Community Inclusion and the Social Determinants of Mental Health

Community inclusion can enhance health, wellness, and recovery for individuals diagnosed with serious mental disorders.

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A recent article reviews the history and development of the idea of community inclusion for people diagnosed with serious mental illnesses. The community inclusion movement articulates inclusion as a legal and human right, highlighting research showing that increased opportunities to live a meaningful life within a community “enhance general medical, cognitive, and mental health and wellness.” As the author, Mark Salzer, a professor of public health at Temple University, notes:

“It is well documented that individuals with serious mental illnesses are disadvantaged in their employment, educational attainment, social relationships, family relationships, and other areas, which are all social determinants of health.”

The movement to include people facing mental health challenges in their communities has been shown to benefit both individuals and society as a whole. Mere physical integration, however, is not sufficient to achieve a sense of stability or belonging – and supports are needed to achieve psycho-social integration.

Effective supports include, for example, arts participation, as in the Open Arts Essex program in the UK, which provided arts courses and was shown to improve well-being and social inclusion; and a befriending program that benefitted in the recovery of people with enduring mental illnesses.

Before the Americans with Disabilities Act (ADA), institutionalization was standard care for people with intellectual disability and serious mental illness. The move to “normalize” the lives of people with mental challenges, which emphasized the need for living conditions that mirrored “everyday living” as closely as possible, began in Denmark in the 1950s, when parents of institutionalized children responded to the isolation and discrimination their children faced in society.

The 1960s saw the emergence of the independent living movement, which emphasized “empowerment, choice, and control over resources among individuals with disabilities.” These movements coalesced into the disability rights movement that brought about the ADA, which required equal opportunities for disabled people to “benefit from all programs, services, and activities (e.g., education, employment, voting, transportation, recreation, etc.).” In 1999, the Supreme Court confirmed the application of the ADA to persons with serious mental illness, concluding that “unnecessary institutionalization” is a form of discrimination prohibited by the ADA.

The Department of Justice interprets the goal of the ADA as providing “individuals with disabilities opportunities to live their lives like individuals without disabilities.” This focus on opportunity and rights is central to the philosophy of the independent living movement.

The rights-based approach “emphasizes a societal commitment to policies, programs, and practices that maximize opportunities for people with disabilities to choose and control their activities … and their interactions and connections with non-devalued people.”

This orientation moves beyond mere integration by aspiring to true community inclusion. Indicators of community inclusion include policies, programs and practices, and environments that provide maximum choice and control for people with disabilities.

Inclusion benefits societies at large as well as individuals. In terms of individual-level outcomes of true community inclusion, the author identifies community presence, increased community participation, altered identities, physical, cognitive, and mental health benefits, including reducing perceived stigma.

Further, as Amartya Sen and Martha Nussbaum have argued, diverse and inclusive communities are stronger and healthier communities, which supports a nation’s economic development. Thus to grow stronger societies and address the social determinants of health that have historically disproportionately affected people with mental health challenges, mental health systems must incorporate community inclusion principles – not mere integration.

 

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Salzer, M. (2021). “Community Inclusion and Social Determinants: From Opportunity to Health.” Psychiatry Online published 3/18/21. (Link)

18 COMMENTS

  1. How can one be completely included in society when society views you as mentally/biologically defective based on your suffering? Those labeled mentally defective are by definition separate from “normal” people. Racists assume blacks/minorities are genetically inferior just like psychiatry assumes those who suffer are. Can a black person be completely included amongst racists who fanatically believe the black person is inherently inferior? If not why would it differ for other groups claimed without evidence to be genetically inferior?

    Mentally ill labeled people can be jailed (hospitalized) and forcibly drugged without a trial, defense or the committing of a crime. Society has made them second class citizens with less rights than violent criminals. It is not surprising that people in that group aren’t included and struggle socially.

    According to psychiatry those with mental illness lack insight. Put more bluntly this means mentally ill people are too stupid to comprehend and know anything. They can’t even know if a chemically altering deadly brain damaging drug makes them feel worse or not. How does one have a meaningful relationship with someone who automatically assumes what you feel and say is wrong because a questionnaire resembling a vapid Facebook quiz finds you suffer?

    Social relationships are a two way street. Psychiatry convinces families and friends that they need to hide and avoid having meaningful discussion with mentally ill labeled people because it will upset them. There’s lots of academic discussion about how social media is detrimental to mental well being because posters only choose to post the good in their life. This occurs with mentally ill labeled people because others refuse to share the negative aspects of their lives with them.

    Psychiatry has convinced society that being a good family member and friend consists of making sure those labeled mentally ill are taking drugs, and going to therapy to be reminded that they are mentally defective (all forms of “therapy” where your thinking is claimed to be wrong and the cause of your suffering so let’s correct it take this route to some extent). When you yourself and/or others are told and believe you are defective it will cause social anxiety and a desire for isolation. Therapy then tells you your thinking is wrong and stupid and needs fixing. A reason therapy has little to no recorded long term benefits in quality studies is because it mostly reinforces a major cause of the anxiety.

    For those who are labeled mentally ill is a bit difficult if not near impossible to be fully included in the community, and have deep meaningful social relationships with people who mindlessly accept psychiatry.

    • A commitment hearing to be understood as a part of the a-part dysfunctional scales of a process also moves at the speed of Light requiring only if the community of citizens to engage? Both the objectivity withe the subjectivity? The realities of being block-chained are inevitable, though freedom can and will happen. When the Whole Story is understood outside of the moving scales of opinions perceived as The Law! The Rights?

    • The psych curricula is not about science. It is about language. Even the sciency sounding words are
      simply there to prop up the practice. (not sure it’s even a belief) I think psych students find
      out pretty quickly that they signed up to enforce an imaginary ideology.

    • Exactly, Willoweed, You said it better than I could have.
      Back when I was in the throes of DBT treatment for borderline personality, which got diagnosed after a series of ECT treatments did nothing to help my “treatment resistant depression” and caused memory loss problems to the extent that I could no longer work, I had a neighbor who also had a diagnosis but had managed to keep a full-time job and had a pretty extensive social network and support system. For a long time I thought that she was my friend until I realized that she wasn’t. Over the years she saw me being excluded in all kinds of ways, denied opportunities and left out of social engagements. I spent every holiday alone. After another stint in the psych ward I was always sent home in a cab because there was never anyone to call for a ride. She said to me one day, “I try to pass for normal.”. I believe the subtext was that if I tried harder to “pass for normal” then I would be more welcome in society. It was something I had to earn by being less obviously in pain. I’ve now stopped trying. I’ve been considered an outcast for so long, and even if it was possible for me to “rate” a place in society again, society isn’t worth it.

      • The insidious part is when they electrocuted your brain and filled you with chemical altering drugs they caused you to “appear less normal” they hurt your ability to socialize, maintain relationships, and function. Then they blamed you for it and recommended more drugs and/or electrocutions.

        • Yes, sometimes when I think about the all the ways Psychiatry harms and gets away with it, all the invisible unprovable damage they cause to people they purport to help, it seems like some kind of sick genius to me, committing The perfect crime over and over again and profiting from it over and over again. But I’ve met enough of these people to know that there’s no genius going on here, they’ve just stumbled into something, and they probably realize at the same time how lucrative and how horrible it is and keep doing it because the former is a bigger priority.

    • Well said!
      Now that I left my old community I’m doing better.
      My undrugged personality is nicer and I can understand social cues at last.
      My neighbors think I’m only disabled due to my autoimmune disease. (I really have one thanks to 25 years on drugs.) They treat me like a normal human. The whole experience is overwhelmingly sweet.

  2. In regarding the second sentence containing the following: “enhance general medical, cognitive, and mental health and wellness.”

    I haven’t been to see a primary care physician in years, exactly because of this idea of “enhanced” medical care. But today I saw one. And sure enough, they are required to do a “depression” test. And one of the two questions the nurse asked me even before I saw the doctor was whether I have feelings of being hopeless, or giving up. All under “enhanced” care. In relaying this to my sister and having the space to actually express how ridiculous this was I finally found myself able to respond in a natural (normal) way. To begin with, given the way society runs, and the amount of insane petty nonsense everyone has to deal with, if you don’t at one point in any given day feel a bit hopeless or have the urge to “give up” I think you actually DO have emotional problems. It’s called denial. And for someone to have such feelings, and not really have the matrix of knowledge or experience to understand the feeling itself, and get this “enhanced” care which involves “medications” which turn OFF your ability to go that one step further and understand why you feel the way you do, as if that’s healing…..

    The other side of the coin, might be having a primary care physician who asks one: “Do you know society is a BITCH, the amount of petty nonsense we all have to deal withe very day, and do you actually feel hopeless and sometimes want to give up, because you SHOULD, that’s normal, it means you aren’t blinded, brainwashed or completely numb and in the danger of becoming clueless” that might be more appropriate, although I don’t really see it happening. Must be my schizo-effective tendencies.

    But it’s completely wrong to not even ask someone what they are upset about, and label the feeling a sign of a disease. And yet that’s consistently what the “medical” profession does.

    And when they have art therapy, is one allowed to express oneself there. What would happen in the asylum, if you wanted to draw the picture a baby being fed not with a baby bottle but with a bottle of pills with a nipple attached?

    A person is supposed to be happy to not be human, to not feel their own feelings, to push to the side the thoughts that explain why they are they way they are?

    • There’s good reason why people harmed by psychiatry tend to avoid doctors, and medical establishments. 1) Psych labels cause a large increase in medical errors for those labeled. 2) A “respected medical group” causes massive harm which is proved by the research and society doesn’t care. It is a standard defense strategy to become skeptical and distrusting, of those who not only ignore the suffering done to you but perpetuate it on others. 3) In psych physical, health and other complaints are considered signs of “mental illness.” For minor issues it might not be worth it to go tell them to a doctor who might proclaim they are because you’re mentally ill and should take some psych drugs.

      You pointed out how disrespectful it is to not ask someone why they are upset and just assume they have a biological problem. I agree, however I think another scenario can be even more wrong. Patient: “I feel sad, fearful and can’t sleep because (insert any horrid thing occurring in life)”
      Doctor: “Oh, well you feel that way because your brain is defective. Here are some deadly addicting drugs to fix you.”
      I wonder if a lot of people do not share what is upsetting them because they don’t want to be further insulted and blamed for their emotional response to horrible shit. The major result either way will be a psych label, and drugs. This would also apply to sharing with family and friends.
      “Hey, mom/dad when you insults me it makes me unhappy.”
      “Son did you take your drugs? You know you lack insight and this is just your illness.”
      In practice one effect of psychiatry is to silence people. To stop them from complaining. Interestingly psych mental illness scales consider complaints to be a sigh of illness that needs to be eradicated with drugs. In the HAM depression scale someone no longer complaining is considered to have had a larger improvement then the total drug improvement in the most pro-drug biased short term studies. Flat out psych says that in effect silencing someone is a good thing.

      • Willoweed, that very occurrence happened in a blog I just posted in again, concerning someone who took his own life, a musician whose life was canceled by the lockdown, and then of course a psychiatric nurse comes along with the standard plug, delineating exactly what you just shared, and how as you put it so well: “I wonder if a lot of people do not share what is upsetting them because they don’t want to be further insulted and blamed for their emotional response to horrible shit.”

        That’s beyond even how the drugs have been proven to cause more problem than help. If “antidepressants” help marginally more than placebo, if at all, and in the meantime can cause suicidal ideation where does this put even such data, highly corrupted to begin with to even get at marginally helpful. Placebo hasn’t been shown to cause suicidal ideation.

        Anyhow, this stuff is so ridiculous. You’re free to look at that blog here https://slippedisc.com/2021/03/ensemble-leader-39-kills-himself-amid-covid-cancellations/ and can comment yourself. That psychiatric nurse is the on blogging under the name “Sharon.” By some miracle there’s another person (Karl) saying he was worked in the mental health field for years, and has seen people come in with worsening problems because they were ever prescribed anti-depressants.

        It really gets to be something when it’s clearly shown someone had no place to turn, that once again we hear this song and dance number that “sounds” good although in reality upon real investigation is shown to be in collusion with causing the problem.

        • American conservatives throw around a phrase called “virtue signaling” Essentially it means doing something that doesn’t actually help but makes it appear you are being helpful and are a good person so you can assuage the guilt of not taking any substantial actions. That is what psych is about; allowing people to appear helpful so they won’t feel guilty. Allowing people to blame a mythical “chemical imbalance” so they don’t have to change horrible aspects of society. Allowing people to say “go get therapy” so they won’t feel bad about refusing to listen and provide social support.

  3. “The community inclusion movement articulates inclusion as a legal and human right, highlighting research showing that increased opportunities to live a meaningful life within a community ‘enhance general medical, cognitive, and mental health and wellness.'”

    But this would mean the insane psychological professions would need to end their recommendations that people “quit all your activities, and concentrate on the meds.” Thankfully, I didn’t take that extraordinary bad psychological advise, and did “live a meaningful life within” my community.

    So the psychiatrist who was anticholinergic toxidrome poisoning me, did finally bother to look at my work, and he concluded it was “work of smart female” and “insightful.” Thus he did conclude my, what turned out to be, according to my child’s medical records, child rape covering up Lutheran psychologist, had misdiagnosed me. And he weaned me off his neurotoxins, albeit prior to either him or I knowing the psychologist who’d misinformed him, had gotten all her misinformation about me, from child abusers.

    “It is well documented that individuals with serious mental illnesses are disadvantaged in their employment, educational attainment, social relationships, family relationships, and other areas, which are all social determinants of health.”

    I think a big part of the problem seems to be that “mental health” workers tend to assume that being a fiscally responsible young mother – who’d already made and saved enough, prior to having children, to pay for her half of her family’s home – while trying to properly raise her children, functioning as a very active volunteer, and artist working on her portfolio.

    Merely because us visual artists, working on our portfolios, in the hopes of future profits, rather than immediate profits. We are all considered “w/o work, content, and talent” and “unemployed,” by the “mental health professionals,” prior to them even looking at our work. At least that’s what my medical records prove as true.

    As one who was co-chairing a 250+ strong member volunteer school arts program, while I was being defamed and neurotoxic poisoned by “mental health” workers. I do agree, “Effective supports include, for example, arts participation.”

    But I also know my paternalistic childhood religion fraudulently claims they support the arts. When in reality their walls are bare, because they only fund support for the musical arts, not the visual arts. And this lack of funding for the visual arts, by the ELCA, did result in my Lutheran pastors and psychologist wanting to murder, and steal from artists like me, once they finally bothered to look at my work. Crimes of which I do have both medical and legal proof.

    I’m quite certain, that if the religions set up funding to support their visual artists, rather than just “conspiring” with the systemic child abuse covering up “mental health” system, we’d be living in a much more just and sane society.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/
    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    And I will say, if the religions had actually supported their visual artists historically, their churches would now feel like museums, rather than having bare walls. Or stupid posters on their walls, because some people in their church saw the problem.

    And I say this because the places where my work is now displayed, do feel like museums, according to others. The visual artists are not actually “irrelevant to reality,” as the satanic, systemic, child abuse covering up “mental health” system – and my former religious leaders, for whom they systemically cover up child abuse – believe.

    Truly, the paternalistic psychological profession, who has been “conspiring” with the systemic, child abuse covering up, DSM deluded psychiatric profession, and their pastors, are on the wrong side. Murdering, and stealing from all the artists in America – merely because we are working for future profits, rather than immediate profits – is NOT the answer.

    The insane, systemic child abuse covering up, psychological and psychiatric industries, are the problem. Now that we all live in a “pedophile empire,” whose monetary system is being imploded, by the powers that shouldn’t be.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT

    Gosh, but some satanic, systemic child abuse covering up “mental health” workers, neurotoxic poisoned me, right after 9/11/2001, because I knew the wrong banksters had taken control of this planet, decades ago.

    But now that the globalist banksters are imploding our entire monetary system, maybe “mental health professionals” and pastors should learn to listen to the ethical, and fiscally responsible banking families, that had made your religions millions, decades ago? And had helped to make America great.

    And maybe you should garner some insight into Jesus’ theology, since it is one of repentance and turning from one’s evil ways, not one of free forgiveness. And one that says God is the judge, not the systemic child abuse covering up psychological or psychiatric, who are the judges of humanity.

    The psychological, psychiatric and therapy industries, who mostly know nothing about the “inclusion movement,” and are merely functioning as systemic child abuse cover uppers for the mainstream religions, need to repent, and change from their evil ways. As do the paternalistic religions, who chose to enter into a faustian deal, and participate in “the dirty little secret of the two original educated professions.”

    It’s just appalling that the medical, “mental health,” religious, and pharmaceutical industries are literally running a multibillion dollar, systemic child abuse covering up system, that has resulted in us all now living in a “pedophile empire.” Let’s hope and pray all are judged fairly by God.

    • We will probably never know but I wonder if many sexual abuse victims don’t share because they fear being proclaimed to be “mentally ill” and “lacking insight” It is hard enough sharing sexual abuse in our society even without a mental illness being subjectively slapped on because of it.

        • Yes, we will know! If the gradations of abuse move to the more/most intense under the category of sexual abuse, the horrofic challenge to unpack that moment, to replay and attempt to stay with what happened to be told in a current time by the violated is a space, peculiar to covey the and place in the language of law, the legal that is driven by the rules on the books. But if one explores the context at that moment when the violation was occurring and then knowing how silence occurred, there might emerge further trials or party collapse. Has the time clock, the impact of logging in now, or the home security camera add to an understanding of what constitutes the nature of realizing a healthier security? Or are the gated doors and entrance ways just a front? And at times, when the individual’s mind turns on itself for the lack of realizing justice, even to the extent of committing suicide, then who or what level of government/governance is responsible. For the liability issues are not necessarily buried, but rather like ploughing a field for diamonds, at what point to the rocks, the solid information surfaces to convey the story?

  4. Yes, we will know! If the gradations of abuse move to the more/most intense under the category of sexual abuse, the horrofic challenge to unpack that moment, to replay and attempt to stay with what happened to be told in a current time by the violated, is a space! This hot zone of thinking is difficult and peculiar to covey and place in the language of law, the legal that is driven by the existing rules on the books.
    But if one explores the context at that moment when the violation was occurring and then knowing how silence also was being reinforced, to not tell of occurance, there might emerge further trials or even party collapse. Sadly, the issue is not reserved to a corporate party or individual, but rather seems to be an issue being lost in the aggregation of numbers, that make data sets.

    Has the time clock, the impact of logging in now or then, or the home security camera add to an understanding of what constitutes the nature of realizing a healthier security? Or are the gated doors and entrance ways just a front? And at times, when the individual’s mind or even a community mind turns on itself for the lack of realizing justice, even to the extent of committing suicide, then who or what level of government/governance is responsible?

    For the liability issues are not necessarily buried, but rather like ploughing a field for diamonds, at what point to the rocks, the solid information surfaces to convey the story? Perhaps the proper attorney as yet to emerge, for fear of not being able to earn a living if the truth were to understood, the degrees to which people knew but remained silent?

    (I attempted to edit, but then the clock expired so I copied what I meant to review and perhaps convey greater clarity),

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