education and leisure activities; there can also be discrimination from housing providers; financial services are hard to access and also people with mental illness find it socially difficult to form emotional and sexual relationships and are indeed often discouraged from doing so by health professionals.

Service users become isolated, only mixing in the community of other service users at mental health day centres or clinics. They find it difficult to engage in the mainstream of society and become institutionalised within the community – within the virtual asylum of community care. People with mental health problems can be “unwell some of the time – excluded all of the time”.

Stigma and discrimination, lack of social networks and social activities to take service users into the social mainstream, the financial limits that living on benefit impose and also lack of confidence and opportunity that such elements create, compound social isolation behind the transparent walls of the virtual asylum.

The government set up the Social Exclusion Unit which published a report entitled Mental Health and Social Exclusion. The Sainsbury Centre for Mental Health has also published Working for Inclusion – Making Social Inclusion a Reality for People with Severe Mental Health Problems. Between them they have stated that action on inclusion is a “moral imperative” and there is a vision of a future where people with mental health problems have the same opportunities to work and participate in the community as any other citizen.

The National Institute for Mental Health in England (NIMHE) has also put into place their Social Inclusion Implementation Programme. They are giving priority to eradicating stigma and discrimination and are promoting equality in employment, income and benefits, education, housing, community participation and social networks.

Is social inclusion what service users really want? Whilst on the one hand it is good that stigma and discrimination should be eradicated, service users also have the right to choose the life style that they want – as does every other honest citizen. Some feel that the government's social inclusion programme is nothing more that a means of coercing service users into work in order to cut expenditure on Incapacity Benefit – especially as the government has clearly stated their policy to reduce the numbers of those claiming this benefit and to make substantial savings on pay outs. The service user should always be allowed the right to decide whether he/she wants to work or not.

Whilst entering the work place might be a pathway to social inclusion, work can also create more problems that it solves. The work place can be brutal and competitive. People can feel degraded, belittled and dissatisfied with the work they are asked to do – especially as most service users are usually offered only the sort of work that is demeaning and that erodes self respect. The stress of work and the friction and tension of work politics can be a certain pathway back to a long stay in a psychiatric ward and a rather uncertain pathway into greater social inclusion in the community.

Society breaks down into small units and many service users already enjoy the satisfaction of inclusion within these small segments without entering the work place. Such segments include religious groups, creative and artistic groups, ethnic minority groups and the subculture of male homosexual and lesbian society.

There are also service users who are happy to be disengaged from the mainstream of society as a way of coping with their condition and who also feel secure with minimum help from mental health services who they consider intrusive to their life. They may spend the day in their accommodation watching television for most of the time, broken by visits to the supermarket and a trip to the post office to collect their benefit. They feel safe, happy and secure with the minimum of social engagement, apart perhaps from contact with their immediate family. Society is diverse and accommodating enough to make space for those service users who prefer to disengage as much as possible as a way of coping with their mental condition – after all they are socially included on their terms.

We all have the right to choose about what social opportunities we want to take. Rather than expecting everyone with mental health problems to now enter the work place in order to be socially included the government should make adequate benefit provisions for those who are not able to work in order that they too can make choices about the way they want to be socially included.

If you want more information about current trend in the social inclusion programme, the following websites will help:

NIMHE: www.nimhe.org.uk (disappeared)

Social Exclusion Unit: www.socialexclusionunit.gov.uk (gone)

Sainsbury Centre form Mental Health:

www.scmh.org.uk

25th November 2005