Book Review: SOCIAL INCLUSION OF PEOPLE WITH MENTAL ILLNESS By Julian Leff and Richard Warner Cambridge University Press, 2006. 202pp. Pb. £30.99 ISBN 0—521—61536—4

Abstract

According to the 2004 Mental Health and Social Exclusion Report from the Offi ce of the Deputy Prime Minister, London, UK, only 24% of adults with long term mental health problems are in work, and too many spend their time inactive and alone. It is clear that social exclusion is a problem for people with mental illness. However, why is it a problem and what can be done about it? This book addresses these questions using a comprehensive and interesting approach drawing from international examples of relevant studies including those that were part of the World Psychiatric Association’s (WPA) programme against the stigma of schizophrenia. Written by Julian Leff from the UK and Richard Warner from the USA, it also gives detailed examples of mental health services and employment schemes from both of these countries comparing ‘what works’ to enable social inclusion of people with severe mental illness. The book is divided into two parts, the fi rst part discusses the origins of stigma with insightful chapters on the course of psychoses, the nature of stigma, poverty and social disadvantage, ameliorating users’ symptoms, dismantling psychiatric institutions, reducing fear and discrimination and tackling self-stigmatisation. The second part of the book focuses on overcoming obstacles with regards to employment with chapters explaining why work helps, the economic obstacles to employment, the spectrum of work programmes, social fi rms, innovative strategies and inclusion and empowerment of consumers. All of the chapters contain testimonies from service users regarding their experiences or their own strategies for maintaining social contacts. Each chapter in the fi rst part of the book sheds light on the negative consequences of stigma and discrimination on social inclusion. For example, chapter fi ve shows how symptoms and side effects from medication can impact on the social inclusion of people with mental illness by reinforcing public stereotypes. I found chapters seven and eight particularly interesting as they discussed reducing fear and discrimination among the public as well as tackling self-stigmatisation. In chapter seven for example, establishing a local action committee, selecting target groups and setting up a speaker’s bureau are discussed. These ideas allow people with mental illness to establish contact as well as empower them to help reduce the fear of mental illness by the public. There is also discussion around carers of people with mental illness and what they can do to help. In chapter eight, the importance of normalising unusual experiences is emphasised as well as the importance of self esteem and creative activity. Each chapter of the second part provides solutions to the problem of social exclusion in people with mental illness, focusing on employment. Employment is important because a job is rewarding, a source of income, an opportunity for social contact and gives people a purpose. To give examples, chapter eleven discusses a spectrum of previously tried work programmes, with the supported employment being the most benefi cial, and chapters twelve and thirteen discuss social fi rms and innovative ideas for service user employment such as employing service users in the psychiatric system. Lastly, chapter fourteen discusses strengths and weaknesses of the psychosocial clubhouse model as well as the accurate theme for the entire book, the recovery model. This book is a real gem and is invaluable because of its pragmatic view on the importance of social inclusion of people with mental illness. It empowers the service user with ideas on how to establish and maintain social contacts throughout each chapter. I also recommend it to carers of people with mental illness as well as all types of mental health care workers. Primarily however, it should be a desk top reference guide for every mental health service planner and policy maker.