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S Dunn. MIND (National Association for Mental Health), 1999, £9.99 (£1 p+p), pp 181. ISBN 1874690871
The government's social exclusion unit (SEU) was established to help individuals, groups, and regions overcome deprivation and discrimination resulting from a combination of problems, including unemployment, poor quality housing, low income, lack of education/training opportunities, bad health, and family breakdown. Such difficulties are commonly experienced by people with mental health problems who also have to cope in a society which alienates and rejects them, barring them from every aspect of community life. Remarkably, even the SEU's remit excludes consideration of the obstacles to social inclusion faced by those with a psychiatric diagnosis.
Creating Accepting Communities is the final report of an inquiry commissioned by MIND, which looked at the nature and extent of social exclusion experienced by people who use mental health services in Britain. The inquiry panel received written and oral evidence from a wide range of individuals and organisations, including mental health practitioners, high street retailers, groups working within the voluntary sector, and, importantly, service users.
The book is clearly written and the material well organised into four main chapters, each of which ends with a useful summary of the key issues raised. Quotations from witnesses are used extensively throughout the narrative, giving real meaning to the findings, and to participants a sense of “ownership” in the report.
The first chapter summarises evidence presented to the inquiry on how a psychiatric diagnosis can exclude people from a range of socially significant areas such as employment, education and training, aspects of daily life (that is, access to goods and services, social networks, etc), and empowerment within mental health services. The panel found widespread evidence of social exclusion and dismissed claims that this was simply the result of poverty. Instead, they argue that while policy initiatives should focus on addressing the poor material circumstances of service users, they should also work towards creating greater social cohesion or social inclusion.
A range of ethical aspects associated with social inclusion is briefly but coherently discussed in chapter 2. In particular, inquiry evidence is used to evaluate the relationship between individuals and their wider community, and to address the following questions: how does society judge the value of a person? How does society differentiate individual “badness” from “mental illness”? How should risk be defined? What is meant by the participation and empowerment of service users? Essentially, the findings support the basic need to recognise the absolute value of individuals and to acknowledge that any ethical approach to social inclusion needs to balance this against existing social forces: differences can only be resolved through the participation of everyone involved.
Chapter 3 discusses a range of initiatives that have been set up to promote social inclusion within the key areas of work, education, the arts and the media, daily living, and the mental health services. The panel highlighted three areas where more work should be done to improve social inclusion: the development of more local initiatives based on inter-agency cooperation, legal and policy-based reforms at national level and the promotion of more intensive public education programmes on mental health. Based on this inquiry evidence, chapter 4 presents a series of recommendations aimed at directing social progress “from exclusion to cohesion”.
In general, the report raises the profile of a wide range of issues concerning social exclusion and provides an informative overview of current policy and practice initiatives. Unfortunately, because the book's remit is so wide, its depth of analysis is compromised, leaving unchallenged some very difficult ethical barriers to social inclusion.
For example, little is currently known about the nature of day-to-day interactions between “them and us” and the consequences of these interactions for the promotion of a society based on “inclusive diversity”, particularly in the face of: 1) growing public demands for more zero tolerance initiatives; 2) the threat of new legislation designed to exclude those with a serious personality disorder, those who fail to comply with medication while living in the community, and those who are disruptive in schools; 3) media campaigns provoking street demonstrations against groups the media feels society should no longer tolerate, and 4) employment practices which measure individual value in terms of productivity to the point whereby even mental health services lack confidence in service users' abilities.
Ultimately, the problem of analytical depth is a methodological one that requires the development and integration of research initiatives at both the micro and macro levels of social inquiry. Moreover, these observations should not detract from what is an excellent report and an important reference point for anyone interested in promoting the social inclusion of people who experience mental ill health.
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