Becoming socially included

Authors

DOI:

https://doi.org/10.1921/swssr20252508

Keywords:

social exclusion, social psychiatry, employment, health inequalities, public mental health, mental ill-health

Abstract

Professor Peter Huxley has made a considerable contribution to Social and Community Psychiatry. In this paper, I reflect on some aspects of social psychiatry including its importance, scope and current status, as well as contemporary thinking on the social exclusion and employment of people with mental health conditions. Central to much of the thinking in these areas are health inequalities, the social determinants of ill-health and the bidirectional relationship between social factors and mental ill-health. I leave the final words to Peter Huxley: “Psychiatry and social science both work to understand and address the consequences of social adversity and injustice, even if psychiatry is sometimes reluctant to acknowledge this

Author Biography

Jed Boardman, nstitute of Psychiatry, Psychology & Neuroscience, King’s College London

Dr Jed Boardman PhD FRCPsych, is visiting Senior Lecturer in Social Psychiatry at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London. Throughout his career, he has worked mainly in social and community psychiatry and was Consultant Psychiatrist at South London and Maudsley Trust until 2016. He is lead for Social Inclusion at the Royal College of Psychiatrists.

References

Andreeva, E., Magnusson-Hanson, L.L., Westerlund, H., Theorell, T., Brenner, M.H. (2015) Depressive symptoms as a cause and effect of job loss in men and women: evidence in the context of organisational downsizing from the Swedish Longitudinal Occupational Survey of Health. BMC Public Health, 15, 1045. DOI 10.1186/s12889-015-2377-y

Aldridge, R.W., Story, A., Hwang, S.W., Nordentoft, M., Luchenski, S.A., Hartwell, G., Tweed, E.J., Lewer, D., Vittal Katikireddi, S. and Hayward, A.C. (2018) Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet, 391, 10117, 241-250. https://doi.org/10.1016/S0140-6736(17)31869-X

Allen, J., Balfour, R., Bell, R. and Marmot, M. (2014) Social determinants of mental health. International review of psychiatry, 26, 4, 392-407. https://doi.org/10.3109/09540261.2014.928270

Allwood, L. and Bell, A. (2020a) Briefing 1. Covid-19: understanding inequalities in mental health during the pandemic. Centre for Mental Health, 18, 2020-07.

Allwood, L. and Bell, A. (2020b) Briefing 2. Covid-19: Acess to Mental Health Support, understanding inequalities in mental health during the pandemic. Centre for Mental Health, 18, 2020-07.

Atkinson, A.B. (2015) Inequality: What Can Be Done? (1st ed.). Cambridge, MA: Harvard University Press. https://doi.org/10.4159/9780674287013

Bailey, N. (2016) Exclusionary employment in Britain’s broken labour market. Critical Social Policy, 36, 1, 1-22. https://doi.org/10.1177/0261018315601800

Bartley, M. (1994) Unemployment and ill health: understanding the relationship. Journal of Epidemiology and Community Health, 1979, 48, 4, 333-337. https://doi.org/10.1136/jech.48.4.333

Bebbington, P. (Ed.) (1991) Social Psychiatry: Theory, methodology, and practice. New Brunswick: Transaction publishers.

Bebbington, P.E. (2010) Why psychiatry has to be social. in Principles of Social Psychiatry. New Jersey: John Wiley & Sons, Ltd (pp.13-29). https://doi.org/10.1002/9780470684214.ch2

Becker, D.R., and Drake, RE. (1993) A Working Life: The individual placement and support (IPS) program. Concord, NH: Dartmouth Psychiatric Research Center.

Benach, J., Vives, A., Amable, M., Vanroelen, C., Tarafa, G. and Muntaner, C. (2014) Precarious employment: Understanding an emerging social determinant of health. Annual Review of Public Health, 35, 1, 229-253. https://doi.org/10.1146/annurev-publhealth-032013-182500

Boardman, J. (2020) Dismantling the social safety net: Social security reforms, disability and mental health conditions. BJPsych Bulletin, 44, 5, 208-212. https://doi.org/10.1192/bjb.2020.79

Boardman, J. and Rinaldi, M. (2013) Difficulties in implementing supported employment for people with severe mental health problems. British Journal of Psychiatry, 203, 4, 247-249. https://doi.org/10.1192/bjp.bp.112.121962

Boardman, J., Currie, A., Killaspy, H. and Mezey, G. (2010) Social Inclusion and Mental Health. London: RCPsych Publications.

Boardman, J., Killaspy, H. and Mezey, G. (2022) Social Inclusion and Mental Health: Understanding poverty, inequality and social exclusion. Cambridge : Cambridge University Press. RCPsych publications.

Bond, N. and D’Arcy, C. (2020) Mind the income gap. Money and Mental Health Policy Institute, 13.

Bourdieu, P. (1989) Social space and symbolic power. Sociological Theory, 7, 1, 14-25. https://doi.org/10.2307/202060

Bramley, G., Fitzpatrick, S., Edwards, J., Ford, D., Johnsen, S., Sosenko, F. and Watkins, D. (2015) Hard Edges. Mapping severe and multiple disadvantage. London: Lankelly Chase.

Burchardt, T., Le Grand, J. and Piachaud, D. (2002) Degrees of Exclusion: Developing a dynamic, multidimensional measure. New York: Oxford University Press (pp.30-43).

Burchardt, T., Le Grand, J. & Piachaud, D. (2002b) Degrees of exclusion: Developing a dynamic, multidimensional measure. in Understanding Social Exclusion (Eds. J. Hills, J. Le Grand & D. Piachaud). Oxford: Oxford University Press, pp. 30–43.

Butterworth, P., Leach, L.S., Strazdins, L., Olesen, S.C., Rodgers, B. and Broom, D.H. (2011) The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey. Occupational and Environmental Medicine, 68, 11, 806-812. https://doi.org/10.1136/oem.2010.059030

Campion, J. (2019) Public mental health: Evidence, practice and commissioning. Royal Society for Public Health.

Campion, J., Javed, A., Sartorius, N. and Marmot, M. (2020) Addressing the public mental health challenge of COVID-19. The Lancet Psychiatry, 7, 8, 657-659. https://doi.org/10.1016/S2215-0366(20)30240-6

Connell, J., Brazier, J., O’Cathain, A., Lloyd-Jones, M. and Paisley, S. (2012) Quality of life of people with mental health problems: A synthesis of qualitative research. Health and Quality of Life Outcomes, 10, 1, 138. https://doi.org/10.1186/1477-7525-10-138

Crowther, R.E., Marshall, M., Bond, G.R. and Huxley, P. (2001a) Helping people with severe mental illness to obtain work: systematic review. BMJ, 322, 7280, 204-208. https://doi.org/10.1136/bmj.322.7280.204

Crowther, R., Marshall, M., Bond, G. and Huxley, P. (2001b) Vocational rehabilitation for people with severe mental illness. Cochrane Database of Systematic Reviews, 2001, 2, CD003080-CD003080. https://doi.org/10.1002/14651858.CD003080

Danley, K. S., & Anthony, W. A. (1987). The choose–get–keep model: Serving severely psychiatrically disabled people. American Rehabilitation. 13; 4, 27–29

Delgadillo, J., Asaria, M., Ali, S. and Gilbody, S. (2016) On poverty, politics and psychology: the socioeconomic gradient of mental healthcare utilisation and outcomes. British Journal of Psychiatry, 209, 5, 429-430. https://doi.org/10.1192/bjp.bp.115.171017

Desjarlais, R., Eisenberg, L., Good, B. and Kleinman, A. (1995) World Mental Health: Problems and priorities in low-income countries. New York: Oxford Universoty Press.

De Witte, H., Jaco Pienaar, J., De Cuyper, N. (2016) Review of 30 Years of Longitudinal Studies on the Association Between Job Insecurity and Health and Well-Being: Is There Causal Evidence? Australian Psychologist, 51, 18–31.

Dohrenwend, B.P. (1990) Socioeconomic status (SES) and psychiatric disorders: Are the issues still compelling?. Social Psychiatry and Psychiatric Epidemiology, 25, 1, 41-47.

Dooley, D., Catalano, R. and Wilson, G. (1994) Depression and unemployment: Panel findings from the Epidemiologic Catchment Area study. American Journal of Community Psychology, 22, 6, 745-765. https://doi.org/10.1007/BF02521557

Drake, R.E., McHugo, G.J., Becker, D.R., Anthony, W.A. and Clark, R.E. (1996) The new Hampshire study of supported employment for people with severe mental illness. Journal of Consulting and Clinical Psychology, 64, 2, 391-399. https://doi.org/10.1037/0022-006X.64.2.391

DWP (2016) Improving Lives: The Work, Health and Disability Green Paper. https://www.gov.uk/government/statistics/work-health-and-disability-green-paper-data-pack. Accessed 26 February 202

Eliason, M. and Storrie, D. (2009) Job loss is bad for your health – Swedish evidence on cause-specific hospitalization following involuntary job loss. Social Science & Medicine, 1982, 68, 8, 1396-1406. https://doi.org/10.1016/j.socscimed.2009.01.021

Ernst, W. (2016) Work, psychiatry and society, c. 1750–2015. in Work, Psychiatry and Society, C. 1750-2015. Manchester: Manchester University Press.

Faris, R.E.L., and Dunham, H.W. (1939) Mental Disorders in Urban Areas: An ecological study of schizophrenia and other psychoses. Chicago Ill: Chicago University Press. https://doi.org/10.2307/2852039

Farré, L., Fasani, F. and Hannes, M. (2018) Feeling useless: The effect of unemployment on mental health in the Great Recession. IZA Journal of Labor Economics, 7, 8, 1-34. https://doi.org/10.1186/s40172-018-0068-5

Fitzpatrick, S., Bramley, G. and Johnsen, S. (2013) Pathways into Multiple Exclusion Homelessness in Seven UK Cities. Urban Studies, 50, 1, 148-168. https://doi.org/10.1177/0042098012452329

Flint, E., Bartley, M., Shelton, N. and Sacker, A. (2013) Do labour market status transitions predict changes in psychological well-being? Journal of Epidemiology and Community Health (1979), 67, 9, 796-802. https://doi.org/10.1136/jech-2013-202425

Fryers, T., Melzer, D. and Jenkins, R. (2003) Social inequalities and the common mental disorders - A systematic review of the evidence. Social Psychiatry and Psychiatric Epidemiology, 38, 5, 229-237. https://doi.org/10.1007/s00127-003-0627-2

Garrard, G. (2022) The Return of the State: And why it is essential for our health, wealth and happiness. London: Yale University Press.

Gilbert, E., Marwaha, S., Milton, A., Johnson, S., Morant, N., Parsons, N., Fisher, A., Singh, S. and Cunliffe, D. (2013) Social firms as a means of vocational recovery for people with mental illness: A UK survey. BMC Health Services Research, 13, 1, 270. https://doi.org/10.1186/1472-6963-13-270

Goldberg, D. and Huxley, P. (1983) Mental illness in the community: The pathway to psychiatric care. International Journal of Rehabilitation Research, 6, 1, 127. https://doi.org/10.1097/00004356-198303000-00021

Harvey, S.B., Sellahewa, D.A., Wang, M.-J., Milligan-Saville, J., Bryan, B.T., Henderson, M., Hatch, S.L. and Mykletun, A. (2018) The role of job strain in understanding midlife common mental disorder: a national birth cohort study. The Lancet. Psychiatry, 5, 6, 498-506. https://doi.org/10.1016/S2215-0366(18)30137-8

Hatch, S.L. and March, D. (2010) Concepts and challenges in capturing dynamics of the wider social environment. in Principles of Social Psychiatry. New York: John Wiley & Sons, Ltd (pp.65-76). https://doi.org/10.1002/9780470684214.ch6

Henderson, A. S. (1988) An Introduction to Social Psychiatry. New York: Oxford University Press.

Huxley, P. and Poole, R. (2023) Social psychiatry lives. BJPsych Bulletin, 47, 2, 65-67. https://doi.org/10.1192/bjb.2022.77

Huxley, P. and Thornicroft, G. (2003) Social inclusion, social quality and mental illness. British Journal of Psychiatry, 182, 4, 289-290. https://doi.org/10.1192/bjp.182.4.289

Huxley, P., Evans, S., Madge, S., Webber, M., Burchardt, T., McDaid, D. and Knapp, M. (2012) Development of a social inclusion index to capture subjective and objective life domains (Phase II): Psychometric development study. Health Technology Assessment, 16, 1, 1-248. https://doi.org/10.3310/hta16010

Huxley, P. J., Chan, K., Chiu, M., Ma, Y., Gaze, S. and Evans, S. (2016) The social and community opportunities profile social inclusion measure: Structural equivalence and differential item functioning in community mental health residents in Hong Kong and the United Kingdom. International Journal of Social Psychiatry, 62, 2, 133-140.

International Labour Organization (2015). World employment and social outlook. The changing nature of jobs. Geneva: International Labour Office. https://www.ilo.org/publications/world-employment-and-social-outlook-2015-changing-nature-jobs. Accessed 26 February 2025.

International Labour Office (2019) World Employment and Social Outlook: Trends 2019. Geneva: International Labour Office.

International Labour Organization. (2015) World Employment Social Outlook. World employment and social outlook 2015: The changing nature of jobs. International Labor Office.

Jablensky, A. (1990) Public health aspects of social psychiatry. in The Public Health Impact of Mental Disorder. Toronto: Hogrefe & Huber (pp.5-13).

Jablensky, A. (1999) Psychiatric Epidemiology and the Global Public Health Agenda: Mental health as a global public health problem. International Journal of Mental Health, 28, 2, 6-14. https://doi.org/10.1080/00207411.1999.11449450

Jarvis, E. (1971) Insanity and Idiocy in Massachusetts: Report of the commission on lunacy, 1855. Cambridge, MA: Harvard University Press.

Jin, R. L., Shab, C. P. and Svoboda, T. J. (1995) The impact of unemployment on health: A review of the evidence. Canadian Medical Association Journal, 153, 5, 529-540.

Joelson, L. and Wahlquist, L. (1987) The psychological meaning of job insecurity and job loss: Results of a longitudinal study. Social Science & Medicine, 1982, 25, 2, 179-182. https://doi.org/10.1016/0277-9536(87)90386-8

Joseph Rowntree Foundation (2017) UK Poverty 2017. A Comprehensive Analysis of Poverty Trends and Figures. JRF https://www.jrf.org.uk/report/uk-poverty-2017# Accessed 26 February 2025

Kleinman, A., Das, V. and Lock, M. M. (Eds.). (1997) Social Suffering. California: Univ of California Press.

Leamy, M., Bird, V., Boutillier, C. L., Williams, J. and Slade, M. (2011) Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry, 199, 6, 445-452. https://doi.org/10.1192/bjp.bp.110.083733

Leff, J. (2010) The historical development of social psychiatry. in Principles of Social Psychiatry. New York: John Wiley & Sons, Ltd (pp.1-11). https://doi.org/10.1002/9780470684214.ch1

Luchenski, S., Maguire, N., Aldridge, R. W., Hayward, A., Story, A., Perri, P., Withers, J., Clint, S., Fitzpatrick, S. and Hewett, N. (2018) What works in inclusion health: overview of effective interventions for marginalised and excluded populations. The Lancet, 391, 10117, 266-280. https://doi.org/10.1016/S0140-6736(17)31959-1

Luciano, A. and Meara, E. (2014) Employment status of people with mental illness: national survey data from 2009 and 2010. Psychiatric Services, 65, 10, 1201-1209.

Marmot, M. (2015) The health gap: the challenge of an unequal world. The Lancet, 386, 10011, 2442-2444.

Marmot, M. (2018) Inclusion health: addressing the causes of the causes. The Lancet, 391, 10117, 186-188.

Marmot, M., Allen, J., Goldblatt, P., Herd, E., & Morrison, J. (2020). Build Back Fairer: The COVID-19 Marmot Review. The Pandemic, Socioeconomic and Health Inequalities in England. London: Institute of Health Equity.

Marmot Review Team (2010) Fair Society, Healthy Lives: Strategic review of health inequalities in England post-2010. London: Marmot Review Team.

Marwaha, S. and Johnson, S. (2004) Schizophrenia and employment: a review. Social Psychiatry and Psychiatric Epidemiology, 39, 337-349.

Marwaha, S., Johnson, S., Bebbington, P., Stafford, M., Angermeyer, M. C., Brugha, T., Azorin, J.-M., Kilian, R., Hansen, K. and Toumi, M. (2007) Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. British Journal of Psychiatry, 191, 1, 30-37. https://doi.org/10.1192/bjp.bp.105.020982

Marwaha, S., Durrani, A. and Singh, S. (2013) Employment outcomes in people with bipolar disorder: a systematic review. Acta Psychiatrica Scandinavica, 128, 3, 179-193. https://doi.org/10.1111/acps.12087

McCartney, G., Popham, F., McMaster, R. and Cumbers, A. (2019) Defining health and health inequalities. Public Health, 172, 22-30. https://doi.org/10.1016/j.puhe.2019.03.023

McManus, S., Bebbington, P. E., Jenkins, R. and Brugha, T. (2016) Mental Health and Wellbeing in England: The adult psychiatric morbidity survey 2014. NHS Digital.

Montgomery, S. M., Cook, D. G., Bartley, M. J. and Wadsworth, M. E. J. (1999) Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men. International Journal of Epidemiology, 28, 1, 95-100. https://doi.org/10.1093/ije/28.1.95

Morgan, C. & Bhugra, D. (Eds.) (2010) Principles of Social Psychiatry, (2nd ed.) Chichester: Wiley-Blackwell.

Morgan, C. and Kleinman, A. (2010) Social science perspectives: A failure of the sociological imagination. in Principles of Social Psychiatry. New York: John Wiley & Sons, Ltd (pp.51-64). https://doi.org/10.1002/9780470684214.ch5

OCDE, O. (2014) Mental Health and Work: United Kingdom. OECD Publications Centre.

Platt, S., Stace, S. and Morrissey, J. (2017) Dying from Inequality: Socioeconomic disadvantage and suicidal behaviour. Samaritans: London.

Priebe, S., Burns, T. and Craig, T. K. J. (2013) The future of academic psychiatry may be social. British Journal of Psychiatry, 202, 5, 319-320. https://doi.org/10.1192/bjp.bp.112.116905

Public Health England (2015) Local Action on Health Inequalities. Promoting good quality jobs to reduce health inequalities. London: Public Health England.

Rose, N. (2016) Neuroscience and the future for mental health?. Epidemiology and Psychiatric Sciences, 25, 2, 95-100. https://doi.org/10.1017/S2045796015000621

Royal College of Psychiatrists (2002) Employment opportunities and psychiatric disability. in Council Report CR111. London: Royal College of Psychiatrists.

Royal College of Psychiatrists (2013) Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health. in Occasional Paper OP88. London: Royal College of Psychiatrists. https://www.drugsandalcohol.ie/19579/

Rudkjoebing, L. A., Bungum, A. B., Flachs, E. M., Eller, N. H., Borritz, M., Aust, B., Rugulies, R., Rod, N. H., Biering, K. and Bonde, J. P. (2020) Work-related exposure to violence or threats and risk of mental disorders and symptoms: a systematic review and meta-analysis. Scandinavian Journal of Work, Environment & Health, 46, 4, 339-349. https://doi.org/10.5271/sjweh.3877

Santos, J. C. dos, Barros, S., and Huxley, P. J. (2018) Social inclusion of the people with mental health issues: Compare international results. International Journal of Social Psychiatry, 64, 4,344-350. https://doi.org/10.1177/0020764018763941

Scambler, G. (2018) Heaping blame on shame:‘Weaponising stigma’for neoliberal times. The Sociological Review, 66, 4, 766-782. https://doi.org/10.1177/0038026118778177

Sen, A. (2000) Social Exclusion: Concept, application, and scrutiny. Manila: Office of Environment and Social Development, Asian Development Bank.

Smith, G. D. (2011) Epidemiology, epigenetics and the “Gloomy Prospect”: embracing randomness in population health research and practice. International Journal of Epidemiology, 40, 3, 537-562. https://doi.org/10.1093/ije/dyr117

Stein, L. I. and Test, M. A. (1980) Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 4, 392-397. https://doi.org/10.1001/archpsyc.1980.01780170034003

Strandh, M. (2000) Different exit routes from unemployment and their impact on mental well-being: the role of the economic situation and the predictability of the life course. Work, Employment and Society, 14, 3, 459-479. https://doi.org/10.1017/S0950017000000271

Tinson, A. (2020) What the Quality of Work Means for Our Health. London: The Health Foundation. https://www.health.org.uk/infographic/how-is-work-good-for-our-health

TUC (2018) 1 in 9 workers are in insecure jobs, says TUC. [Accessed 18 October 2020 at https://www.tuc.org.uk/news/1-9-workers-are-insecure-jobs-says-tuc]

Uher, R. and Zwicker, A. (2017) Etiology in psychiatry: embracing the reality of poly‐gene‐environmental causation of mental illness. World Psychiatry, 16, 2, 129. https://doi.org/10.1002/wps.20436

van Bergen, A.P., Wolf, J.R., Badou, M., de Wilde-Schutten, K., IJzelenberg, W., Schreurs, H.,... and van Hemert, A.M. (2018) The association between social exclusion or inclusion and health in EU and OECD countries: a systematic review. European journal of public health, 29, 3, 575-582.

Virtanen, M., Kivimäki, M., Joensuu, M., Virtanen, P., Elovainio, M. and Vahtera, J. (2005) Temporary employment and health: a review. International Journal of Epidemiology, 34, 3, 610-622. https://doi.org/10.1093/ije/dyi024

Voss, M., Nylen, L., Floderus, B., Diderichsen, F. and Terry, P. D. (2004) Unemployment and Early Cause-Specific Mortality: A Study Based on the Swedish Twin Registry. American Journal of Public Health, 1971, 94, 12, 2155-2161. https://doi.org/10.2105/AJPH.94.12.2155

Warner, R. (2013) Recovery from Schizophrenia: Psychiatry and political economy. Abingdon: Routledge.

Warr, P. (1987) Work, Unemployment and Mental Health. Oxford: Oxford University Press.

Weich, S. and Lewis, G. (1998) Poverty, unemployment, and common mental disorders: population based cohort study. Bmj, 317, 7151, 115-119. https://doi.org/10.1136/bmj.317.7151.115

Whiteford, H. A., Ferrari, A. J., Degenhardt, L., Feigin, V. and Vos, T. (2015) The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PloS one, 10, 2, e0116820.

Wilkinson, Iain. (2005) Suffering: A sociological introduction. Bristol: Polity.

Wing, J. K. (1980) Innovations in social psychiatry1. Psychological Medicine,10, 2, 219-230. https://doi.org/10.1017/S0033291700043981

Wing, J. K. (1991) Social psychiatry. In Social Psychiatry: Theory, Methodology, and Practice (Ed. P. E. Bebbington). London: Transaction Publishers, pp. 3–22

Wing, J.K & Brown, G.W. (1970) Institutionalism and Schizophrenia. Cambridge. Cambridge University Press

Winkelmann, L. and Winkelmann, R. (1998) Why are the unemployed so unhappy? Evidence from panel data. Economica, 65, 257, 1-15. https://doi.org/10.1111/1468-0335.00111

World Health Organisation (2010) Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. Geneva: World Health Organisation.

Wright Mills, C. (2000) The Sociological Imagination. Oxford University Press. (originally published 1959).

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Published

2025-08-29

How to Cite

Boardman, J. (2025). Becoming socially included. Social Work and Social Sciences Review, 25(3). https://doi.org/10.1921/swssr20252508