Mental Health Nursing

Social inclusion and acute care 59
have mental illness, unwilling to be seen in the company of someone with
this affliction, may simply ignore that individual (and their family) –
effectively withdrawing support and, through ostracisation, making their
life more difficult. Barham and Hayward (1995) have described how
people make efforts to ‘prove’ their ‘sanity’ and trustworthiness to friends
and neighbours following acute relapse.
Employment has long been acknowledged as central to social inclusion
(Bennett, 1975). Work links an individual to the society in which they
live: without work, these links are all too easily lost – a fact recognised in
various government ‘New Deal’ policies, including the New Deal for
Disabled People which explicitly includes those with mental health problems.
As well as an income, work provides social identity and status;
social contacts and support; a means of structuring and occupying time;
activity and involvement; and a sense of personal achievement (Jahoda
et al., 1933; Bennett, 1975; Shepherd, 1984; Warr, 1987; Rowland and
Perkins, 1988; Pozner et al., 1996; Grove, 1999). Work tells us who we
are and enables us to tell others who we are: it is typically the second
question we ask when we meet someone: ‘What is your name?’, ‘What do
you do?’
The existence of work in a person’s life is a necessary counterpoint to
leisure: without work – the things we have to do – the concept of leisure –
free time – is meaningless (Rowland and Perkins, 1988). Jahoda et al. (1933)
showed that unemployed people do not exploit the extra time they have available
for leisure and social pursuits. Their social networks and social functioning
decrease, as do motivation and interest, leading to apathy.
A person’s employment is severely jeopardised by acute mental health
crisis and admission. At first admission many people are in employment.
Yet many employers are reluctant to retain, or take on, employees with
mental health problems, the prevailing stereotypes of mental illness causing
them to believe that workers with such difficulties are likely to be dangerous,
unreliable, unpredictable, unproductive. Many people who are
admitted to hospital may have behaved inappropriately at work prior to
admission and even a sympathetic employer may not know what to do to
help. Therefore contact with, and support for, employers is essential if
people are to be able to return to their employment on discharge. For those
in education, the role of the student is equally important, but teachers and
lecturers may share much of the ignorance and prejudice of employers and
fail to make the adjustments necessary to enable the person to resume
their course once they are discharged. Again contact with and support
for education providers is equally important in maintaining a person’s
social inclusion.
Once on an acute ward, social roles, activities and routines are suspended,
family relationships are disrupted, time is taken off work or college, and