The Ecology of Social Integration. Practices and policies between social factors and subjectivity

The article emphasizes the importance of policies and practices contrasting social exclusion and promoting social integration in a new ‘ecological’ approach to mental healthcare. The relationship between the subjectivity of the person, their social capital, the services and institutions of our societies, the role of the social determinants of mental health are described. Inequities and inequalities arise from a number of parameters encompassed for instance by the Mental Health Integration Index developed by Peter Huxley and colleagues. At the same time, these parameters impact on individuals and their capabilities to use resources and opportunities, that is crucial in the field of mental health. The overall concept of citizenship is key for social integration. Citizenship rights are related to the power of individuals in the social domain and are regulated in psychiatry by the existing institutions and the level of social sanction they establish for ‘deviant behaviors’, condemning them to social exclusion. Thus, the need for a work of de-institutionalization and the shift of people and otherwise wasted resources to new community services. The example of Trieste, Italy is proposed for a possible action encompassing a set of levels that are required for this action. Merely ‘clinical’ services seem not to address the complex issue of comprehensive care. The main elements of a whole person, whole life and whole system approach, needed to enable individuals to be active member of their community, are finally summarized and outlined.