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Editorial: Reflections on Inclusion

By Bonnie Pape
Network, Spring-Summer 2007

The recent Senate Committee report, ‘Out of the Shadows at Last,’ contains compelling testimony from people who have used mental health services. Their accounts of how it feels to be labelled, marginalized and isolated have brought the issues of stigma, discrimination and exclusion into sharp focus for Canadians.

Even though the concept of ‘inclusion’ is not new, its importance for people with mental illness (and indeed for the mental health of people in general) is becoming increasingly clear. The time is right to initiate a fresh conversation about what inclusion means and how to facilitate it.

My very first project when I joined the CMHA National staff in 1986 was to convene a national User Involvement Task Group with the goal of enhancing the participation of ‘service users’ both within CMHA and in society in general. It’s been an ongoing learning process ever since, but reflection on these years of experience brings a few observations.

Inclusion resists traditional labels: People who have experienced the mental health system are still too often defined by that experience. An inclusive community moves beyond the labels of patient, client or consumer, to embrace people as relatives, friends, neighbours, peers, employees, students – in short, citizens like any other. The experience with mental health services is not the only element of who they are, nor is it relevant for belonging in community.

Inclusion emerges through creative thinking: While service approaches such as psychosocial rehabilitation are certainly important and effective in helping connect people to community, they are not the only possible responses. CMHA’s Framework for Support model discusses how other mediating structures such as religious institutions, interest groups, colleges, and survivor businesses create community linkages. Several years ago, some Ontario CMHA branches built on this model to demonstrate new strategies for inclusion. Their initiatives included a community theatre troupe, partnering with generic agencies such as the Food Bank and United Way for volunteering opportunities, and working with the YMCA to enhance access to recreational programs.

Inclusion thrives on community partnerships: The above examples illustrate how community groups can kick-start an innovative inclusion strategy by engaging partners outside the mental health sector, along with mental health stakeholders (including people who have used services). Not only can this lead to identification of creative joint initiatives, but it also helps keep the focus on people’s capacities and citizenship rather than on just their mental health status.

Inclusion is affected by stigma, and vice versa: Inclusion cannot be successfully achieved if stigma and discrimination continue to shut people out. Must we first tackle stigma before promoting inclusion? Since reducing stigma is a long-term prospect, concurrent strategies would seem to make sense. In fact, evidence that proximity can help reduce unfounded fears and prejudice suggests that inclusion initiatives themselves may help to combat stigma.

Inclusion must be embedded in the broader policy context:Clearly, inclusion is connected to other efforts that support mental health and recovery. A strategic policy approach that includes support for peer initiatives and families, targeted public education, and action on the social determinants of health will create a fertile ground for inclusion to flourish.

Inclusion promotes mental health: Inclusion is a key element of mental health promotion. Regardless of a diagnosis of mental illness, having a place where you belong, can contribute, and feel accepted is fundamental to everyone’s mental health.

Bonnie Pape is an independent consultant and former Director of Programs and Research at CMHA National.

» Return to Network, Spring-Summer 2007 – Contents