The aim of this assignment is to critically analyse the concepts of social inclusion and exclusion and discuss how social exclusion has occurred in the chosen scenario of Feodor. Feodor’s needs will be identified in the care plan (refer to the appendix 1) and one need will be chosen and interventions to address or meet that need will be critically analysed. This assignment will critically analyse how mental health service could be improved with reference to Anti-discriminatory and anti-oppressive perspectives in Feodor’s scenario.
Feodor is a 31 year old man who was born in the Russian Federation. He served as a Russian soldier and saw active duty, in the 1994-6 Chechen war, during which time there was discrimination bombing and shelling of Chechen towns and villages. Feodor has stated that over 250, 000 people of the Russian federation were killed in Chechnya during the collapse of the Soviet Union ‘that was genocide’. He has referred to hostage situations in both Budennovsk and Beslan when hundred died. He has quoted the Russian Premier Putin as stating ‘that the war was over 3 years ago’, Feodor contends that the brutal conflict goes on unabated. As a soldier he say it is no surprise that they (The Russian Army) did what they did, the Chechens gave them no choice. So he has come to the UK seeking asylum, work, a better life, a chance to start again, to escape from the nightmares fear. He is now opposed to the conflict in Chechnya and has expressed his opposition to many people, some of them with power and some from the army in senior positions in the Russian Federation; he believes that he may be at risk of retribution from the Russians and the Chechens.
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The Social exclusion unit (SEU 2004) defines social exclusion as shorthand for what can happen when people or areas suffer from a combination of linked problems such as disabilities, unemployment, poor skills, low incomes, poor housing, high crime environment, bad health and family breakdown. Sayce (2000) described it as the interlocking and mutually compounding problems of impairment, discrimination, diminishing social role, lack of economic and social participation and disability. Also Jermyn (2001) state social exclusion is complex multi-dimensional in the nature and can occur when various linked problems are experienced in combination. Among the factors at play are social status, jobless, lack of opportunities to establish a family, small or non-existent social network, compounding race and other discrimination, repeated rejection and consequent restriction of hope and expectations.
Pierson (2002) suggested that social exclusion is a process that deprives individuals and families, groups and neighbourhoods of the resources required for participation in the social, economic and political activity of society as whole. This process is primarily a consequence of poverty and low income, but other factors such as discrimination, low educational attainment and depleted living environment also underpin it. Through this process people are cut off for a significant period in their lives from institutions and services, social networks and developmental opportunities that the great majority of a society enjoys. Dunn (1999) mentions that the largest UK inquiry into the social exclusion and mental health service users appears to take ‘social model of disability’ perspective and while it discusses social exclusion, the key problem it highlights is discrimination. It states that the inquiry panel receives strong and consistent evidence concerning the discrimination of people experiencing a direct result of their own mental health problems. The report also argues that this discrimination can occur in various areas of life. Especially within jobs and education, this makes mental health service users vulnerable to extreme exclusion from virtually every aspect of society.
On the other hand, Repper and Perkins (2001) suggest that social inclusion requires equality of opportunity to access and participate in the rudimentary and fundamental functions of society, for example access to health care, employment, education good housing and ultimately recovery of status and meaning and reduced impact of disability. According to Department of Health (2009) social inclusion in mental health services is improved rights to access to the social and economic world. The new opportunities to recovery status and meaning have reduced the impact of disabilities. However (Bates, 2002) stated that everyone, including people who use mental health services, should be able to enjoy a good standard of health, develop their skills and abilities, earn a wage and live a life in the community in safety. Similarly, the National Service Framework Health Standard One (Department of Health, 1999b) demands that all people whose care is managed through the enhanced care programme approach should have a plan that addresses their needs for housing, education, employment and leisure. Within this framework, an inclusive mental health services will address basic standards of living issues. According to the Disability Discrimination Act (1995), and the establishment of the new Disability Rights Commission (2004). Social inclusive perspective, including within the antidiscrimination law, equality and human rights, social justices and citizenship, in addition to clinical perspective, it is from this point that pernicious nature of exclusion and the importance of social inclusion for people with mental health problems and those with intellectual disabilities can be most clearly appreciated. In this case Mental Health Professionals have a responsibility in helping people with mental health problems to make sure they become socially included and not socially excluded.
In Feodor’s case mentioned earlier in the assignment that he came to UK seeking asylum, work, and better life. Refuges and asylum-seekers experience a higher incidence of mental distress than the wider population (Future Vision Coalition, 2009). The most common diagnose are trauma related psychological distress, depression and anxiety (Crowley, 2003). In which this is the case with Feodor, much of the distress experienced by him is strongly linked to the events that happened in his home town which have led to his departure. However distress occurs when you are unable to cope with pressure there is also strong evidence that Feodor’s mental distress is as a result of the difficult circumstances experienced in the UK. He was a victim of discrimination and social exclusion and this had very big impact on his mental state. Mental health policy (Department of Health, 2005) recognizes that refugees and asylum-seekers are particularly vulnerable and at risk group, however progressively more restrictive UK asylum policies have had an increasing negative impact on mental health well being (Royal College of Psychiatry, 2007).
Asylum-seekers who are unable to provide accommodation for themselves in UK have been sent to different parts of the country on no choice circumstances. This process does not take into account the community support networks, family of friends. However some of these areas in which dispersed asylum-seekers are housed in many cases are deprived areas with multiple social problems and little experience of diverse communities. This has often resulted in social tension and racism towards refuges and asylum-seekers like Feodor and they are much more often victims than the perpetrators of crime (Leff, and Warner, 2006). Refuge Media Action group (2006) states that accommodation provision for asylum-seekers have improved over the last few years but there are still concerns that it can be poor quality and unstable in some areas. Poor housing, as an immediate environmental stressor, therefore, plays a central role in the psychological well-being of residents both at an individual and community level. (The Acheson Report). Asylum-seekers are prohibited from working or undertaking vocational training and currently receive at around 50% of income support, which has been cut from ?42,16 to ?35,13 a week compared to ?67,50 a week for those on employment support allowance and some are being given vouchers instead of cash (Mind, 2009). As a result many are living in poverty they are deprived of the important integration opportunities which employment can provide (Bloch, 2002). However (Leff, and Warner, 2006) suggested that the working environment offers the opportunity of making friends, gives a structure to the day, increases the person’s self-esteem, and provides an income especially for men like Feodor. Asylum-seekers do not have access to learning opportunities, learning is central to economic success and social cohesion. Feodor was disadvantaged educationally, economically and socially.
One problem that will be addressed from the care plan that has great impact on Feodor’s is employment. Unemployment is both a key characteristic and a primary economic cause of exclusion and is linked with poverty, social isolation and loss of status and significantly increase disability and impedes recovery (Percy- smith 2000). It reduces opportunities for good life which lead to social exclusion as people cannot afford the basic necessities, decent food, clothing, holidays and social activities. It has been linked with increased general health and mental health problems (Repper and Perkins, 2003) which means that as long as Feodor remains unemployed he will be socially deprived. Asylum-seekers like Feodor are prohibited from working whilst waiting for a final decision on their asylum claim, but finding work is their main priority just after granted status (Bloch, 2002). For this reason the mental health services could be improving with reference to anti-oppressive and discrimination by assisting Feodor to find voluntary work as short term goal, volunteering for charities or community organisation. Voluntary work will help Feodor with the opportunity to grow in confidence, reduce his own social isolation and increase opportunities to improve language skills; it also contribute to career development and work experience (Refugee Council Online). Voluntary will also provide some evidence of motivation to prospective employers, enhancing job-readiness and prevent going rusty. It also provides opportunity for Feodor to become familiar with other local services, gain experiences of working practices in the UK hence help him to integrate in the society. Feodor does not have the right to get paid job, but voluntary work and study will help him to prepare for employment and alleviate the stress of his situation. (Sainsbury Centre, 2008). Even though this might not change his situation much since there is no income that comes under voluntary work. Paid work is the only route for Feodor to sustained financial independence, (Askonas and Stewart, 2000) work is an important element of the human condition, it helps fulfil our aspiration-it is a key to independence, self-respect and opportunities for advancement.
The other things what the mental health service need to do for Feodor is to refer him to vocational rehabilitation for vocational training. Vocational rehabilitation is a process of interventions whereby people with mental health problems or disabilities like Feodor can build up individual capacity to enable himself to the best he can be, achieving better work related outcomes (Waddell et al, 2008). Access to vocational training and education system is crucial for migrants to enable them to adapt their skills and qualifications to the labour market requirement of receiving countries. These services will offer Feodor opportunity to develop confidence, resilience and work skills. Vocational rehabilitation programmes have a greater emphasis on work skills development and on progression towards employment. Employment has been identified as a primary factor in the integration of migrants’ life Feodor into UK (Phillimore et al, 2006). Research also shows that employment is good for our physical and mental health (Waddell and Burton, 2006). Unemployment can damage our health and lead to a range of social problems such as debt and social isolation (Black, 2008). Inability to provide for yourself or to contribute to the society can have negative impact on self esteem, confidence and mental health especially for men like Feodor (Mind, 2009). Being in employment and maintaining social contacts can improve Feodor’s mental health prevent suicide and reduces his reliance on mental health services (SEU, 2004). Employment can also improve Feodor’s quality of life and well being, reduces his social exclusion and poverty (Waddell and Burton, 2006).
As stated earlier by (Askonas and Stewart, 2000) that work is an important element of the human condition, it helps fulfil our aspiration-it is a key to independence, self-respect and opportunities for advancement. Employment has a central role in most people’s lives offering beyond that of income but still there are very large and growing numbers of people with mental health illness who are out of work, most of whom want to work (Bond, 2006). They cannot get a job if they have or have had a mental health problem because of the discrimination by employers. This goes on even though it is illegal under the Disability Discrimination Act.
A socially inclusion approach includes recovery-oriented practice, an emphasis on social outcomes and participation, and attention to the rights of people with mental ill health, as well as to citizenship, equality and justice, and stigma and discrimination. (Royal College of Psychiatrists, 2009). Genuine social inclusion can only be achieved by valuing the contribution people can make to society. Because somebody has mental health problems does not mean that he or she can not make a contribution to the community. People need to be given information, choice and freedom and the opportunity to make decisions for themselves. Within the professional service, it is important that staff develop an awareness that different individuals have different needs, and service users should be involved in the care. The Department of Health (2000) states that patients should not be seen as mere recipient of care, but should be empowered to work in partnership with their health and social providers. In helping people to build their lives, mental health workers need to address social inclusion at both ethnos and demos (Repper and Perkins, 2003). People need to participate in and feel part of the community in which they live and more likely to be able to take part if the have a right to those things that are valued in their community such as decent housing and job. Social inclusion is not treatment or care alone, this means identifying, recovery and social inclusion as explicit goals and taking the opportunity of policy initiatives both within and outside the mental health arena to work for the reduction of discrimination against service users. The complementary concepts of inclusion and their application to mental health practice, provide a significant new basis for common between multi-disciplinary team and service users.
To conclude Mental Health does not exist in isolation a good Mental Health is linked to good physical health and is fundamental to achieve improved education attainment, increased employment opportunities, reduce exclusion and criminality and social participation.
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