Mental health, social exclusion and social inclusion

In the UK the concept of social exclusion came into widespread use in mental health following the publication of an influential Social Exclusion Unit report in 2004. Based on a comparison of ways of defining social exclusion with the mental health literature, this article begins by outlining a social systems approach to understanding social exclusion. The approach is later used to examine the position of people with mental health needs in the UK. First, however, a common assumption that social inclusion constitutes the opposite of social exclusion is addressed and an alternative way of thinking about the two concepts is put forward. A further assumption that social inclusion is self-evidently desirable is also critiqued from political and service user perspectives before drawing conclusions from the evidence reviewed. These concern a need for policy initiatives to focus on tackling the structural barriers that work to exclude people with mental health needs, as well as on challenging the deep-rooted prejudice and stigmatisation that reinforce those barriers; and a need to be mindful of the context in which inclusion policies are implemented, the assumptions that become implicit within these policies, and the possible consequences of their adoption as a moral imperative.