Mental health

One way to understand the impact of inequalities is to look at how social exclusion impacts on a specific group.

Overview

Who are they? 

Most of us are affected by some form of mental ill-health during our lives. Common mental disorders (e.g. depression and anxiety-disorders in adults, and emotional and conduct disorders in children) affect over 16% of adults and nearly 10% of children at any one time in the U.K.(Jenkins et al 2008). This can rise to 40-50% in highly vulnerable populations such as prisoners. GPs spend a third of their time on mental health issues (National Social Inclusion Programme 2004).

Severe mental disorders are relatively rare and affect around 0.4% of the general population (Jenkins et al 2008). Addiction rates, on the other hand, are common and growing with 25% of the adult population regularly taking hazardous levels of alcohol, 7% are dependent on alcohol and 22% are dependent on tobacco (Jenkins et al 2008). 

Personality disorders are another group where causation, prevention and treatment is less understood, and affect around 2.4 million people in Britain. Dementias are also common, with senile dementia currently affecting 5% of people aged over 65 and 20% of those aged over 80. The number of people affected by dementia is likely to rise to 1.4 million over the next three decades (Jenkins et al 2008).

How are they affected by social exclusion?

The National Social Inclusion Programme (NSIP) identified five main reasons why mental health problems too often lead to and reinforce social exclusion (NSIP 2004). Firstly, stigma and discrimination persist. Many people fear disclosing their condition and many employers are reluctant to recruit people with mental health problems (NSIP 2004).

Professionals working in health and social care can have low expectations of what people can achieve and services do not always work together effectively to promote vocational and social outcomes or provide the support required(NSIP 2004). Finally people face barriers to accessing the services they need especially housing and transport and participating in social activities such as education, arts and sport and leisure (NSIP 2004).

What is being done?

Self-determination and self-management are important principles driving changes in society and a factor behind the redesign and re-organising of services relating to mental health in other countries and now in the U.K. (Department of Health 2006a, Scottish Executive 2007, Shepherd et al 2008). The key concept of “recovery” is about “a person’s right to build a meaningful life for  themselves, with or without the continuing presence of mental health symptoms” (Shepherd G et al 2008). 

Whether the terms used are recovery, personalisation, co-production or self-directed care, the direction of travel for mental health services is towards a second “deinstitutionalisation” of our time: “The first moved the locus of mental health services from the large institution to the community, but did not significantly alter underlying structures and attitudes. This second addresses a fundamental change in thinking: from… a paternalistic response to those ‘groups’ perceived as ‘less fortunate’ within society to one based on the rights of every person to enjoy equality of access and opportunity within our society, and explore what that means for the provision of adequate support and services” (Social Perspective Network 2008).

References

The items in this reference list are available online. They were last accessed on 19 February 2009.

Some of the references below are in PDF format - see how to access PDF files.

Care Services Improvement Partnership, Royal College of Psychiatrists, Social Care Institute for Excellence (2007) A Common Purpose: Recovery in Future Mental Health Services. London: Social Care Institute for Excellence.

Department of Health (2006) From values to action: The Chief Nursing Officer's review of mental health nursing. London: The Department.

Jenkins R et al (2008) Foresight Mental Capital and Wellbeing Project. Mental health: Future challenges (PDF 3.86MB). London: Government Office for Science.

National Social Inclusion Programme (2004) Mental health and social exclusion. London: Social Exclusion Unit, Office of the Deputy Prime Minister.

Scottish Executive (2007) Rights, relationships and recovery: the national review of mental health nursing in Scotland. Edinburgh. Scottish Executive. 

Shepherd G et al (2008) Making recovery a reality (PDF 454.03KB). London: Sainsbury Centre for Mental Health.

Social Perspectives Network (2008) Power to the people? Notes on a study day on personalisation (PDF 1.56MB). London: Social perspectives Network.