Abstract
Background:Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion.Aims:(1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness.Method:Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations.Results:About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age (p = .008), lack of higher education (p < .001), more previous admissions (p = .005), severity of current symptoms and greater experienced stigma (p = .006) and anticipated stigma (p = .035). Greater social inclusion was associated with better quality of life (p < .001) and less loneliness (p < .001).Conclusions:Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people’s social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.
Highlights
Social inclusion is an important indicator of recovery in individuals with severe mental illness
This study aimed to investigate whether social inclusion differs between diagnostic groups
We hypothesised that levels of social inclusion would vary according to the type of mental disorder
Summary
Social inclusion is an important indicator of recovery in individuals with severe mental illness. People with mental health problems have higher rates of educational drop-out and disruption (Isohanni et al, 2001), unemployment (Boardman et al, 2003; Harvey et al, 2009; Marwaha et al, 2007; Meltzer at al., 2002), poverty and debt compared to the general population They are more likely to experience negative life events, including criminal victimisation (Johnson et al, 2015; Khalifeh & Dean, 2010; Teplin et al, 2005; Walsh et al, 2003), they tend to lack social support (Meltzer et al, 2002) and have fewer and poorer quality social networks compared to the mentally well (Bengtsson-Tops & Hansson, 2001; Sweet et al, 2018). Low levels of social inclusion, sometimes referred to as social exclusion, is a risk factor for poor mental health and the development of, or exacerbation of pre-existing psychiatric disorder (Boardman, 2011; Morgan et al, 2007; Office of the Deputy Prime Minister, 2004)
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