Instant Download Social Inclusion and Mental Health Understanding Poverty Inequality and Social Exclusion 2nd Edition Jed Boardman PDF All Chapters
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I am delighted to welcome this new edition as essential reading for everyone working/
involved in health and social care, not just mental health services. The text expands our
understanding of the means of social exclusion, its poisonous legacy on children and
adults, and how we might change the single, main driver of mental health conditions –
poverty. The book goes beyond theoretical frameworks and the language of exclusion
(inequalities and disparities belong to different political tribes) – it brings exclusion into
the world of service users and health professionals. We learn that exclusion is not merely
economic, but race and disability (to name just two) compound multiple disadvantages. I
wish I had read a social science primer like this book at the start of my career, and can
only hope it will be taken up by the next generations.
Peter Byrne, Consultant Liaison Psychiatrist, Royal London Hospital; Co-director of
RCPsych Public Mental Health Implementation Centre
Without action, the poor may well ‘always be with us’. But as this book makes so clear,
poverty (whether defined in terms of lacking material resources, access to occupational
and leisure opportunities, civil participation, or even supportive social networks) is
partly a consequence of exclusion arising from political, economic, and social structures
but all too often through deliberate actions of individual self-interest, prejudice, and
discrimination.
This book provides a comprehensive and persuasive account of the forces at play and
more importantly what we, collectively, professionally and individually can do to tackle
the social and economic barriers that people with mental health conditions face in daily
life. This is an outstanding book that should be read by all mental health professionals as
a fundamental text for their profession.
Tom K J Craig, Professor Emeritus of Social Psychiatry, King’s College London
The second edition of this impressive volume is timely, as in the United Kingdom and
Europe we confront poverty, a conflict in Europe, and a major energy crisis, whereby
more people will not eat well and use drugs and alcohol and high fat and salt foods will go
up. We can anticipate greater levels of poor health and health crises. The central
messages of this manifesto cut through political instability and poor health literacy,
and give all policymakers and politicians an opportunity to improve the health of the
nation and reduce health inequalities. I especially enjoyed the nuanced exposition of how
as a society we fail to tackle social determinants of poor health at our peril. Poverty and
social adversity, especially child maltreatment, lead to premature mortality and poorer
life chances and quality of life, including the development of mental illnesses.
Furthermore, those with mental illness encounter prejudice, stigma, and discrimination,
all of which mean people with mental illnesses face precarity and structural violence that
deprives them of equal rights to benefit from societal opportunities and care systems. We
need systemic preventive and care interventions. This book is a clarion call to all. We
must do better to prevent mental illness, tackle social determinants, reduce stigma and
discrimination, and promote inclusive public care systems in which those with mental
illness realise their rights as citizens. Inclusive policy and practice are at the heart of
actions that might transform dystopian complacency in mental healthcare and public
mental health.
Kamaldeep Bhui, Professor of Psychiatry, University of Oxford
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Social Inclusion
and Mental Health
Second Edition
Jed Boardman
King’s College London
Helen Killaspy
University College London
Gill Mezey
St George’s Hospital Medical School, University of London
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University Printing House, Cambridge CB2 8BS, United Kingdom
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www.cambridge.org
Information on this title: www.cambridge.org/9781911623595
DOI: 10.1017/9781911623601
© Royal College of Psychiatrists 2010, 2023
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2010
Second edition 2023
A catalogue record for this publication is available from the British Library.
ISBN 978-1-911-62359-5 Paperback
Cambridge University Press has no responsibility for the persistence or accuracy of
URLs for external or third-party internet websites referred to in this publication
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
....................................................................................................
Every effort has been made in preparing this book to provide accurate and up-to-date information that
is in accord with accepted standards and practice at the time of publication. Although case histories are
drawn from actual cases, every effort has been made to disguise the identities of the individuals involved.
Nevertheless, the authors, editors, and publishers can make no warranties that the information
contained herein is totally free from error, not least because clinical standards are constantly changing
through research and regulation. The authors, editors, and publishers therefore disclaim all liability for
direct or consequential damages resulting from the use of material contained in this book. Readers are
strongly advised to pay careful attention to information provided by the manufacturer of any drugs or
equipment that they plan to use.
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Contents
Foreword to Second Edition vii
Foreword to First Edition (2010) ix
Preface xi
Acknowledgements xiii
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Foreword to Second Edition
I have long argued that the health of a society provides insight into how well that society is
functioning. This is true of physical health and life expectancy, and perhaps even more so of
mental health conditions, to use the terminology adopted here. Social inclusion is one
measure of the good society and is vital to health. The evidence on mental health shows how
that plays out.
There are at least three important ways in which society is important for mental health
conditions. The first is the social determinants of mental health. Social structures, poverty,
and inequality, acting through the life course, are important determinants of health.
Psychosocial pathways are important for both physical and mental health, but particularly
for mental health. One example is adverse childhood experiences (ACEs). Children who
experience four or more ACEs have increased risk of mental health conditions and,
probably, physical ill-health. But the frequency of ACEs is strongly linked with level of
deprivation: the greater the deprivation, the more common are most kinds of ACEs. We
therefore have a potential causal chain from the structure of society and magnitude of
inequalities in all the components that go to make up deprivation, to ACEs, to adverse
outcomes.
A second way the nature of society is crucial for mental illness is in the development of
mental health services. When people with mental illness were treated as destitute and
consigned to the workhouse, or locked away in asylums, it told us a great deal about
society’s view of mental illness. Such inhumanity may now seem extreme, but vestiges of
it are still in operation. Much lip service is devoted to parity in provision of services between
mental and physical health, but this is yet to be realised. At a more nuanced but no less
important level, there are marked differences in the conception of what mental illness is and
how it should be treated. It is not difficult to link these back to societal attitudes.
Third is the experience of people with mental health conditions. In general, the social
determinants of health operate more to the detriment of people with mental health condi-
tions and those with disabilities of various kinds. Housing, income, job prospects, and social
inclusion are all more problematic for people with mental health conditions.
The present volume gives a rich and detailed account of how all this works. It has a grand
historical sweep, pays detailed attention to each of the concepts with which it deals, and
provides a comprehensive review of the evidence. There is so much that is good here, not
just on mental health conditions but also on social inclusion, poverty, social capital, welfare
policy, capability theory, human rights, and all the features of social processes relevant to
mental health conditions. It does feel like the definitive book on the subject.
vii
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Foreword to First Edition (2010)
Being part of society, contributing to it and, in return, being recognised and acknowledged,
is a core need of human beings. The impact of social factors, whether they be isolation,
unemployment, poor housing, financial hardship or debt, in the aetiology of mental and
physical ill-health and their role in its management cannot be underestimated. Whether an
individual is egocentric or socio-centric, social inclusion is of great significance in ensuring
that an individual feels part of the larger community. Mentally ill individuals often seek
employment, housing and social contacts as their key priorities and it is essential that
clinicians do not forget these goals. There is little doubt that social inclusion is often seen as
a political or moral concept, but it is much more than that: it is a quintessential basic need
that every individual has, to be accepted and to have the self-esteem and the self-confidence
which will allow the individual to deal with stress. Social inclusion for individuals has many
meanings, depending upon gender, age, sexual orientation, educational attainment or
socio-economic status, among other things. The challenge for clinicians and policy makers
is to make social inclusion work and not simply to rely on rhetoric. This book is doubly
welcome for highlighting an important topic and for guiding practitioners and policy
makers to encourage social inclusion. The book originates from a report which was devel-
oped by Jed Boardman, and for the book he has managed to attract many eminent
contributors. I hope that it will be of interest not only to clinicians but also to stakeholders,
including politicians and policy makers.
ix
xi
expanded the findings of the Scoping Group, examining the ways in which this blight is
manifest and how mental health professionals and services might respond to the challenges
posed by the social exclusion of people with mental health problems and learning difficulties.
This revised edition contains some of the material from that first edition, but this has been
thoroughly updated and rewritten by the three authors. It contains many new chapters,
notably those in Section 1 of the book. Our purpose in updating this book has been to provide
a more coherent account of the position of those with mental ill-health in contemporary
society as well as the importance of the social and economic environment in creating and
maintaining the mental health and well-being of the population. Whilst our primary focus in
this new edition is on people with mental health conditions and working-age adults, we do not
exclude those with substance misuse, intellectual disability or developmental disorders, nor do
we exclude older adults or children and young people. Our focus is on the United Kingdom,
but we also extend our scope to place this in both an international and historical context.
References
Equalities Review (2007) Fairness and Freedom: Social Inclusion: Making Psychiatry and
The Final Report of the Equalities Review. The Mental Health Services Fit for the 21st
Equalities Review. www.equalrightstrust.org Century. Position Statement (PS01/2009).
/content/fairness-and-freedom-final-report- Royal College of Psychiatrists. www
equalities-review. .rcpsych.ac.uk/docs/default-source/mental-
Royal College of Psychiatrists’ Social Inclusion health/work-and-mental-health-library/pos
Scoping Group (2009) Mental Health and ition-statement-2009.pdf?sfvrsn=97bca29e_2.
xiii
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Other documents randomly have
different content
on merkinnyt: »Entwurf einer reinen Philosophie», mutta
valitettavasti tuo vihko on jäänyt — aivan tyhjäksi. Irtonaisista
paperipalasista, joihin hän on merkinnyt ajatuksen juoksuaan ja
joista — niin paljon kuin niitä on säilynytkin — suuri osa lienee
joutunut hukkaan, ei saa mitään kokonaiskäsitystä, ne ovat
aforismeja ja niiden abstraktisuudesta jää lukijalle vahva
»qvasifilosofian»[26] sivumaku. On kuitenkin myönnettävä, että
näiden ajatussirpaleiden pohjana on persoonallisia elämyksiä.
Puhtaus tuntuu olevan hänen filosofiansa ydinkäsitteitä; se ja koko
tuon filosofeeraasimisen abstraktinen luonne löytänevät selvityksen
muualtakin kuin kirjaviisaudesta: tuntuu luonnolliselta, että
aristokraattinen äiti oli lapsuudesta asti varjellut poikaansa
joutumasta liian läheiseen kosketukseen pahan maailman kanssa.
Mutta vielä useammin kuin sana puhtaus esiintyy hänen
kirjoituksissaan sana vapaus. Avioliiton alkuvuosina se sana on
ytimenä kaikissa niissä purkauksissa, joissa hän valittaa
käytännöllisen elämän asettamia kahleita ja huokaa rahallisen
raadannan alla: »Minä en anna pakottaa itseäni, tahdon päästä
käytännöllisen elämän pakkovallasta, tähden elää mielipiteilleni, tuo
käytännöllinen elämä» (Praxis) iljettää minua puolinaisuudellaan»,
hän tavan takaa ja useissa eri muodoissa toistaa.
»30/VIII 95.
Alexander.»
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Ida Aalbergin taiteilijaluonne ei ollut älyllinen. Vapaaherra Uexküll-
Gyllenbandin intellektualismilla jota tarjottiin ylen runsaina
annoksina, oli omat vaaransa Ida Aalbergille. Neuvoja oli liian paljon,
jotta Ida Aalberg olisi voinut niitä kaikkia edullisesti hyödykseen
käyttää. Ne voivat muodostua raskaaksi painolastiksi, joka voi
hävittää hänen taiteensa suurimman vaikutusvoiman: välittömyyden
tunneilmauksissa. Hän tarvitsi Bergbomilta vain pienen vihjauksen
tai lyhykäisen lauseen ohjauksekseen, heti sanotaan hänen
joutuneen inspiratsionin valtaan, joka voimallaan ja hehkullaan ylitti
kaikki toivomukset, ja pystyneen tällöin luomaan sellaista, mitä
ohjaaja omassa mielikuvituksessaan ei ollut nähnyt, mutta johon hän
täysin yhtyi. Tuommoista hetkelliseen inspiratsioniin perustuvaa
taidetta voidaan syyttää pintapuolisuudesta, mutta älyn ylivalta vie
tehon taiteelta ja tekee esityksen kuolleeksi.