Abstract
This article examines social inclusion in the context of the deinstitutionalisation of mental health care. It draws on a scientific evaluation of the Belgian reform of mental health care (2010), designed to assess the influence of organisational mechanisms on the social and care trajectories of service users. The findings highlight the ongoing challenge for mental health systems to support the inclusion of service users within the community, and the increasingly difficult access to mental health care for people with complex and chronic mental health problems. Drawing from Systems Theory (Luhmann, 2013) and the analysis of subjective experiences, this article delves into the complex processes of social inclusion using the empirically-grounded concepts of the patient role and the impatient role. By acknowledging the relational dimensions of social inclusion, this article argues that complementarities between two faces of the mental health system are key to achieving inclusion beyond the walls of institutions and within society at large.
Highlights
Mental health care systems across European countries have undergone major changes since the mid-twentieth century
How do contemporary mental health systems contribute to the process of social inclusion for people with mental health problems? Secondly, how can PCCs navigate towards social inclusion, in the context of their increasing exclusion from the mental health system’s services?
Incorporating the relational dimensions of social inclusion highlights the complementarity between the mental health system and a system made up of alternative services
Summary
Mental health care systems across European countries have undergone major changes since the mid-twentieth century. Growing public criticism of psychiatric hospitals drove policy makers to place increasing emphasis on the inclusion of people with mental health problems within society. The deinstitutionalisation of mental health care gradually gained international consensus, and efforts began to shift mental health care from hospitals to the community. Despite the development of community mental health care, scientific evaluations carried out internationally have revealed undesirable side effects. People with complex and chronic mental health problems (PCCs) Social Inclusion, 2020, Volume 8, Issue 1, Pages 214–224 face difficult access to mental health care (Novella, 2010). There is still an urgent need to facilitate social inclusion of people with mental health problems outside mental health institutions and within the community (Grard, Nicaise, & Lorant, 2015)
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