Inequality In Mental Health:
The Relevance of Current Research and Understanding To Potentially Effective Social Work Responses
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.
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
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
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
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
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
(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
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).
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
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.
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
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
framework, which looks at the imbalance in power as the key to
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
2003, p. 158) which links social stratification with mental illness and
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
victimisation of mental health service users by perpetrators who are
not usually mentally ill
(though a minority of inpatients also do victimise other patients).
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
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
terms of reliability and validity (e.g.
As epidemiology defines
itself as the study of populations, large samples are
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
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
and the Netherlands
(Meltzer et al, 2004, table 1.3).
The high risk groups evidence
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
expertise, monopoly over both knowledge and methods of intervention,
the almost inevitable rejection of lay knowledge.
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,
et al., 1997). Taylor and
Gunn’s 1999 British study has
despite the assumption of the media and politicians of an increase in
identified patients during the acceleration of psychiatric hospital
closure, the numbers
were slightly reduced. Trieste, where there is no psychiatric hospital
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
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
· 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,
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
some more of it relates to the reluctance of professionals, governments
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,
work, group work and community work in the field of mental health. By
community work has been taken out of social work altogether for
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
social work (Allan,
Pease and Briksman, 2003) . This would require moving away from the
position MHSW tended to occupy within the mental health system
and vis a vis
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
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
inequality in mental health.
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,
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,
(1978). The social origins of
depression. London: Tavistock Publications.
Busfield, J. (2000). Rethinking the sociology of mental health. Oxford: Blackwell.
Bywaters, P. and
(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
Journal of Psychiatry, 145, 636-640.
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,
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
study of persons with severe mental illness: long term outcome of
retrospectively met DSM III criteria for Schizophrenia. American Journal of Psychiatry,
Hauck, K. and Rice, N.
(2004). A longitudinal analysis of mental health mobility in Britain. Health
Economics, 13, 981-1001.
Huxley, P. and
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
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
British Journal of General Practice,
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
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
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,
(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
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
Journal of Integrated Care, 14
Repper, J. and Perkins, R. (2003). Social inclusion and recovery: A model for mental health practice. Edinburgh: Balliere Tindall.
Roberts, G. and
P. (2004). The rediscovery of recovery: Open to all. Advances in Psychiatric Treatment,
Rogers, A. and Pilgrim,
(2003). Mental health and
Inequalities. Basingstoke: Palgrave Macmillan.
Rose, N. (2000). Powers
of freedom: Reframing political thought. Cambridge: Cambridge
Sain, F., Norcio, B. and Malannino,
S. (1988). Compulsory health
treatment: The experience in trieste
from 1978 to 1988. For Mental Health,
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
Community development, mental health and diversity. Sainsbury
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
people with severe mental illness. Journal
of Law and Human Behaviour, 23, 2,
Swanson, J. Swartz, M.,
Borum, R., Hiday, V, Wagner, R. and Burns, B. (2000). Involuntary
commitment and reduction of violent behaviour in persons with mental
British Journal of Psychiatry,
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.
Wilkinson, R. (2005). The impact
of inequality. London: Routledge.
Paper prepared initially for the first ESRC sponsored seminar of the Social Work and Health Inequalities Research network: 20th January 2006