Wednesday, September 22, 2010

Stigma, Social Inclusion, and Recovery from Psychiatric Illness

I'd not applied the concept of "social inclusion" to mental health work until I read the August 2010 editorial in Psychiatric Services:
Promoting tolerance and community acceptance of persons with psychiatric disorders, although necessary, is no longer sufficient. We need to move beyond "antistigma" initiatives and predominantly biological-pharmacological treatments. Promoting "social inclusion," an approach that originated in European Union countries, is one way we can move forward. It requires that society and its institutions actively promote opportunities for the participation of excluded persons, including persons with psychiatric disabilities, in mainstream social, economic, educational, recreational, and cultural resources..."Exclusion" is beginning to replace so-called stigma in our conceptualization of social attitudes associated with disabling mental illnesses.
"Social inclusion" has the key mark of an excellent idea - it seems totally obvious. But as the editorial suggests, it's a new way of thinking about and approaching discrimination, stigma, and chronic psychiatric illness.

A central advantage of the concept is that it focuses on what we are for (social inclusion) rather than what we are against (stigma). We can work towards inclusion at multiple levels - with patients (sharpening skills that facilitate inclusion), with communities (supporting workplace and recreational inclusion), and at the level of policy and law (promoting access and reducing barriers).

Reducing stigma has long been an objective in mental health, but stigma is an intervening variable, not an end target. The underlying hypothesis of efforts to reduce stigma is that folks with serious psychiatric conditions will experience more social opportunity and will develop more positive self images. But it's better to make outcomes of this kind the direct target of advocacy and clinical work rather than assuming that they will emerge on their own if stigma decreases.

Social inclusion is a human rights approach. It's an extension of the Declaration of Independence:
We hold these truths to be self-evident, that all [humans] are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
That's a strong grounding for clinical work and the mental health recovery movement!

(To learn more about the concept of social inclusion, see the U.N. Department of Economic and Social Affairs publication on "Measuring Social Inclusion" and the U.K. Inclusion Institute's document "Social Inclusion and Mental Health.")

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