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Social exclusion of people with severe mental illness in Switzerland: results from the Swiss Health Survey

  • D. Richter (a1) (a2) and H. Hoffmann (a1) (a3)
Abstract
Aims.

People with severe mental illness (SMI) have a high risk of living socially excluded from the mainstream society. Policy initiatives and health systems aim to improve the social situation of people who suffer from mental health disabilities. The aim of this study was to explore the extent of social exclusion (employment and income, social network and social activities, health problems) of people with SMI in Switzerland.

Methods.

Data from the Swiss Health Survey 2012 were used to compare the social exclusion magnitude of people with SMI with those suffering from severe physical illness, common mental illness and the general population.

Results.

With the exception of Instrumental Activities of Daily Living, we found a gradient of social exclusion that showed people with SMI to be more excluded than the comparison groups. Loneliness and poverty were widespread among people with SMI. Logistic regression analyses on each individual exclusion indicator revealed that people with SMI and people with severe physical illness were similarly excluded on many indicators, whereas people with common mental illness and the general population were much more socially included.

Conclusions.

In contrast to political and health system goals, many people with SMI suffer from social exclusion. Social policy and clinical support should increase the efforts to counter exclusionary trends, especially in terms of loneliness and poverty.

Copyright
Corresponding author
*Author for correspondence: Dirk Richter, University Bern Psychiatric Services, Centre for Psychiatric Rehabilitation, Murtenstrasse 46, CH-3008 Bern, Switzerland. (Email: dirk.richter@upd.unibe.ch)
References
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Baer, N, Frick, U, Fasel, T (2009). Dossieranalyse der Invalidisierungen aus psychischen Gründen/Case analyses of disability pensions due to mental health issues (in German). Bundesamt für Sozialversicherungen/Federal Office of Social Security: Bern.
Baumgartner, JN, Burns, JK (2014). Measuring social inclusion--a key outcome in global mental health. International Journal of Epidemiology 43, 354364.
Baumgartner, JN, Susser, E (2013). Social integration in global mental health: what is it and how can it be measured? Epidemiology and Psychiatric Sciences 22, 2937.
Breslau, J, Miller, E, Jin, R, Sampson, NA, Alonso, J, Andrade, LH, Bromet, EJ, de Girolamo, G, Demyttenaere, K, Fayyad, J, Fukao, A, Galaon, M, Gureje, O, He, Y, Hinkov, HR, Hu, C, Kovess-Masfety, V, Matschinger, H, Medina-Mora, M E, Ormel, J, Posada-Villa, J, Sagar, R, Scott, KM, Kessler, RC (2011). A multinational study of mental disorders, marriage, and divorce. Acta Psychiatrica Scandinavica 124, 474486.
Bundesamt für Statistik/Federal Statistical Office (2014). Armut in der Schweiz/Poverty in Switzerland (in German). Bundesamt für Statistik: Neuchatel.
Chakravarty, SR, D'Ambrosio, C (2006). The measurement of social exclusion. Review of Income and Wealth 3, 377398.
Coombs, T, Nicholas, A, Pirkis, J (2013). A review of social inclusion measures. Australian and New Zealand Journal of Psychiatry 47, 906919.
Dalgard, OS, Bjork, S, Tambs, K (1995). Social support, negative life events and mental health. British Journal of Psychiatry 166, 2934.
Davidson, M, Kapara, O, Goldberg, S, Yoffe, R, Noy, S, Weiser, M (2016). A nation-wide study on the percentage of schizophrenia and bipolar disorder patients who earn minimum wage or above. Schizophrenia Bulletin 42, 443447.
de Girolamo, G, Picardi, A, Santone, G, Falloon, I, Morosini, P, Fioritti, A, Micciolo, R, Group, P (2005). The severely mentally ill in residential facilities: a national survey in Italy. Psychological Medicine 35, 421431.
Doherty, AM, Gaughran, F (2014). The interface of physical and mental health. Social Psychiatry and Psychiatric Epidemiology 49, 673682.
Evans-Lacko, S, Courtin, E, Fiorillo, A, Knapp, M, Luciano, M, Park, A L, Brunn, M, Byford, S, Chevreul, K, Forsman, AK, Gulacsi, L, Haro, JM, Kennelly, B, Knappe, S, Lai, T, Lasalvia, A, Miret, M, O'Sullivan, C, Obradors-Tarrago, C, Rusch, N, Sartorius, N, Svab, V, van Weeghel, J, Van Audenhove, C, Wahlbeck, K, Zlati, A, Consortium, R, McDaid, D, Thornicroft, G (2014). The state of the art in European research on reducing social exclusion and stigma related to mental health: a systematic mapping of the literature. European Psychiatry 29, 381389.
Evensen, S, Wisloff, T, Lystad, JU, Bull, H, Ueland, T, Falkum, E (2016). Prevalence, employment rate, and cost of schizophrenia in a high-income welfare society: a population-based study using comprehensive health and welfare registers. Schizophrenia Bulletin 42, 476483.
Fakhoury, WK, Priebe, S & PLAO Study Group (2006). An unholy alliance: substance abuse and social exclusion among assertive outreach patients. Acta Psychiatrica Scandinavica 114, 124131.
Gaebel, W, Kowitz, S, Fritze, J, Zielasek, J (2013). Use of health care services by people with mental illness: secondary data from three statutory health insurers and the German Statutory Pension Insurance Scheme. Deutsches Ärzteblatt International 110, 799808.
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388, 15451602.
Gill, KJ, Swarbrick, M, Murphy, AA, Spagnolo, AB, Zechner, MR (2009). Co-morbid psychiatric and medical disorders: challenges and strategies. Journal of Rehabilitation 75, 2340.
Heinz, A, Müller, S, Wackerhagen, C, Sartorius, N (2015). Inclusion as the goal of psychiatric care - impact of the UN convention on the rights of persons with disabilities. Ethics in Medicine and Public Health 1, 300305.
Hoffmann, H, Jackel, D, Glauser, S, Mueser, KT, Kupper, Z (2014). Long-term effectiveness of supported employment: 5-year follow-up of a randomized controlled trial. The American Journal of Psychiatry 171, 11831190.
Jenkins, R, Bhugra, D, Bebbington, P, Brugha, T, Farrell, M, Coid, J, Fryers, T, Weich, S, Singleton, N, Meltzer, H (2008). Debt, income and mental disorder in the general population. Psychological Medicine 38, 14851493.
Kessler, RC, Walters, EE, Forthofer, MS (1998). The social consequences of psychiatric disorders, III: probability of marital stability. American Journal of Psychiatry 155, 10921096.
Killaspy, H, White, S, Lalvani, N, Berg, R, Thachil, A, Kallumpuram, S, Nasiruddin, O, Wright, C, Mezey, G (2014). The impact of psychosis on social inclusion and associated factors. International Journal of Social Psychiatry 60, 148154.
Killaspy, H, Priebe, S, Bremner, S, McCrone, P, Dowling, S, Harrison, I, Krotofil, J, McPherson, P, Sandhu, S, Arbuthnott, M, Curtis, S, Leavey, G, Shepherd, G, Eldridge, S, King, M (2016). Quality of life, autonomy, satisfaction, and costs associated with mental health supported accommodation services in England: a national survey. Lancet Psychiatry 3, 11291137.
Kohn, R, Saxena, S, Levav, I, Saraceno, B (2004). The treatment gap in mental health care. Bulletin of the World Health Organization 82, 858866.
Lipskaya-Velikovsky, L, Jarus, T, Easterbrook, A, Kotler, M (2016). Participation in daily life of people with schizophrenia in comparison to the general population. Canadian Journal of Occupational Therapy 83, 297305.
Luciano, A, Meara, E (2014). Employment status of people with mental illness: national survey data from 2009 and 2010. Psychiatric Services 65, 12011209.
Marwaha, S, Johnson, S, Bebbington, P, Stafford, M, Angermeyer, M C, Brugha, T, Azorin, JM, Kilian, R, Hansen, K, Toumi, M (2007). Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. British Journal of Psychiatry 191, 3037.
Morgan, C, Burns, T, Fitzpatrick, R, Pinfold, V, Priebe, S (2007). Social exclusion and mental health: conceptual and methodological review. British Journal of Psychiatry 191, 477483.
Muntaner, C, Eaton, WW, Miech, R, O'Campo, P (2004). Socioeconomic position and major mental disorders. Epidemiologic Reviews 26, 5362.
Parabiaghi, A, Bonetto, C, Ruggeri, M, Lasalvia, A, Leese, M (2006). Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions. Social Psychiatry and Psychiatric Epidemiology 41, 457463.
R Core Team (2016). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna.
Repper, J, Perkins, R (2003). Social Inclusion and Recovery: A Model for Mental Health Practice. Ballière Tindall: Edinburgh.
Richter, D (2010). Evaluation des stationären und ambulant betreuten Wohnens psychisch behinderter Menschen in den Wohnverbünden des Landschaftsverbands Westfalen-Lippe. Psychiatrische Praxis 37, 127133.
Richter, D, Hoffmann, H (2017). Preference for independent housing of persons with mental disorders: systematic review and meta-analysis. Administration and Policy in Mental Health 44, 817823.
Richter, D, Eikelmann, B, Reker, T (2006). Arbeit, Einkommen, Partnerschaft: Die soziale Exklusion psychisch Kranker. Gesundheitswesen 68, 704707.
Rimmerman, A (2013). Social Inclusion of People with Disabilities: National and International Perspectives. Cambridge UP: New York.
Ruggeri, M, Leese, M, Thornicroft, G, Bisoffi, G, Tansella, M (2000). Definition and prevalence of severe and persistent mental illness. British Journal of Psychiatry 177, 149155.
Sayce, L (2001). Social inclusion and mental health. Psychiatric Bulletin 25, 121123.
Schinnar, AP, Rothbard, AB, Kanter, R, Jung, YS (1990). An empirical literature review of definitions of severe and persistent mental illness. American Journal of Psychiatry 147, 16021608.
Sibitz, I, Amering, M, Unger, A, Seyringer, ME, Bachmann, A, Schrank, B, Benesch, T, Schulze, B, Woppmann, A (2011). The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. European Psychiatry 26, 2833.
Social Exclusion Unit (2004). Mental Health and Social Exclusion. Office of the Deputy Prime Minister: London.
Todd, J, Green, G, Harrison, M, Ikuesan, BA, Self, C, Pevalin, DJ, Baldacchino, A (2004). Social exclusion in clients with comorbid mental health and substance misuse problems. Social Psychiatry and Psychiatric Epidemiology 39, 581587.
van Bergen, AP, Hoff, SJ, van Ameijden, EJ, van Hemert, AM (2014). Measuring social exclusion in routine public health surveys: construction of a multidimensional instrument. PLoS ONE 9, e98680.
Wang, Y, Henriksen, CA, Ten Have, M, de Graaf, R, Stein, MB, Enns, MW, Sareen, J (2017). Common mental disorder diagnosis and need for treatment are not the same: findings from the NEMESIS study. Administration and Policy in Mental Health 44, 572581.
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Epidemiology and Psychiatric Sciences
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