Inequality In Mental Health:
The Relevance of Current Research and
Understanding To Potentially Effective Social Work Responses
Introduction
Inequality in mental health and illness is a long standing issue in mental health research, initially raised by sociologists and later taken up by epidemiologists too. Sociologists proposing to look at inequality as an issue in this field were divided in their views as to whether people become poor because they are mentally ill and thus unable to function (social selection) or they become mentally ill because of being poor (social causation). Although most sociologists today tend to favour social causation, the distinction between social selection and social causation continues to be reflected today in the dominance of genetic and biochemical explanations within psychiatry vs. the belief of sociologists and social workers that the social context acts as a major etiological determinant, though it is not the only such factor. The belief in either social selection or social causation is important since it guides us in terms of policies, methods of interventions, the message given to the person experiencing mental distress and illness, her family, friends, and society. Current interest in social inclusion (Sayce, 2000, Repper and Perkins, 2003) is rooted in Durkheim’s focus on the damage caused by social anomie (Durkheim, 1897), a version of social causation, not less than in governmental wish to reduce the number of people living on benefits.
The interest of many sociologists in mental illness has largely moved on from inequality to a discourse on power and control (Busfield, 2000), shifting more recently to the implications of modern approaches to risk for people experiencing mental illness. Nicholas Rose’s recent work (2000) illustrates well this shift in which what leads to experiencing mental illness and to recovering from it is put to one side in favour of seeing the mentally ill as one of the groups whose image depends on social fears of risk.
Conceptual approaches
a. Current Epidemiology
Instead of sociologists, epidemiologists have become the professional group most occupied with collecting the evidence concerning inequality and interpreting it. They see themselves as scientists responsible for mapping illness and health in large populations, through the application of reliable methods to the collection of valid data, analysed through parametric statistical packages.
Data on mental ill health and health is thus collected from different settings (e.g. households surveys, the census, populations living in institutions). Variables on which data is collected include age, diagnosis, ethnicity, gender, education, employment, income, housing, living arrangement, personal status, social networks, frequency and length of hospitalisation, intervention methods, criminal justice history, and physical ill health. Epidemiologists would see these as objective variables; and have paid little attention to subjective and inter-subjective variables and their indicators.
This is based on the
assumption that the variables listed above may reflect risk factors
related to having and
maintaining a mental illness. It is rare for epidemiologists i
n mental health to come up
with their own explanatory framework; most mental health
epidemiologists have
trained as psychiatrists first, and are based in departments o
f psychiatry or public
health. This is in contrast to the work of some leading general health
epidemiologists
who are ready to accept the primacy of social factors in healt
h (e.g. Muntaner, 2000,
Krieger, 2005, Wilkinson, 2005); the
latter illustrate a revived trend
within a
globalised approach to epidemiology of health.
A current debate which
highlights the core of the conceptual framework -- or lack of it -- is
the on-going discussion as to whether social class, income or poverty
are
the more relevant factors
underlying inequality in mental health. Informed by US
findings that income is a more
discerning variable than social class (derived from a mixture of
education,
employment, income, housing, and parental background information) in
terms of
inequality, UK leading epidemiologists express their readiness to
discard
social class too as a major variable. The explanatory framework itself
reads as a list
of social variables overarched by biological ones, as Table 1
illustrates.
Table 1: Diagram of the potential influences on prevalence rates of the common mental disorders.
Source: Melzer, D et al. (2004), ”Social Inequalities and the Distribution of the Common Mental Disorders”, Psychology Press Ltd
The specific factors
perceived as impacting on mental ill health (physical illness,
stressful life events,
lack of supportive social networks, work circumstances) are described
as
contributing factors to one’s social position, while the latter is seen
as both contributing to
mental illness and impacted by it. Thus the framework does not look at
issues such as
poverty, stigma and discrimination due to age, ethnicity and gender, in
preference of
individualised psychosocial experiences which may be the result of
these issues.
While a number of these specific factors are usually perceived as part
of the
experience of poverty (Bywaters
and McLeod, 1996) the concept of
poverty is not focused
upon in the writings of epidemiologists in mental health.
Likewise, although
victimisation, personal attacks, and racial discrimination are
specifically mentioned
as risk factors for common mental disorders in ethnic minority groups
(Meltzer et al,
2004, p. 207) they are left out of the more comprehensive
framework,
presumably because they can be subsumed under the “stressful life
events”
category, even if the latter is thus rendered meaningless of a central
and irreducible
risk factor.
Table 2: Risk factors for common mental disorders in ethnic minority groups
The experience of either
poverty or discrimination should be treated as a necessary
but insufficient
explanation of mental illness, as they do not explain why a specific
person responds to these
states of being with a mental illness.
A number of the eminent
psychiatrists-epidemiologists are also known for being protagonists for
relatively progressive social policies in mental health, thus the
exclusion of poverty and
discrimination does not necessarily indicate an adherence to a
particular
conservative ideology. It is more likely to reflect being trained to
believe that a list of factors
passes as an explanatory framework, and that the more specific and
descriptive a factor
is, the more scientific it is assumed to be.
The current conceptual framework used by epidemiologist in psychiatry does not explain much, especially not in terms of what leads to experiencing and maintaining a mental illness, and why agreed policies in this field are less likely to be budgeted and implemented by government than policies related to heart disease, even though the social magnitude of mental illness and heart disease is similar (Moser, 2001).
b. Current sociology
Sociological research on
mental illness invariably touches on the issue of inequality
in
mental illness
(Busfield, 2000). Historically, Goffman (1961) and Scheff (1975) looked
at processes of
institutionalising mental illness and of how people came to be
defined as mentally ill,
rather than at the traditional set of inequalities in mental health.
This has marked
the introduction of a very different conceptual and
methodological framework
from the epidemiological framework.
Brown and Harris’ (1978)
researched the social and emotional isolation of clinically depressed
women who are
single parents, identifying these types of isolation and having three
children
below the age of 14 as the main reasons for their depression.
Dohrewend and Dohrenwend
(1981) have focused on life events as the major trigger of mental
ill
health in
people coming from deprived backgrounds. Although neither of these
authors openly
criticises traditional psychiatry, their approach to research also
parts way with epidemiology.
Rogers and Pilgrim have
been interested in the issue of inequality in mental illness for
sometime, as reflected
in their writings (Pilgrim
and Rogers, 1996, Rogers
and Pilgrim, 2003).
While
the 1996 approach applied the usual set of epidemiological
variables to mental
illness, it has also looked at discrimination in the context of age,
ethnicity and gender.
However, it is Rogers and
Pilgrim’s 2003 framework which is
more radical than their
1996 approach was. It includes the services themselves as a source of
inequality;
and a central place is given to violence as an inequality factor.
The inclusion of the
services relates to the application of professional ways of working
more as a means
of social control than care, one which ignores lay
perceptions and users’
own understanding of what mental distress and illness are about.
Coercive social
control comes into this discourse, but is no more than one
means of such a control.
The majority of professionals for clients who reflect come from a
well-educated,
Caucasian group. Their preference for clients who reflect their
own background has been
noted before in discussing inequality in terms of access to
psychotherapy of ethnic
minority service users by a number of authors (including
Pilgrim and Rogers), a
much wider range and hence a greater impact is given to this factor in
the 2003
framework, which looks at the imbalance in power as the key to
maintaining professional
control.
Rogers and Pilgrim also
take into account the existence of a more vocal and
articulate user movement in most
Western societies, while being aware that its impact on professional
ways of
thinking and working to date is negligible. This is attributed by the
authors to the
continuing dominance of the medical psychiatric perspective which
believes in the
centrality of genetic and biological approaches to mental ill health
over psychosocial ones,
discarding the significance of inequality which is by definition a
social phenomenon.
The inclusion of various facets of violence in their framework merits attention too. For them violence in the context of mental illness includes not only traditional aspects such as compulsory admission and intervention, harm to self and to others by people experiencing mental illness, but also their victimisation by the community, as well as the impact of warfare on people’s mental health.
The complexity of
understanding violence and inequality in mental illness is
highlighted by their use
of the causal model created by Hiday (1995, reproduced from Rogers and
Pilgrim,
2003, p. 158) which links social stratification with mental illness and
violence.
Table 3: Casual model linking social stratification with mental illness and stratification
Rogers and Pilgrim also
point out that although misuse of alcohol and drugs is
recognised as leading to
violent behaviour, it is misleadingly attributed to users’ mental
illness. Such a
categorisation reinforces the public’s and the politicians’
tendency to over-focus
on mental illness as a source of violence, while undermining the aspect
of
victimisation of mental health service users by perpetrators who are
not usually mentally ill
(though a minority of inpatients also do victimise other patients).
Methodological issues
The key factors to be
investigated in the context of inequality in mental health are
complex in so far as
they are either a construct combining several variables, or that the
validity and
reliability of the measurements used are known to be doubtful.
For example, psychiatric
diagnosis, taken for granted repeatedly in each epidemiological study,
has been the subject of many studies which highlighted its problematic
record in
terms of reliability and validity (e.g.
Scheff, 1975).
As epidemiology defines
itself as the study of populations, large samples are
preferred
population diversity
does not fall neatly into any randomisation models. Measurement to
small ones. The
belief in the value of Randomised Controlled Trials (RCT) to provide
representativeness of these populations continues to be assumed, even
though instruments are usually
questionnaires in which each item merits as short as possible an
inquiry, and one
focused on functional issues. While only instruments proven to be
reliable are applied, their validity and their relevance to diverse groups remains debateable; the lack of a qualitative research element is also a methodological drawback.
In table 4 Shah (2004)
lists eleven methodological problems in need of paying attention to in
the
context of studying ethnicity and inequality in mental health.
Table 4: Methodological issues
Source: Melzer, D et all (2004), ”Social Inequalities and the Distribution of the Common Mental Disorders”, Psychology Press Ltd
While it could be argued
that researching ethnic minorities raises some special difficulties,
most of
the issues listed by Shah are not limited in significance only to these
groups, but are
relevant to any socially marginalised group. The complexity of
running a large scale study and analysing the data often leads to
findings being published
on average at least five years after the study took place; by which
time they may/may
not represent accurately the reality of a given population any longer.
The methodology of
researching the contribution of services and of violence to inequality
is at its
infancy, and requires further elaboration.
The main empirical evidence
I have opted to compare
British findings (Meltzer et al, 2004)
with those of continental Europe
(Stakes, 2004, Eurobarometer 2003),
Australia (Andrews et
al, 2001) and the
US (Kessler,
1995, 2005) mainly due to similarities in social structure, psychiatric
diagnosis
and attitudes towards mental ill health. It could be argued that a
comparison with very
different societies could have been equally useful in
highlighting trends in
inequality particular to the UK. A case could be made also for
the inclusion of
longitudinal studies or repeated cross-sectional research. The main
British study includes
comparison to eight international studies from Australia, the
US
and the Netherlands
(Meltzer et al, 2004, table 1.3).
The high risk groups evidence
produced by
epidemiologists is summarised in table 5.
Table 5: High-risk as a percentage of the population aged 16-64 and the percentage of each high-risk group who suffer from neurotic disorder
Source: Melzer, D et al (2004), ”Social Inequalities and the Distribution of the Common Mental Disorders”, Psychology Press Ltd
Broadly, the
similarities in findings in relation to inequality in mental health are
greater than the
differences. The prevalence of
serious mental illness (affecting 7 people out of 1000) and common
mental disorders
(affecting 1 in 6 people) provides an indication of how many people
suffer from
mental ill health, an experience which is at the core of their
inequality but one
impossible to quantify.
The most significant
findings include:
A number of studies in
the past have found that members of ethnic minorities had a higher
rate of mental illness, and have under-utilised psychiatric services.
Further
clarification indicated that this was true for some ethnic minorities,
but not for others, and
that the dividing line is not colour or race. Thus Irish people in the
US and the UK tend
to have higher rates of psychosis than any group of black people; and
people of
Pakistani origin in the UK have the highest rate of neurosis.
The much publicised finding
that Caribbean men have a higher rate of psychosis has been
supplemented more
recently by findings from a larger study (Nazaroo,
1997, 1998)
which suggests that
these men do not have a higher rate of psychosis than white men.
US findings indicate the
same conclusion (Kessler, 1995).
Pertaining to common
mental disorders most ethnic minority groups share a similar rate to
that of the
general population. There is some indication that depression is higher
in
Afro-Caribbeans and Africans; anxiety is higher among Irish-born and
non-British white groups,
and phobias more prevalent among Asian and Oriental people than in the
indigenous
British white population (in Meltzer
et al, 2004, p.208).
The centrality of
poverty is retained when looking at ethnicity; poorer people in
ethnic minorities are more
likely to experience mental ill health than those who are not. Current
evidence related
to prevalence and ethnicity may indicate changing patterns (Rogers and
Pilgrim,
2003, p.30-31).
There are a number of
ways in which services assert their control, including the claim
to professional
expertise, monopoly over both knowledge and methods of intervention,
and hence
the almost inevitable rejection of lay knowledge.
Most epidemiological
research on inequality does not look at the traditional indicators
of violence in mental
health, namely harm to others and to oneself by service users.
The statistical evidence
shows a small increase in harm to others under the experience
of psychosis, and a
considerable increase in self harm (Monahan,
1992, Swanson et al.,1999,
2000, Appleby
et al., 1997). Taylor and
Gunn’s 1999 British study has
demonstrated that
despite the assumption of the media and politicians of an increase in
homicide by
identified patients during the acceleration of psychiatric hospital
closure, the numbers
were slightly reduced. Trieste, where there is no psychiatric hospital
since1978 and
when necessary hospitalisation takes place in open community
mental health centre,
has reported very few cases of homicide or suicide between 1978 and
1988 (Sain et
al., 1988).
Rogers and Pilgrim’s
overview of violence in mental illness looks at the many instances in
which
service users are victims of violence rather than the very few ones in
which they are its
perpetrators , including warfare, hate crimes, neighbourhood stigma
which leads to
victimisation , child abuse, adult to adult violence (mainly domestic
violence), and
eugenic psychiatry (the enforced sterilisation of women
patients, practised in many European countries until the end of the 2nd World War, but until 1975 in Sweden, a country known otherwise for its enlightened social policy). They highlight the attention to individual pathology when the focus should be on socially caused violence, as well as to the fact that unlimited detention without due legal process takes place only in mental health.
Implications for social work
Although qualified by
beliefs, conceptual perspectives, and related methodological
limitations, the
findings highlight:
· inequality does exist in mental health, coming largely out of factors external to it;
· the central role played by poverty in being a major risk factor in leading to and maintaining mental illness;
· discrimination too has a central role in creating inequality in mental health (e.g. ageism in the context of not identifying and not treating depression of older people beyond medication; abuse in the lives of children, women and men; racism in the case of ethnic minorities, stigma and victimisation in neighbourhoods, politicians’ emphasis on harm to others and under-emphasis on victimisation of service users).
· psychosocial vulnerability factors interplay in the context of mental illness (e.g. physical illness and recent adverse life events, likely to include physical illness as one such event, which also affects the social position and socially valued roles of the ill person);
· mental health services and their providers contribute to inequality in a variety of ways through their monopoly on knowledge and expertise and through the exclusion of other types of knowledge.
· it stands to reason that biological factors may play a part in leading to and in maintaining mental ill health, but the evidence for this belief is not provided by the research on inequality in mental health.
The evidence illustrates the serious limitations incurred by locating the study of mental health within medicine as a scientific tradition (a rather separate issue from the usefulness or otherwise of medical interventions) , and vindicates the case for a psychosocial approach to mental health and illness, one in which social structural factors need to be tackled not less than psychological ones.
To anyone coming from
the social sciences the centrality of poverty as a context
which creates and
reinforces vulnerabilities while sapping resilience is no more than a
confirmation of past
understanding and knowledge (e.g.
Jones, 2006, Raphael, 2006).
Yet the acquiescence to
medicine by all mental health professions, including social workers,
continues. Some
of it is rooted in the status given to medicine in our
societies; some of it
stems from the ease of dishing out medication as compared to the
complexity of providing
psychosocial interventions and of securing their
effectiveness. Still
some more of it relates to the reluctance of professionals, governments
and the
general public to invest a lot more, and in more sophisticated
ways, in tackling social
structural factors and in fostering resilience instead of treating
users as an underclass
(Murray, 1994, Jones, 2006).
In the specific case of
social work the separation of theory, research and policy from everyday
social work,
the minority position of social work in multidisciplinary teams, the
relative lack of
respect towards it by successive government, and the lack of
sufficient knowledge and
skills for psychosocial work at different societal levels,
prevent it from taking
the central position it should take. These obstacles apply not
only to British mental
health social work.
More than their
colleagues in other Western countries, British mental health social
workers (MHSW) are
heavily focused on legal work related to compulsory admissions, in
their
role as Approved Social Workers (ASW) (Barnes et al., 1990).
In
Australia MHSWs are
responsible for care management, and for compulsory treatment orders in
the
community (Brophy and Ring, 2004).
Some US MHSWs are responsible for
planned
discharge from inpatient facilities, while the majority is engaged in
private
practice psychotherapy. More voluntary sector social work is provided
in Canada
(Shera et al., 2002). Continental
European MHSWs offer a range of
services, from
sorting out financial benefits to leading community work projects, but
focus less on
individual psychological interventions.
The proposed British mental health legislation will make it possible for other mental health professions to carry out the legal duties presently performed only by social workers, namely providing an additional perspective to that of psychiatrists (and GPs) during the process of compulsory admission. Rightly, social workers are afraid that this change will dilute further the psychosocial dimension in the assessment, given the lack of training and professional socialisation into this dimension by members of the other professions (Rapaport, 2006). Wrongly in my view is the lack of discussion as to what else could/should social workers add to their ASW work, or replace it with, when this task will be shared with mainly nursing colleagues.
Elsewhere I have
highlighted the price paid by social workers and their clients for the
over-emphasis on ASW
work (Ramon, 2006), which meant severely
cutting down on casework,
family
work, group work and community work in the field of mental health. By
now
community work has been taken out of social work altogether for
political reasons,
and to the limited extent that it is taking place in mental health it
is carried out by
voluntary sector organisations (Seebohm
et al., 2005). The central role
played by some
social workers in initiating user involvement in mental health has not
only not been
recognised within and outside social work, including by service users,
but has not led
to diffusion of such an involvement in everyday practice, where it
could have a truly
culturally transforming role.
The change in the
British Mental Health Act provides an opportunity for MHSW to
re-consider its values,
knowledge and skills base, both within the context of each society and
internationally, along the lines developed within the critical
perspective of
social work (Allan,
Pease and Briksman, 2003) . This would require moving away from the
defensive
position MHSW tended to occupy within the mental health system
and vis a vis
governments.
Instead, MHSW needs to
move to:
· genuine partnership in working with service users, their family members and friends (Beresford, 2005),
· become more engaged in the work to be done about the reduction and eradication of poverty as it relates to mental health , which includes being actively involved in social inclusion work (Repper and Perkins, 2003).
· be active in the development and implementation of recovery work (Roberts and Wolfson, 2004, Wallcraft, 2005, Ramon et al., 2006, Ramon et al., 2007).
· engage in the application of the strengths approach and the development of resilience layers at the individual and group levels (Norman, 2000, Greene, 2002).
· move away from its anti-intellectual, anti-research stance (Jones, 1996) to initiate its own research and theoretical framework in mental health.
These are not easy
options to put into practice, as they would require a significant
shift in training,
knowledge and skills in addition to government’s investment and work on
public
attitudes. However, their implementation would mean that social work
would be able to claim
that it attempts to move away from its current contribution to the
status-quo re
inequality in mental health.
References
Andrews, G., Henderson, S. and Hall, W. (2001). Prevalence, co-morbidity, disability and service utilisation: Overview of the Australian national Mental health Survey. British Journal of Psychiatry, 178,145-153.
Allan, J., Pease, B.
Briksman, L. (2003). Critical
Social Work: An introduction to theories and practice. Crows
Nest: Allen and Unwin.
Appleby, L., Shaw, J.
and Amos, T. (1995). Confidential Inquiry into
Suicide and Homicide, DoH,
HMSO.
Barnes, M. Bowel, R., Newton, A. and Fisher, M. (1990). Sectioned. London: Routledge.
Beresford, P. (2005). Developing self-defined social approaches to madness. In Ramon, S. and Williams. J.E. (Ed.). Mental health at the crossroads: The promise of the psychosocial approach. Aldershot: Ashgate Publishing,109-123.
Brophy, L. and Ring, D. (2004). The efficacy of involuntary treatment in the community: Consumer and service provider perspectives. Social Work in Mental Health, 2, p.157-174
Brown, G.W. and Harris,
T.
(1978). The social origins of
depression. London: Tavistock Publications.
Busfield, J. (2000). Rethinking the sociology of mental health. Oxford: Blackwell.
Bywaters, P. and
McLeod, E.
(1996). Working for equality in
health. New York: Routledge.
Campbell, C., Cornish, F. and McLean, C. (2004). Social capital, participation and the perpetuation of health inequalities: Obstacles to African-Caribbean participation in “partnerships” to improve mental health. Ethnicity and Health, 9(4), 313-335.
Castillo, H. (2002).
Personality disorder: Temperament or
trauma? London: Jessica Kingsley.
Ciompi, L. (1982). Is
there really a schizophrenia: The long term course of psychotic
phenomena. British
Journal of Psychiatry, 145, 636-640.
Dohrenwend, B.S.
and
Dohrenwend, B.P. (1981). Life
stress and illness. New York: Neale Watson.
Durkheim, E. (1897). Le Suicide, Paris: Alcan.
Eurobarometer (2003). The
mental health status of the European population, Eurobarometer 56.2,
Brussels: Author.
Goffman, I. (1961). Asylums. Harmondworth: Penguin.
Green, R.D. (2002).
Resilience: an integrated approach to
practice, policy and research. Washington DC: NASW Press.
Harding, C.M., Brooks,
G.W., Ashikaga, T. Strauss, T.S. and Breier, A. (1987). The Vermont
longitudinal
study of persons with severe mental illness: long term outcome of
subjects who
retrospectively met DSM III criteria for Schizophrenia. American Journal of Psychiatry,
144, 727-735.
Hauck, K. and Rice, N.
(2004). A longitudinal analysis of mental health mobility in Britain. Health
Economics, 13, 981-1001.
Huxley, P. and
Thornicroft,
G. (2003). Social inclusion, social quality and mental illness. British Journal of
Psychiatry,182, p. 289-290.
Jones, C. (1996). Anti-intellectualism and the pecularities of British social work education. In Parton, N. (Ed.). Social Theory, Social Change and Social Work. London: Routledge.
Jones, C., Burstrom, B. Marttila, A., Canvin, K., Whitehead, M. (2006). Studying social policy and resilience to adversity in different welfare states: Britain and Sweden, International Journal of Health Services, 26 (3), 425-442.
Kessler, R.C. (1995). The
epidemiology of psychiatric disorders. Boston: Harvard
University Press.
Kessler, R.C. (2005).
Lifetime risk and persistence of psychiatric disorders across ethnic
groups in the US. Psychological
Medicine, 35, 317-327.
Krieger, N., Williams, D.R. and Moss, N.E. (1997). Measuring social class in US public health research: Concepts, methodologies and guidelines, American Public Health,18, 341-378.
Meltzer, D., Fryers, T. and
Jenkins, R. (2004). Social
inequalities and the distribution of the common mental disorders.
Hove: Psychology Press
Monahan, J. (1992).
Mental Disorder and Violent Behaviour: perceptions and evidence. American
Psychologist, 47, 511-521.
Moser, K. (2001).
Inequalities in treated heart disease and mental illness in England and
Wales, 1994-1998.
British Journal of General Practice,
438-444.
Myles, F., McCollan, A. and
Woodhouse, A. (2005). National
Programme for Improving
Mental Health and
Wellbeing: Addressing Inequality in Mental Health in Scotland.
Equal Minds, Scottish
Centre for Mental Health, Scottish Executive. Edinburgh: Author.
Muntaner, C. (2004).
Commentary: Social capital, social class, and the slow progress of
psychosocial
epidemiology. International Journal
of Epidemiology, 33(4), 1-7.
Murray, C. (1994).
Underclass: The crisis deepens.
London: Institute of Economic Affairs.
Norman, E. (2000). Resiliency
enhancement: Putting the strengths perspective into social work practice.
Columbia University Press.
Nazaroo, J. (1997).
Ethnicity and mental health: Findings
from a national community survey. London: Policy Studies
Institute.
Nazaroo, J. (1998). Rethinking the relationship between ethnicity and mental health: The British fourth national survey of ethnic minorities. Social Psychiatry and Psychiatric Epidemiology, 33,145-148
Pilgrim, D. and Rogers,
A.
(1996). A sociology of mental health
and illness. Buckingham: The Open University.
Ramon, S. (2006). British Mental Health Social Work and The Psychosocial Approach in Context. In Double, D. (Ed.). Critical psychiatry: The limits of madness. Basingstoke: Palgrave Macmillan, 33-148.
Ramon, S. Lachman, M.,
Renouf, N. and Shera, W (2006). The
rediscovery of recovery from mental illness: A
multi-country comparison of policy and practice. Paper given
at the 5th
International Congress of Health and Mental Health Social Work, 13th
December.
Ramon, S. Healy, B. and Renouf, N. (2007). Recovery from mental illness as an emergent concept and practice in Australia and the UK, International Journal of Social Psychiatry, 53, 2, 108-122.
Raphael, D. (2006). Social determinants of health: Present status, unanswered questions, and future directions. International Journal of Health Services, 36, 651- 677.
Rapaport, J. (2006). New
role in mental health: The creation of the approved mental health
professionals.
Journal of Integrated Care, 14
(5), 37-46.
Repper, J. and Perkins, R.
(2003). Social inclusion and
recovery: A model for mental health practice. Edinburgh:
Balliere Tindall.
Roberts, G. and
Wolfson,
P. (2004). The rediscovery of recovery: Open to all. Advances in Psychiatric Treatment,
10, 37-49.
Rogers, A. and Pilgrim,
D.
(2003). Mental health and
Inequalities. Basingstoke: Palgrave Macmillan.
Rose, N. (2000). Powers
of freedom: Reframing political thought. Cambridge: Cambridge
University Press.
Sain, F., Norcio, B. and Malannino,
S. (1988). Compulsory health
treatment: The experience in trieste
from 1978 to 1988. For Mental Health,
4,139-151.
Sayce, L. (2000). From
psychiatric patient to citizen: Overcoming discrimination and social
exclusion. Basingstoke: Macmillan.
Scheff, T. (1975).
Labelling Madness. Englewood
Cliffs, NJ: Prentice Hall.
Shah, A. (2004). Report
3: Ethnicity and the common mental disorders. In: Meltzer, D., Fryers,
T. and Jenkins, R. (Eds.). Social
inequalities and the distribution of the common mental disorders.
Hove: Psychology Press.
Shera, W., Healy, B., Aviram, U. and Ramon, S. (2002). Mental health policy and practice: A multi -country comparison. Journal of Health and Mental Health Social Work, 35, 1-2, 547-575.
Seebohm, P., Henderson,
P., Munn-Giddings, C., Thomas, P., Yasmeen, S. (2005). Together we will
change:
Community development, mental health and diversity. Sainsbury
Centre for
Mental Health, London: Author.
Lehtinen, L. Stakes (2004). Action for mental health: Activities
co-funded from the European community public health programme
1997-2004, Report prepared for the European Commission,Health and
Consumer Protection Directorate-General. Helsinki: Author.
Swanson, J., Borum, R.,
Swartz, M. and Hiday, V. (1999). Violent behaviour preceding
hospitalisation among
people with severe mental illness. Journal
of Law and Human Behaviour, 23, 2,
185-204.
Swanson, J. Swartz, M.,
Borum, R., Hiday, V, Wagner, R. and Burns, B. (2000). Involuntary
out-patient
commitment and reduction of violent behaviour in persons with mental
illness.
British Journal of Psychiatry,
176, 324-331.
Taylor, P. and Gunn, A.
(1999). Homicide by people with mental illness: myth and
reality. British Journal of
Psychiatry, 174, 9-14.
Wallcraft, J. (2005). The Place of Recovery. In Ramon, S. and Williams, J.E. (Ed.). Mental health at the crossroads: The promise of the psychosocial approach (pp. 127-136). Aldershot: Ashgate Publishing.
Warner, R. (1985).
Recovery from schizophrenia.
London: Routledge.
Wilkinson, R. (2005). The impact
of inequality. London: Routledge.
Notes:
Paper prepared initially
for the first ESRC sponsored seminar of the Social Work and
Health Inequalities Research network: 20th January 2006