Social inclusion of people with severe mental illness: a review of current practices, evidence and unmet needs, and future directions

Overview

This paper examines social inclusion for individuals with severe mental illness, defined as psychoses, bipolar disorder, and severe depression. Social inclusion is conceptualized as the ability to participate in valued community and societal activities according to individual preference. The review addresses the paradox that people with severe mental illness experience disproportionately high rates of social exclusion compared to people with other disabilities, even in contexts where specialist mental health services are available. This raises fundamental questions about whether mental health services adequately prioritize social inclusion as a service provision goal and what strategies beyond mental health services are required across legislative, policy, statutory service, and civil society levels. The analysis considers cultural and contextual variations in how social inclusion is understood and valued, recognizing that the significance attached to different activities varies across cultures, life stages, and gender.

Methods and approach

The paper employs a narrative review approach to synthesize current practices, evidence, and gaps related to social inclusion for people with severe mental illness. The review examines subjective experiences of social exclusion through the lens of loneliness and evaluates the evidence base for interventions addressing this dimension. It then systematically considers strategies to increase observable forms of social inclusion across multiple levels: legislation, services, and community assets. The review draws primarily on evidence from the Global North but deliberately incorporates evidence and examples from the Global South where available. The analysis extends to examining predominant frameworks for social inclusion used in health services and explores alternative approaches that may offer more empowering pathways. The review additionally addresses interventions targeting stigma and discrimination, both at targeted group and population levels.

Results

The review identifies that social inclusion interventions exist across multiple domains but reveals significant evidence gaps and implementation challenges. Loneliness represents a critical subjective manifestation of social exclusion requiring specific intervention strategies. Evidence for various interventions shows differential strength, with some approaches better supported empirically than others, though much of the evidence base remains concentrated in Global North contexts. Health services predominantly employ particular frameworks for conceptualizing social inclusion, yet alternative frameworks may provide more empowering approaches for certain individuals. Stigma and discrimination reduction interventions have been developed for both targeted populations and broader communities, though their effectiveness varies. The review reveals substantial unmet needs across legislative, service, and community levels, indicating that existing approaches inadequately address the scope of social exclusion experienced by this population.

Implications

The findings lead to specific recommendations for multiple stakeholder groups including policy makers, researchers, health professionals, and advocates. These recommendations encompass legislative reforms, service delivery modifications, and changes to mental health research priorities. The conclusions emphasize that mental health services alone cannot resolve social exclusion for people with severe mental illness, necessitating coordinated action across sectors and levels of intervention. Future directions include intervention development, rigorous evaluation of existing approaches, implementation science to support intervention uptake, and contextual adaptation to ensure interventions are culturally and locally appropriate. The paper highlights the need for frameworks that empower service users in defining and pursuing their own social inclusion goals rather than imposing predetermined outcomes. These recommendations aim to shift social inclusion from a peripheral concern to a central organizing principle in mental health policy and practice.

Disclosure

• Research title: Social inclusion of people with severe mental illness: a review of current practices, evidence and unmet needs, and future directions
• Authors: Claire Henderson, Yasuhiro Kotera, Brynmor Lloyd‐Evans, Gerald Jordan, Matthew Gorner, Anthony Salla, Jasmine Kalha, Peter A. Coventry, LAURA BOJKE, Sebastian Hinde, Mike Dominic Slade
• Publication date: 2026-01-14
• DOI: https://doi.org/10.1002/wps.70031
• OpenAlex record: View
• Image credit: Photo by Vitaly Gariev on Unsplash (Source • License)
• Disclosure: This post was generated by artificial intelligence. The original authors did not write or review this post.