Social Exclusion and Psychosis

SUMMARY

This article considers aspects of the possible impact of social exclusion upon psychosis and the implications of this for mental health social work practice. Against a background of calls for evidence based practice, and increasing recognition of the significance of theories and understandings as the foundations of practice, the article will first explore current and historical ways of viewing and intervening with the relationship between social adversity and mental health. Then, alternative understandings of this relationship, supported by recent research regarding the impact of trauma and extreme social adversity upon physiological and physical processes implicated in mental ill-health, will be discussed. These approaches have major implications for social work practice with psychosis, suggesting that experiences of trauma and disadvantage, and interventions seeking to alleviate the inner and outer effects of these experiences-tasks central to the social work remit-can make a significant difference to mental health outcomes. However, this is not to advocate a simple (albeit under-resourced) 'social solution'! On the contrary, the understandings underpinning these approaches recognise biological processes play a role in mental and physical ill-health: importantly, however, they can be shown to question the stigma traditionally attached to the concept of biological disorder in mental health, thus pointing to the value of a truly biopsychosocial approach with psychosis, involving fully holistic interventions that differ from those currently dominant, and which carry implications for more egalitarian worker-user relationships.

Key Words:

• Mental health
• psychosis
• social exclusion
• social work
• sociological realism
• enduring serious mental health problems
• psychobiology
• trauma
• poverty
• biopsychosocial approach