Barriers and facilitators to social inclusion among people with severe mental illness: A qualitative study

People with severe mental illness are often socially excluded. Social exclusion is associated with worse mental health outcomes and poorer quality of life, making it a key target for recovery. Despite this, people with severe mental illness often do not receive support for social inclusion. Further, it has not been clearly established how to improve social inclusion in this population. This study aimed to qualitatively examine the barriers and facilitators to social inclusion among people with severe mental illness, from the perspective of both mental health service users and staff. We conducted individual interviews with people with a severe mental illness and focus groups with mental health staff. Both service user and staff participants were recruited from a range of mental health services in two NHS trusts in London. Questions explored participant views on the barriers and facilitators to social inclusion among people with severe mental illness, using semi-structured topic guides. Interviews and focus groups were analysed using inductive thematic analysis. Interviews were conducted with fifteen service users and four focus groups were conducted with sixteen mental health staff. We identified six primary themes representing a range of barriers and facilitators to social inclusion. These related to: (i) a person's own individual characteristics and abilities; (ii) the role of their mental illness; (iii) the influence of their social relationships; (iv) the system of mental health care and support; (v) their financial situation and access to opportunities; and (vi) the impact of different types of stigma. Social inclusion is a complex but important priority for people with severe mental illness. This study highlights the particular need for continued development into social interventions, an individualised approach to care, and stigma reduction in mental health.