The ambiguities of social inclusion in mental health: learning from lived experience of serious mental illness in Ghana and the occupied Palestinian territory

Abstract

Purpose Social inclusion of people living with serious mental illness is widely promoted. However, only limited consideration has been given to the meanings of social inclusion within different settings and the ways in which it is envisioned, negotiated, and practised. In this paper, we explore meanings and practises of social inclusion from the perspectives of people living with serious mental illness and their families in Ghana and Palestine and how this is shaped by differing political and socio-cultural contexts. Methods This paper draws on comparative ethnographic research including participant observation and interviews with people living with mental illness and family members in Ghana and the occupied Palestinian territory. Data were triangulated and analysed using thematic analysis. Results Participants described experiences of social inclusion and participation within communities, home and family life, friendships and social life, and work and livelihoods. This revealed how such experiences were variously shaped by differing political contexts and socio-cultural norms and expectations within the two settings. These in turn intersected with aspects such as gender roles, age, and socio-economic status. Aspirations for inclusion included greater awareness and understanding within society, accompanied by opportunities and support for meaningful inclusion at the political as well as community level. Conclusion Findings point to the value of a contextual understanding of social inclusion, taking account of the impact of the wider socio-cultural, political, and economic environment. They also point to the need for an intersectoral approach, beyond communities and mental health services, to provide meaningful opportunities and support for social inclusion.

Inverting the deficit model in global mental health: An examination of strengths and assets of community mental health care in Ghana, India, Occupied Palestinian territories, and South Africa

“…Family members can also play a key role in supporting participation in the social life of the community, including family events such as weddings and funerals, as observed in India and Ghana [ 74 , 76 ]. However, people with mental health conditions can also face prejudice and exclusion within their communities [ 84 ]. The extent of involvement in family activities depends on several factors, including the perceived severity of the distress, family attitudes, the person’s gender and the nature of the occasion.…”

“…The extent of involvement in family activities depends on several factors, including the perceived severity of the distress, family attitudes, the person’s gender and the nature of the occasion. Care that starts as well-intended can also become overpowering and controlling [ 84 ].…”

“…This points to a need to consider how the rights and safety of people living with mental illness could be protected without stifling the innovation, creativity and responsiveness that makes these informal supports so relevant and valued. A recent paper by colleagues in Ghana and Palestine profiled practices for social inclusion and human rights operating within communities and suggested where and how some localised accountability mechanisms operate [ 84 , 96 ].…”

“…This was leveraged to access informal and formal care and opportunities for participation in income generation and household responsibilities, such as farming, child-minding, livelihood-related tasks and community participation. For example, one man in Ghana with bipolar disorder who had been dismissed from formal employment gained employment in his mother's bread-making business, enabling him to work in a more flexible and supportive environment [83].…”

“…I've never received anything. I've written [our names] for it two or three times, but they haven't given us anything" [81,83].…”