National mental health policy 2008

2.6 Participation and inclusion

Page last updated: 2009

People with mental health problems and mental illness have the same rights as other Australians to full social, political and economic participation in their communities.
Improved mental health outcomes will increase our human capital through greater productivity and active participation in social and community roles. Community participation (e.g. employment) can have a significant positive mental health impact, such that people with mental health problems and mental illness should be supported to engage in all aspects of society.

There are clear benefits to be gained from an approach that involves government and community partnerships that include but extend beyond mental health. In addition to the examples of housing, employment and criminal justice, other sectors have an important role to play. These sectors include, but are not limited to, education and training, family and community services, immigration and citizenship, Indigenous affairs, defence and veterans’ affairs, child and youth affairs, ageing, police, human rights and anti-discrimination, and disability. Such an approach requires strategic, coordinated efforts across sectors.

It is the responsibility of all sectors to promote positive reforms that facilitate participation and inclusion. For example, the provision of appropriate housing and support for individuals with mental health problems and mental illness is widely recognised as enhancing effectiveness of treatment and maintenance of positive outcomes, and decreasing community resistance to deinstitutionalisation. People with mental health problems and mental illness are over-represented among homeless populations, and among those seeking rental assistance and accommodation support. They often experience discrimination in housing, and their housing preferences typically do not match the options most commonly made available to them. Multi-faceted coordinated accommodation programs that encompass a range of public and private housing options may redress this imbalance.

Employers should ensure equitable participation in work for people with mental health problems and mental illness who are currently disproportionately represented among unemployed groups, and consequently among those on low incomes. Unemployment and low socio-economic status are identified risk factors for mental illness, and mental health problems can sometimes lead to unemployment and/or a downturn in social mobility. Other social factors, such as discrimination and stigma, may further contribute to disadvantage. A coordinated range of strategies to promote social inclusion is required to correct the current situation.

The criminal justice sector also has a role in ensuring that people with mental health problems and mental illness can participate in and contribute to the community. At present, people with mental health problems and mental illness are over-represented in the criminal justice system, and some, such as Aboriginal and Torres Strait Islander people, experience double disadvantage. People with a mental illness who are arrested for minor offences are four times more likely to be jailed for these offences than their counterparts with no mental illness. Offenders with a mental illness have a higher likelihood of being remanded in custody than non-mentally ill offenders, and spend longer in custody awaiting sentencing. Prisoners have higher rates of mental health problems and mental illness than the general population, and those with mental illness who spend time in jail face additional stigma when they return to the community.

Suitable programs are necessary to divert people with mental health problems and mental illness from criminal courts and from custody when appropriate. Care and support are also required pre and post release to support reintegration into the community in a manner that allows them to fulfil satisfying roles and social inclusion. For those who have experienced prolonged incarceration, or high levels of recidivism, comprehensive cross-sectoral approaches are most likely to minimise the risk of relapse and recidivism.

Homelessness is a common consequence of untreated severe mental illness. Severe mental illness is often accompanied by personal disorganisation and episodes of acute care, resulting in loss of rental accommodation, or leaving the family home due to conflict arising from behaviour associated with the mental illness. Unstable housing arrangements also contribute to deterioration of mental health. Appropriate clinically supported short-term and long-stay accommodation options for people with severe or ongoing disability caused by mental illness should be developed, enabling early intervention at points of crisis and instability and preventing avoidable homelessness. In addition, multi-faceted coordinated accommodation programs that encompass a range of public and private housing options may further enhance consumer outcomes.