Skip to main content Accessibility help
×
Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-18T00:33:07.328Z Has data issue: false hasContentIssue false

Chapter 15 - Social Exclusion in Specific Social Groups and Individuals with Mental Health Conditions

from Section 2 - Participation of People with Mental Health Conditions

Published online by Cambridge University Press:  24 November 2022

Jed Boardman
Affiliation:
King's College London
Helen Killaspy
Affiliation:
University College London
Gillian Mezey
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

This chapter examines the ways in which people with mental health conditions who also belong to other excluded groups may be particularly disadvantaged, in general and by mental health services. People with mental health conditions are at risk of social exclusion, but many from certain social identity groups are particularly at risk: for example, women, people from black and minority ethnic groups, and those from sexual minorities. In addition, certain groups of people are defined by their exclusion from society, such as refugees and asylum seekers, prisoners, and the homeless. The occurrence of mental health conditions in these groups is much higher than in the general population and they will often face barriers to accessing essential material resources and adequate healthcare. The presence of mental health conditions and group characteristics intersect to exacerbate the degree of exclusion experienced by the people in these groups. Some combinations may result in particularly profound states of deprivation and destitution. These severe and multiple forms of exclusion have been named ‘deep social exclusion’ or ‘people with multiple and complex needs’, two examples of which are seen in ‘multiple exclusion homelessness’ and people with multiple diagnoses.

Type
Chapter
Information
Social Inclusion and Mental Health
Understanding Poverty, Inequality and Social Exclusion
, pp. 299 - 320
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agar, K. & Read, J. (2002) What happens when people disclose sexual or physical abuse to staff at a community mental health centre? International Journal of Mental Health Nursing, 11, 70–9.CrossRefGoogle ScholarPubMed
Aldridge, R. W., Story, A., Hwang, S. W., et al. (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. Lancet 391, 241–50.Google Scholar
Amnesty International UK (2005) Seeking Asylum is not a Crime: Detention of People Who Have Sought Asylum. Amnesty International.Google Scholar
Bacchus, L., Mezey, G. and Bewley, S. (2003) Experiences of seeking help from health professionals in a sample of women who experienced domestic violence. Health & Social Care in the Community, 11, 1018.CrossRefGoogle Scholar
Bartlett, A., King, M. & Phillips, P. (2001) Straight talking: An investigation of the attitudes and practice of psychoanalysts and psychotherapists in relation to gays and lesbians. British Journal of Psychiatry, 179, 545–9.Google Scholar
Barnett, P., Mackay, E., Matthews, H, et al. (2019) Ethnic variations in compulsory detention under the Mental Health Act: A systematic review and meta-analysis of international data. The Lancet Psychiatry 6, 4, 305–17.CrossRefGoogle ScholarPubMed
Bebbington, P., Jakobowitz, S., McKenzie, N. et al. (2017) Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder. Social Psychiatry Psychiatric Epidemiology 52, 2, 221–9.CrossRefGoogle ScholarPubMed
Bhugra, D., Eckstrand, K., Levounis, P. et al. (2016) WPA position statement on gender identity and same-sex orientation, attraction and behaviours. World Psychiatry, 15, 3, 299300.CrossRefGoogle ScholarPubMed
Bhugra, D. & King, M. B. (1989) Controlled comparison of attitudes of psychiatrists, general practitioners, homosexual doctors and homosexual men to male homosexuality. Journal of the Royal Society of Medicine, 82, 603–5.Google Scholar
Bhui, K. & McKenzie, K. (2008) Rates and risk factors by ethnic group for suicides within a year of contact with mental health services. Psychiatric Services, 59, 414–20.CrossRefGoogle ScholarPubMed
Bhui, K., Stansfeld, S., Hull, S., et al. (2003) Ethnic variations in pathways to and use of specialist mental health services in the UK: Systematic review. British Journal of Psychiatry, 182, 105–16.CrossRefGoogle ScholarPubMed
Bignall, T., Jeraj, S., Helsby, E. et al. (2019) Racial Disparities in Mental Health: Literature and Evidence Review. Race Equality Foundation.Google Scholar
Bines, W. (1994) Health of Single Homeless People. Centre for Housing Policy, University of York.Google Scholar
Bloor, R., Crome, I., Astari, A., et al. (2007) Service Responses and Outcomes for Adults Described as Having Chaotic Lives and Multiple Needs. A Scoping Exercise. Clinical Effectiveness Support Unit and Keele University.Google Scholar
Brooker, C., Gojkovic, D. & Shaw, J. (2008) The 2nd National Survey of Prison In-Reach. Report to the Department of Health. Department of Health.Google Scholar
Butler, P. & Kousoulou, D. (2006) Women at Risk: The Mental Health of Women in Contact with the Judicial System. Care Services Improvement Partnership.Google Scholar
Campbell, J. (2002) Health consequences of intimate partner violence. Lancet, 359, 1331–6.Google Scholar
Care Quality Commission (2018). Sexual Safety on Mental Health Wards, Care Quality Commission, 2018. www.cqc.org.uk/sites/default/files/20180911c_sexualsafetymh_report.pdf.Google Scholar
Care Quality Commission, National Mental Health Development Unit (2010) Count Me in 2009.Results of the 2009 National Census of Inpatients and Patients on Supervised Community Treatment in Mental Health and Learning Disability Services in England and Wales. Care Quality Commission.Google Scholar
Cascardi, M., Mueser, K. T., DeGiralomo, J., et al. (1996) Physical aggression against psychiatric inpatients by family members and partners. Psychiatric Services, 47, 531–3.Google Scholar
CEMACH (2007) Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer, 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH.Google Scholar
Chaimowitz, G. A. (1991) Homophobia among psychiatric residents, family practice residents and psychiatric faculty. Canadian Journal of Psychiatry, 36, 206–9.Google Scholar
Corston, Baroness Jean (2007) The Corston Report: A Review of Women with Particular Vulnerabilities in the Criminal Justice System. Home Office.Google Scholar
Craig, T., Bayliss, E., Klein, O., et al. (1995) The Homeless Mentally Ill Initiative. Department of Health.Google Scholar
Craig, T. & Timms, P. W. (1992) Out of the wards and onto the streets? Deinstitutionalization and homelessness in Britain. Journal of Mental Health, 1, 265–75.Google Scholar
Cullum., S., O’Brien, S., Burgess, A., et al. (1995) Deliberate self-harm: The hidden population. Health Trends, 27, 130–2.Google ScholarPubMed
Dean, R. & Craig, T. (1999) Pressure Points: Why People with Mental Health Problems become Homeless. Crisis.Google Scholar
Department for Health and Social Care (2019) Independent Review of the Mental Health Act 1983. DHSC, 2019.Google Scholar
Diaz-Caneja, A. & Johnson, S. (2004) The views and experiences of severely mentally ill mothers: A qualitative study. Social Psychiatry and Psychiatric Epidemiology, 39, 472–82.Google Scholar
Dienemann, J., Boyle, E., Baker, D., et al. (2000) Intimate partner abuse among women diagnosed with depression. Issues Mental Health Nursing, 21, 499513.Google Scholar
Equality and Human Rights Commission (2016) England’s most disadvantaged groups: Migrants, refugees and asylum seekers. An Is England Fairer? review spotlight report (4 of 4). EHRC, 2016.Google Scholar
Evans, J. K., Bingham, J. S., Pratt, K., et al. (1993) Attitudes of medical students to HIV and AIDS. Genitourinary Medicine, 69, 377–80.Google ScholarPubMed
Fazel, M. & Silove, D. (2006) Detention of refugees. BMJ, 332, 251–2.Google Scholar
Fazel, M., Wheeler, J. & Danesh, J. (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. Lancet, 365, 1309–14.CrossRefGoogle ScholarPubMed
Fitzpatrick, S., Bramley, G., & Johnsen, S. (2013) Pathways into multiple exclusion homelessness in seven UK cities. Urban Studies 50, 1, 148–68.CrossRefGoogle Scholar
Fitzpatrick, S., Johnsen, S., & White, M. (2011) Multiple exclusion homelessness in the UK: Key patterns and intersections. Social Policy & Society 10, 4, 501–12.Google Scholar
Gill, B., Meltzer, H., Hinds, K., et al. (1996) OPCS Surveys of Psychiatric Morbidity in Great Britain: Report 7: Psychiatric Morbidity among Homeless People. HMSO.Google Scholar
Golding, J. (1997) Without Prejudice: The Mind Lesbian, Gay and Bisexual Health Awareness Research. Mind.Google Scholar
Golding, J. M. (1999) Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99132.CrossRefGoogle Scholar
Goldman, H. H. (1982) Mental illness and family burden: A public health perspective. Hospital Community Psychiatry, 33, 557–60.Google Scholar
Gorst-Unsworth, C. & Goldenberg, E. (1998) Psychological sequelae of torture and organised violence suffered by refugees from Iraq: Trauma-related factors compared with social factors in exile. British Journal of Psychiatry, 172, 90–4.Google Scholar
Harlow, B. L., Vitonis, A. F., Sparen, P., et al. (2007) Incidence of hospitalization for post-partum psychotic and bipolar episodes in women with and without prior pre-pregnancy or prenatal psychiatric hospitalizations. Archives of General Psychiatry, 64, 42–8.Google Scholar
Hassiotis, A., Gazizova, D., Akinlonu, L., et al. (2011) Psychiatric morbidity in prisoners with intellectual disabilities: Analysis of prison survey data for England and Wales. British Journal of Psychiatry, 199, 156–7.Google Scholar
Haw, C., Hawton, K., & Casey, D. (2006) Deliberate self-harm patients of no fixed abode: A study of characteristics and subsequent deaths in patients presenting to general hospital. Social Psychiatry and Psychiatric Epidemiology, 41, 918–25.Google Scholar
Hearle, J. & McGrath, J. (2000) Motherhood and schizophrenia. In Women and Schizophrenia (eds Castle, D. J., McGrath, J., & Kulkarni, J.). Cambridge University Press, pp. 7994.Google Scholar
Hearle, J., Plant, K., Jenner, L., et al. (1999) A survey of contact with offspring and assistance with child care among parents with psychotic disorders. Psychiatric Services, 50, 1354–6.CrossRefGoogle ScholarPubMed
Her Majesty’s Prison and Probation Service (2020) Youth Custody Report: March 2020. HMPPS.Google Scholar
Howard, L. M., Goss, C., Leese, M., et al. (2003) Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth. British Journal of Psychiatry, 182, 63–7.Google Scholar
Howard, L. M., Hunt, K., Seneviratne, T., et al. (2008) CAN–M: Camberwell Assessment of Need for Mothers. RCPsych Publications.Google Scholar
Howard, L. M., Kumar, R. & Thornicroft, G. (2001) Psychosocial characteristics and needs of mothers with psychiatric disorders. British Journal of Psychiatry, 178, 427–32.Google Scholar
Howard, L. M., Leese, M., Kumar, C., et al. (2002) The general fertility rate in women with psychotic disorders. American Journal of Psychiatry, 159, 991–7.Google Scholar
Howard, L. M., Thornicroft, G., Salmon, M., et al. (2004) Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units. Acta Psychiatrica Scandinavica, 110, 347–55.Google Scholar
Iverson, V. C. & Morken, G. (2004) Differences in acute psychiatric admission between asylum seekers and refugees. Nordic Journal of Psychiatry, 58, 465–70.Google Scholar
Johnson, A., Mercer, C., Erens, B., et al. (2001) Sexual behaviour in Britain: partnerships, practices and HIV risk behaviours. Lancet, 358, 1835–42.Google Scholar
Killaspy, H., Dalton, J., McNicholas, S., et al. (2000) Drayton Park, an alternative to hospital admission for women in acute mental health crisis. Psychiatric Bulletin, 24, 101–4.CrossRefGoogle Scholar
Kincaid, S, Roberts, M, Kane, E. (2019) Children of Prisoners: Fixing a Broken System. Crest Consultancy.Google Scholar
King, M. & McKeown, E. (2003) Mental Health and Social Well-being of Gay Men, Lesbians and Bisexuals in England and Wales. Mind.Google Scholar
King, M., Semlyen, J., See Tai, S., et al. (2007a) Mental Disorders, Suicide, and Deliberate Self Harm in Lesbian, Gay and Bisexual People: A Systematic Review. National Institute for Mental Health in England.Google Scholar
King, M., Semlyen, J., Killaspy, H., et al. (2007b) A Systematic Review of Research on Counselling and Psychotherapy for Lesbian, Gay, Bisexual and Transgender People. Report for British Association for Counselling.Google Scholar
Kingston University, Department for Business, Innovation and Skills, National Offender Management Service (NOMS), Policis, Kingston University and Toynbee Hall (2014). Parenting and Relationship Support Programmes for Offenders and Their Families. Policis.Google Scholar
Kirkbride, J. B., Barker, D., Cowden, F., et al. (2008) Psychoses, ethnicity and socio-economic status. British Journal of Psychiatry, 193, 1, 1824.Google Scholar
Krug, E. G., Dahlberg, L. L., Mercy, J. A., et al. (2002) World Report on Violence and Health. WHO.CrossRefGoogle ScholarPubMed
Krumm, S. & Becker, T. (2006) Subjective views of motherhood in women with mental illness: a sociological perspective. Journal of Mental Health, 15, 449–60.Google Scholar
Laban, C. J. Gernaat, H. B. P. E., & Komproe, I. H. (2004) Impact of a long term asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in the Netherlands. Journal of Nervous and Mental Diseases, 192, 843–51.CrossRefGoogle Scholar
Lader, D., Singleton, N. & Meltzer, H. (2000) Psychiatric Morbidity among Young Offenders in England and Wales. Office for National Statistics.Google Scholar
Lancaster, S. (1999) Being there: How parental mental illness can affect children. In Children of Parents with Mental Illness (ed. Cowling, V.). Australian Council for Educational Research, pp. 1433.Google Scholar
Langdon, P. E., Yaguez, L., Brown, J., et al. (2001) Who walks through the ‘revolving door’ of a British psychiatric hospital? Journal of Mental Health, 10, 525–33.Google Scholar
Leff, J. (1993) All the homeless people – where do they all come from? BMJ, 306, 669670.CrossRefGoogle ScholarPubMed
Lelliott, P. Audini, B. & Duffett, R. (2001) Survey of patients from an inner-London health authority in medium secure psychiatric care. British Journal of Psychiatry, 178, 62–6.CrossRefGoogle ScholarPubMed
Lewis, H. (2007) Destitution in Leeds. Joseph Rowntree Trust.Google Scholar
Link, B. & Phelan, J. (1995) Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 35, 8094.Google Scholar
Little, L. & Hamby, S. L. (1996) Impact of a clinician’s sexual abuse history, gender and theoretical orientation on treatment issues related to childhood sexual abuse. Professional Psychology: Research and Practice, 27, 617–25.Google Scholar
Marpasat, M. (1999) An advantage with limits: The lower risk for women of becoming homeless. Population, 54, 885932.Google Scholar
Marshal, C. & Jeered, J. L. (1992) Psychiatric morbidity in homeless British women. British Journal of Psychology, 160, 761–8.Google Scholar
McFarlane, L. (1998) Diagnosis: Homophobic. The Experiences of Lesbians, Gay Men and Bisexuals in Mental Health Services. PACE.Google Scholar
McGrath, J. J., Hearle, J., Jenner, L., et al. (1999) The fertility and fecundity of patients with psychoses. Acta Psychiatrica Scandinavica, 99, 441–6.Google Scholar
McKenzie, K. (1999) Something borrowed from the blues? BMJ, 318, 616–17.Google Scholar
McKenzie, K. (2008) Improving mental healthcare for ethnic minorities. Advances in Psychiatric Treatment, 14, 285–91.Google Scholar
McKenzie, K. & Bhui, K. (2007) Better mental healthcare for minority ethnic groups: Moving away from the blame game and putting patients first. Psychiatric Bulletin, 31, 368–9.Google Scholar
McKenzie, K., Bhui, K., Nanchahal, K., et al. (2008) Suicide rates in people of South Asian origin in England and Wales: 1993–2003. British Journal of Psychiatry, 193, 406–9.Google Scholar
Meltzer, H. (2008a) The Mental Ill-Health of Prisoners. Report for Foresight Review Mental Capital and Wellbeing: Making the Most of Ourselves in the 21st Century. State-of-Science Review: SR-B5. Government Office for Science.Google Scholar
Meltzer, H. (2008b) The Mental Ill-Health of Homeless People. Report for Foresight Review Mental Capital and Wellbeing: Making the Most of Ourselves in the 21st Century. State-of-Science Review: SR-B6. Government Office for Science.Google Scholar
Mezey, G., Hassell, Y. & Bartlett, A. (2005) Safety of women in mixed-sex and single-sex medium secure units: Staff and patient perceptions. British Journal of Psychiatry, 187, 579–82.Google Scholar
Morgan, C., Mallett, R., Hutchinson, G., et al. (2005) Pathways to care and ethnicity. 2: Source of referral and help-seeking: report from the ÆSOP study. British Journal of Psychiatry, 186, 290–6.Google ScholarPubMed
Neria, Y., Bromet, E., Carlson, G., et al. (2005) Assaultive trauma and illness course in psychotic bipolar disorder: Findings from the Suffolk County mental health project. Acta Psychiatrica Scandinavica, 111, 380–3.Google Scholar
Niven, S. & Stewart, D. (2005) Resettlement Outcomes on Release from Prison in 2003. Home Office.Google Scholar
Nugraha, I. Y. (2017). The compatibility of sexual orientation change efforts with international human rights law. Netherlands Quarterly of Human Rights, 35, 3, 176–92.Google Scholar
O’Neill, A., Casey, P. & Minton, R. (2007) The homeless mentally ill: An audit from an inner city hospital. Irish Journal of Psychological Medicine, 24, 62–6.Google ScholarPubMed
Porter, M, & Haslam, N. (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. JAMA. 3;294, 5, 602–12. https://doi.org/10.1001/jama.294.5.602. PMID: 16077055.Google Scholar
Post, R. D., Willett, A. B., Franks, R. D., et al. (1980) A preliminary report on the prevalence of domestic violence among psychiatric inpatients. American Journal of Psychiatry, 137, 974–5.Google ScholarPubMed
Read, J., van Os, J., Morrison, A. P., et al. (2005) Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330–50.Google Scholar
Richardson, J., Feder, G., Eldridge, S., et al. (2001) Women who experience domestic violence and women survivors of sexual abuse: A survey of health professionals’ attitudes and clinical practice. British Journal of General Practice, 51, 468–70.Google Scholar
Rickford, D. & Edgar, K. (2005) Troubled Inside: Responding to the Mental Health Needs of Men in Prison. https://prisonreformtrust.org.uk/publication/troubled-inside-responding-to-the-mental-health-needs-of-men-in-prison/.Google Scholar
Royal College of Psychiatrists (2002) Domestic Violence (CR102). Royal College of Psychiatrists.Google Scholar
Royal College of Psychiatrists (2014). Royal College of Psychiatrists’ statement on sexual orientation. Position Statement PS02/2014. www.rcpsych.ac.uk/pdf/PS02_2014.pdfGoogle Scholar
Rutter, M. & Quinton, D. (1984) Parental psychiatric disorder: Effects on children. Psychological Medicine, 14, 853–80.Google Scholar
Sands, R. G., Koppelman, N. & Solomon, P. (2004) Maternal custody status and living arrangements of children of women with severe mental illness. Health Social Work, 29, 317–25.Google Scholar
Schneider, J. (2007) Better Outcomes for the Most Excluded. Report for Social Exclusion Task Force, February 2007. Nottingham, Institute of Mental Health.Google Scholar
Scott, J. (1993) Homelessness and mental illness. British Journal of Psychiatry, 162, 314–24.Google Scholar
Silove, D., Steel, Z., & Mollica, R. (2001) Refugees – detention of asylum seekers: Assault on health, human rights, and social development. Lancet, 357, 1436–7.Google Scholar
Sims, J. & Victor, C. R. (1999) Mental health of the statutorily homeless population: Secondary analysis of the psychiatric morbidity surveys. Journal of Mental Health, 8, 523–32.Google Scholar
Singleton, N., Meltzer, H. & Gatward, R. (1998) Psychiatric Morbidity among Prisoners in England and Wales. Office for National Statistics.Google Scholar
Social Exclusion Unit (2002) Reducing Re-Offending by Ex-Prisoners. Office of the Deputy Prime Minister.Google Scholar
Sproston, K. & Nazroo, J. (eds.) (2002) Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) Quantitative Report. The Stationery Office.Google Scholar
Steel, Z., Silove, D., Brooks, R., et al. (2006) Impact of immigration detention and temporary protection on the mental health of refugees. British Journal of Psychiatry, 188, 5864.Google Scholar
Tacchi, M. J. & Scott, J. (1996) Characteristics of homeless women living in London hostels. Psychiatric Services, 47, 196–8.Google ScholarPubMed
Targosz, S., Bebbington, P., Lewis, G., et al. (2003) Lone mothers, social exclusion and depression. Psychological Medicine, 33, 715–22.Google Scholar
Timms, P. & Balazs, J. (1997) ABC of mental health: Mental health on the margins. BMJ, 315, 536–9.Google Scholar
Tribe, R. (2002) Mental health of refugees and asylum-seekers. Advances in Psychiatric Treatment, 8, 240–7.CrossRefGoogle Scholar
Tribe, R. & Lane, P. (2009). Working with interpreters across language and culture in mental health. Journal of Mental Health, 18, 3, 233–41.Google Scholar
Vostanis, P., Grattan, E., Cumella, S., et al. (1997) Psychosocial functioning of homeless children. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 881–9.Google ScholarPubMed
Walby, S. & Allen, J. (2004) Domestic Violence, Sexual Assault and Stalking: Findings from the British Crime Survey. Home Office Research Study 276. Home Office.Google Scholar
Wang, A. R. & Goldschmidt, V. V. (1994) Interviews of psychiatric inpatients about their family situation and young children. Acta Psychiatrica Scandinavica, 90, 459–65.Google Scholar
Williamson, M. (2006) Improving the Health and Social Outcomes of People Recently Released from Prisons in the UK: A Perspective from Primary Care. Sainsbury Centre for Mental Health.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×