Social Inclusion
Manchester Mental Health &
Social Care Trust
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Aims & Objectives of
Session
To consider the problem of social exclusion
as it affects people with a psychotic illness
To examine the causes of social exclusion
To explore the current position of people with
SMI in relation to work and education
To look at the government’s action plan to
promote enhanced inclusion, with a particular
emphasis on the needs of young people
experiencing psychosis & their carers
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Social Exclusion – A service
user’s perspective
“ For some of us, an episode of mental
distress will disrupt our lives so that we are
pushed out of the society in which we were
fully participating. For others, the early onset
of distress will mean social exclusion
throughout our adult lives, with no prospect of
training for a job or hope of a future in
meaningful employment. Loneliness and loss
of self worth lead us to believe we are
useless, and so we live with this sense of
hopelessness, or far too often choose to end
our lives…we are seen as a social burden”
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The Problem of Social
Exclusion
Adults with long term mental health problems
are one of the most excluded groups in
society
When asked, many say they want to work –
but fewer than a quarter do
This is the lowest employment rate for ANY
group of disabled people (Office for National
Statistics 2003)
This leads directly to social isolation,
boredom, depression and suicide
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The Problem of Social
Exclusion
Social isolation is an important risk factor for
deteriorating mental health and suicide.
Two thirds of men under the age of 35 with
mental health problems who die by suicide
are unemployed (DOH 2001)
Mental health problems can have a
particularly strong impact on families – both
financially and emotionally. They are twice as
likely themselves to have a mental health
problem if they provide substantial care
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The Cost of Social Exclusion
Mental health problems are estimated to cost
the UK over £77 billion a year through the
costs of care, economic losses and
premature death (Sainsbury Centre 2003)
Over 900,000 adults in England claim
sickness and disability benefits for mental
health conditions, with higher rates in the
North – more than are claiming Jobseekers’
Allowance
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What Causes Social
Exclusion?
Stigma & discrimination – despite
campaigns, attitudes haven’t changed
(Taylor et al 2003). Fewer than four in
ten employers say they would recruit
someone with a mental health problem
(Manning & White 1995)
Many people fear disclosing their
condition, even to family and friends
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Group Exercise
As a large group –
Consider any portrayals of mental illness you
have seen, heard or read about in the last
few years
Group these into positive and negative
images and discuss their impact on the
general understanding of the issues facing
people with mental health problems
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What Causes Social
Exclusion?
Low expectations – professionals often
display pessimism about what clients can
achieve. There is limited recognition in the
NHS that returning to work & overcoming
isolation is associated with better health
outcomes.
Education & employment opportunities are
not seen as key objectives by many health &
social care professionals
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What Causes Social
Exclusion?
Lack of clear responsibility – It
appears to be nobody’s actual JOB to
promote vocational and social outcomes
for adults with mental health problems
Services don’t work effectively together
to meet individual needs and maximise
the impact of available resources
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What Causes Social
Exclusion?
A deficit in ongoing support to enable
people to return to education/employment
- £140 million per year is invested by health &
social care in vocational and day services
(Mental Health Strategies 2003). But not all
promote social inclusion effectively
Links with Jobcentre Plus can be weak
People fear loss of benefits if they find work
People lose the jobs they find because of
poor support
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What Causes Social
Exclusion?
Barriers to engagement – Clients may have
poor access to housing & transport
Education, arts, sports and leisure providers
are often not aware how their services could
benefit clients and how they can make them
more accessible
Clients don’t want to use services alone but
don’t like to ask for support
Clients are actually EXCLUDED by law from
jury service!
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Barriers to inclusion
among specific groups
Ethnic minorities – they may feel alienated
from mainstream (predominantly white)
mental health services and tend to seek help
from these services later than white people
They are more likely to disagree with their
diagnosis
They may encounter discrimination on
grounds of both mental health & ethnicity
when seeking work
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Barriers to inclusion
among specific groups
Young men – They are at a high risk of
dropping out of education or work
They may become involved in crime
They are at particularly high risk of suicide
If they have other complex needs (substance
misuse, homelessness) they struggle to gain
access to statutory services (Rankin & Regan
2004)
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Group Exercise
In small groups –
Read the brief case vignette
List the ways in which Dennis may be
experiencing social exclusion.
Accompany each of these examples
with an explanation as to why that might
be happening
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Tackling Social
Exclusion
Some important measures are already in
place to address social inclusion –
Pathways to Work( DOH 2005) – ‘ a radical
new approach to supporting incapacity
benefit claimants back into work’
National Service Framework for Mental
Health (DOH 1999) – recognises the
importance of promoting social inclusion
Disability Discrimination Act (1995) –
outlaws discrimination of disabled people
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Tackling Social
Exclusion
Local initiatives – innovative examples,
often led by the voluntary and community
sector, exist that are having an impact on
both health & work
Successful local projects are characterised by
close partnership working between agencies,
a clear focus on the aspirations of the clients
and strong local leadership.
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Tackling Social Exclusion –
What else needs to be done?
“Our vision is 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 Social Exclusion Unit (DOH 2005)
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The Social Exclusion Unit’s
Action Plan
Stigma & discrimination – Mental health
has not benefited in recent decades from the
progress seen in tackling stigma and
discrimination about race and sexuality
A sustained programme to challenge negative
attitudes and promote awareness of people’s
rights (£1.1 million investment – 2004 – 5)
Schools have been provided with practical
teaching resources to challenge stigma
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The Social Exclusion Unit’s
Action Plan
The role of health & social care services –
The advice that people get from professionals
can set the tone for the course of their illness
and its impact on their lives
Support for re-integration into the community
is an integral part of the work of effective
mental health services. Early access to MH
services regardless of age, ethnicity, gender
or social status may reduce the risk of
problems becoming more intractable.
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The Social Exclusion Unit’s
Action Plan
Health & social care services will tackle social
exclusion through :
Modernised vocational services, reflecting
best practice from an evidence base
Access to an employment advisor and social
support for everyone with MI
Redesigning MH day services to promote
social inclusion
Strengthening training on social inclusion for
professionals and police/prison staff
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The Social Exclusion Unit’s
Action Plan
Employment promotes enhanced
mental health
The Pathways to Work pilots are testing
the impact of a comprehensive
employment support package including
specialist personal advisers, help to
manage illness at work and a £40 per
week ‘return to work’ credit.
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The Social Exclusion Unit’s
Action Plan
Getting the basics right –
There is little prospect of accessing work or
community activities for people whose
housing is unstable, who have problems with
money and who are unable to access
affordable transport
New guidelines to Housing Authorities on
lettings and stability for clients with MI have
been given
There should also be improved access to
financial and legal advice
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Making it Happen
To ensure that the action plan is
implemented, strong leadership and effective
coordination is required, at both national and
local level
Local implementation is to be undertaken by
primary care trusts and local authorities,
supported by the National Institute for Mental
Health in England (NIMHE 2005)
However, it needs better use of the expertise
of the voluntary and community sectors to
really make it all work
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Conclusion
Social exclusion is a huge (often hidden or
neglected) problem for people with mental
health problems, their families and friends
and for all of us
It is caused by stigma, low expectations, lack
of resources and poor coordination
Some progress has been made to improve
the situation
Much more needs to be done. However, if
improvements are achieved, they can have
far reaching and lasting impact on all aspects
of people’s lives
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