Socially Inclusive Practice

First Step
Mark Hayward
Sussex Partnership NHS Foundation Trust

Why now?
Psychological health is strongly influenced
by context. It is essential that Clinical
Psychologists pay attention to the influence
of race, gender and culture in the expression
of psychological difficulties and the
professional response, and the relationship
of these variables to the accessibility and
acceptability of services.
(Professional Practice Guidelines, 1995)

People Become Very Isolated

Services

Sport &
exercise

Employment

Education

Family &
neighbourhood

Volunteering

Faith
communities

Arts and
Culture

Sue attends the day centre and the clinic.

She has 5 friends she sees at outpatients or the day centre.

Applied Psychologists
broadening our contexts?

How accessible are the skills and knowledge of applied psychology to

service users and community stakeholders?

How much do I know about the local community - its population,

employers, educators, voluntary services, self-help groups, etc?

How am I using psychological theory to understand the processes of

stigma, discrimination and exclusion?

How can I work collaboratively alongside service users as colleagues,

rather than as clients?

How will I mange the anxieties generated by collaborating and working

across service/community boundaries?

Define the policy drivers

Defining socially inclusive

practice
Socially inclusive practice seeks to make explicit links between the
needs, identity, aspirations and behaviour of individuals in distress (or
who experience disability), and the needs, identity,aspirations, and
behaviour of their local communities or communities of interest. The
process of creating a safe space for personal exploration, the gathering
of information, enhancing awareness, negotiating opportunities and
appropriate interdependence and supporting autonomy may involve
the practitioner working with individuals in distress, their family and
friends and pivotal members of local communities. Change will
culminate in an individual who experiences a personally meaningful
life and is able to make choices and contribute to their community in
ways that are valued.

What does socially inclusive

practice look like?

ESC 1: Working in partnership

Work actively to build, maintain and sustain
partnerships with other community
agencies so as to foster understanding,
access resources and create a wide
spectrum of opportunities for people with
mental health problems. This work is
recognised and valued by the mental health
organisation

Working in partnership
Facilitating a group of service users and providers
who are working with local employers and
businesses to raise awareness of mental health
issues, how to prevent these, how to support people
at work, and how to facilitate the gaining and
retaining of employment for people with mental
health problems if they so wish. The group is
working on the development of courses and a Mental
Health Promotion Charter for employers.

ESC 4: Challenging Inequality

'Demonstrate an understanding of people
with mental health problems, particularly
as this relates to access to community
inclusion. This includes recognition of the
feelings of distress and shame that can be
caused by discrimination and how negative
reputations can develop and be sustained,
and how they can be dismantled

Raising awareness in schools

In East London, trainee clinical psychologist Catherine
Sholl conducted a four session intervention at a secondary
school to change discriminatory attitudes and beliefs about
mental health. Catherine co-facilitated the sessions with
someone who had personal experience of using mental
health services. She recruited an intervention and control
group and found significant before and after differences.
The pupils commented on how much they had enjoyed the
sessions and learnt from them. They particularly liked
meeting the person with experience of using services and
would also have liked to meet others, particularly service
users of a similar age to them.

ESC 6: Identifying peoples needs &

strengths
Carry out or contribute to a systematic,
whole systems assessment that has, as its
focus, the strengths and needs of the service
user and he family and friends who support
them

Working with families

In Wandsworth, clinical psychologists have initiated and led

the development of a multidisciplinary family therapy clinic
offered to adults in acute inpatient settings. The clinic team
consists of both community and ward staff helping to provide
a seamless service and continuity of service provision for the
service users and carers. The aims of the service are to:

Provide service users and their families an opportunity to

think about the impact of admission.
Reflect on individual strengths of each family member and
explore how each persons strengths can be used to enhance
the familys ability to solve problems.
Help families identify helpful ways of dealing with the
specific problems that they meet and to help family members
look after their own needs as well as each others needs during
this stressful time.

ESC 8: Making a difference

Recognise the healthy and inclusive
elements of a service users current life and
help them to sustain these

Existing valued roles

During one workshop I was exploring issues of
employment with workers from an inpatient unit. What
struck these workers was their neglect of employment
as a possible vehicle for recovery. Not so much
exploring future employment opportunities, as this
may be difficult to do when someone is very
distressed. But assessing the impact of hospital
admission on existing employment did employers
need to be contacted, sick certificates arranged, etc.?
The staff had been operating under the assumption
that individuals admitted to the ward were
unemployed, and the workshop assisted them to
examine this assumption and recognise the role they
could play in assisting people to maintain employment
as part of a process of remaining connected with
valued activity and existing networks.

ESC 9: Promoting safety and

positive risk taking
Include risk of exclusion in risk
assessments by ensuring that risk
assessments are hopeful rather than
pessimistic, informed by the service users
ambitions and increase rather than
decrease opportunities for recovery and a
valued lifestyle

Risk taking in context

An unemployed man in his late fifties was admitted to an
acute mental health unit after making an attempt to end
his life. After a few days in the unit, he revealed to staff
that he hoped to attend a previously arranged job
interview, set for a few days hence. He remained
ambivalent about carrying on with his life, but explained
to staff that he worried he would further lose hope if he
did not keep his commitment to interview for the job, as
the interview had been arranged by a former work
colleague. His clinical team members were concerned
about his ongoing risk to himself when under his own
care, especially if the job interview did not go well. But
they were also aware that he might become more
distressed if he were deprived of the opportunity to
attend the interview. The team negotiated a careful risk
management plan with the man, and allowed him to
attend the interview. He did not get the job, but returned
to the ward safely, stating he was grateful for the chance
to plan for his future.

objectives

demographics

How inclusive are

you/ your service?
belief
systems

community
contact &
engagement

Next steps?