Abstract
BackgroundSocial exclusion is both cause and consequence of mental disorders. People with mental disorders (PWMD) are among the most socially excluded in all societies yet little is known about their experiences in North India. This qualitative study aims to describe experiences of exclusion and inclusion of PWMD in two rural communities in Uttar Pradesh, India.MethodsIn-depth interviews with 20 PWMD and eight caregivers were carried out in May 2013. Interviews probed experiences of help-seeking, stigma, discrimination, exclusion, participation, agency and inclusion in their households and communities. Qualitative content analysis was used to generate codes, categories and finally 12 key themes.ResultsA continuum of exclusion was the dominant experience for participants, ranging from nuanced distancing, negative judgements and social isolation, and self-stigma to overt acts of exclusion such as ridicule, disinheritance and physical violence. Mixed in with this however, some participants described a sense of belonging, opportunity for participation and support from both family and community members.ConclusionsThese findings underline the urgent need for initiatives that increase mental health literacy, access to services and social inclusion of PWMD in North India, and highlight the possibilities of using human rights frameworks in situations of physical and economic violence. The findings also highlight the urgent need to reduce stigma and take actions in policy and at all levels in society to increase inclusion of people with mental distress and disorders.
Highlights
Social exclusion is both cause and consequence of mental disorders
We worked with two project teams of Emmanuel Hospital Association (EHA), an organisation that works across North India in community health and development
While experiences of exclusion were dominant for most participants, the subheading of inclusion includes three themes, Participation, Belonging and Support related to experiences of inclusion showing experiences to have a dappled light mixed through the darkness of exclusion
Summary
Social exclusion is both cause and consequence of mental disorders. People with mental disorders (PWMD) are among the most socially excluded in all societies yet little is known about their experiences in North India. Social exclusion creates a sense of not belonging, non-participation in community life and diminished opportunity and capacity to participate. Status loss, stereotyping, separation and discrimination occur together in situations that allow them [2] clarifying that social exclusion entails both prejudice (attitudes) and discrimination (behaviour). It leads to individuals being perceived as ‘tainted and discounted’ [3]. Social exclusion can be conceptualised as interlocking and mutually compounding problems of impairment, discrimination, diminished social role, lack of economic and social participation and disability [4]
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