Table 3

Summary of articles defining social inclusion and occupational justice in mental illness and HIV

Author(s) year	Participants Setting		Design	Aim	Definition(s) of social inclusion and/or occupational justice	How operationalised		Associated key terms used
3a: Studies with primary data collection
Mazzi et al 201839	30 people with non-affective psychosis. In a social inclusion intervention programme Italy		Cross-sectional study	‘To assess whether a social inclusion intervention is associated with better outcomes in terms of personal and social recovery, with particular reference to the areas of social functioning and activity, and subjective dimensions such as self-esteem, self-stigma and perceived quality of life’ (p1)	Social inclusion is the opportunity for an individual to participate in key functions or activities and in the economic, social and cultural life of his/her community, exercising the rights of his/her citizenship and enjoying an adequate standard of living and well-being.	As an outcome and intervention As a human rights issue		social withdrawal, quality of life, discrimination, social recovery, social inclusion activities, social disadvantage
Saavedra et al 201843	31 service users with severe mental illness. In workshops for social integration Spain		Mixed-methods study	To evaluate the impact of an artistic workshop on a group of people diagnosed/screened for with severe mental illness with focus on the impact of creative practices on well-being and social inclusion outcomes.	Social inclusion stated as a personal construct measured through perception of social isolation, social relationship and social acceptability	As an outcome to be evaluated based on personal perception Measured using Social Inclusion Questionnaire		stigma, wellbeing, recovery, social isolation, social relationship, social acceptability
Berry and Greenwood 201733	51 young outpatient service users with first episode psychosis. In Early Intervention in Psychosis, Community Mental Health and Assertive Outreach services UK		Longitudinal study	‘To investigate the direct and indirect associations between dysfunctional attitudes, self-stigma, hopefulness, social inclusion and vocational activity for young people with psychosis’ (p197).	Social inclusion comprises social activity and community belonging.	As measured by levels of social activity and community belonging using Social Relationships Scale and Social Inclusion Scale		self-stigma, hopefulness, social activity, community belonging, social network, social contact, vocational activity
Turner et al 201745	71 people with psychotic-related conditions. In a research programme on schizophrenia Ireland		Quantitative descriptive study	To explore ‘the level of social inclusion among people with psychotic-related conditions using a standardised interview’ (p195)	Social inclusion is a multidimensional phenomenon with a number of domains including socially valued role functioning, social support, absence of stigma and integration in rehabilitation community and wider community	As a multidimensional phenomenon As both objective and subjective outcome Assessed using Social Inclusion Interview Schedule		supportive relationships, stigma, integration, social exclusion, social support, rehabilitation
Raitakari et al 201641	16 mental health service users. In two mental health FSSs Finland		Qualitative study	To explore how community integration is understood and tackled in mental health FSSs and, more precisely, in service user–practitioner home visit interaction	Social inclusion is articulated in political discourse as a way to tackle social exclusion and to increase citizens’ participation and activity in society	As supported integration in community life As participation in what marginalised individuals are usually excluded from		social exclusion, citizenship, community integration, housing, interaction, mental health, recovery
Killaspy et al 201438	67 mental health service users with psychosis. Living in the boroughs of London and the inner-city UK		Quantitative study	To investigate change in social inclusion after the development of a psychotic illness (clinically diagnosed) and associated factors	‘Social inclusion refers to the opportunities that individuals have to participate in key areas of economic, social and cultural life’ (p148)	Focus on participation and access to services and opportunities Five domains of social inclusion: social integration, consumption, access to services, productivity, political engagement Assessed using the Social Inclusion Questionnaire User Experience		social exclusion, social disadvantage, social integration, employment, social isolation
Salles and Barros 201349	17 mental health service users and 12 individuals from their social networks. In Psychosocial Care Centres Brazil		Qualitative study	‘To identify and analyse the conceptions expressed by the interviewees about social inclusion and mental illness’ (p37)	‘Social inclusion is a process of promoting rights, access, choice and participation. For individuals with mental health problems, this also means access to the best possible forms of treatment’ (p37)	As a dynamic, multidimensional process		work participation poverty
Salles and Barros 201349	17 mental health service users and 12 individuals from their social networks. In Psychosocial Care Centres Brazil		Qualitative study	‘To identify the daily life experiences of users of a psychosocial care centre related to processes of social exclusion and inclusion’ (p704).	‘Social inclusion is a process of the individual’s choice on how to live her daily life’ (p710) and not just about experiencing full participation in society	As a multidimensional process As a human rights issue As subjective experience centred on work participation		social exclusion, discrimination, prejudice, stigma, social isolation, social participation, empowerment, poverty
Clewes et al 201334	Single case-study with bipolar depression. In occupational therapy interventions under UK National Health Services (NHS) UK		Case study	To illustrate how the combination of medical outpatient clinic and occupational therapy intervention together made a big difference in a person’s life.	Social inclusion was taken as meaningful inclusion in the areas of life where the participant wished to be.	As personal experience As a degree of autonomy, ownership, responsibility and independence		stigma, recovery, social policy, empowerment, rights, engagement, spirituality, client leading
Nieminen et al 201240	23 mental health service users. In an intervention group follow-up study The European Union		Qualitative study	To describe how the mental health service users experienced social inclusion and employment in the European Union EMILIA project	Social inclusion is a subjective sense of belonging and active citizenship that enhances social integration	As an experience and feeling of active citizenship		empowerment, social network, finance and housing employment, social exclusion, stigma, prejudice
Fieldhouse 201236	Eight mental health service users in a 2 year action research project UK		Qualitative research	To describe an action research project that explored the recovery journeys of a group of assertive outreach service users who had progressed from being socially excluded and occupationally deprived to being participants in their local communities and to use this knowledge to inform local service development.	Social inclusion is when people with mental health challenges enjoy rewarding social relations through renewed engagement in mainstream occupations resulting in fuller community participation	As active participation in context or local community As an outcome of occupation-based interventions		social participation, social relationships, stigma, social exclusion, community participation, belonging, social capital
Stain et al 201247	1825 adults with psychosis in an Australian national survey of psychosis Australia		Quantitative study	‘To explore the impact of psychosis on an individual’s social and community participation’ (p879)	‘Social inclusion refers to the participation of a person in society and is evidenced by an individual having the opportunities, resources and abilities to build and maintain relationships, engage in education and employment and participate in community events and organisations’ (p880)	As participation in mainstream life as empowered individuals		social isolation, social anxiety, stigma, social participation, community participation
Smyth et al 201144	Eight mental health service users in mental health rehabilitation services in inner-city area UK		Qualitative study	To explore the experiences of social inclusion for mental health service users and factors associated when engaging in everyday community occupations	Social inclusion is developing fair access to opportunity in key social and economic spheres for marginalised groups	As an issue of participation and access to services and opportunities		stigma occupational deprivation, discrimination, social networks
Ramon et al 201142	27 key informants in an evaluation study of the EMILIA project The European Union		Qualitative study	To identify how participation in the EMILIA project affects the lives of mental health service users in relation to social inclusion, employment and recovery	Social inclusion is a subjective sense of belonging and active citizenship that enhances social integration	As an experience and feeling about participation in society		employment, well-being, quality of life, social networks
Hamer et al 201746	82 mental health service users New Zealand and Brazil		Qualitative study	To present service users’ stories of distressing exclusion that interrupted their rights to occupational justice, and marginalised them from occupation. The paper also presents the practices of inclusion that service users engaged in that restored their rights and responsibilities as occupied and active citizens	Social inclusion is the extent to which people are confident about and able to exercise their rights and participate, by choice, in the ordinary activities of citizens Occupational justice recognises the person’s right to inclusive participation in everyday occupations regardless of age, ability, gender, social class or other differences	Social inclusion as a policy issue As a dynamic concept, derived from subjective experiences Social inclusion is enhanced through occupational justice As inclusive participation As a human right issue		occupational injustice, citizenship, stigma, discrimination
Fieldhouse 201236	Eight mental health service users in a 2 year action research project UK		Qualitative Study	To examine the impact of community participation on their recovery and social inclusion and how service users’ experiences informed joint planning between mental health services and the learning community to promote social inclusion.	Social inclusion as the process of enabling citizenship through fuller community participation Occupational justice defined as the process of lobbying for the occupational needs of individuals and communities as part of a fair, inclusive, and empowering society; as a community reintegration issue	As active participation in mainstream society		social participation, social relationships, stigma, social exclusion, community participation, belonging
Farrell and Bryant 200935	Nine recruiters of volunteers who had mental illness UK		Qualitative study	To explore the recruiters’ understanding of mental health problems, drawing on their experiences	Occupational justice is an intrinsic part of social justice, permitting equitable opportunity and the means to choose, organise and perform meaningful occupations Social inclusion stated but not defined	As a process and an outcome Occupational justice as an intrinsic aspect of social inclusion		volunteering, discrimination, stigmatisation, social exclusion, social attitudes, prejudice, occupational deprivation, occupational marginalisation, occupational apartheid
3b: Review, commentary, lectureship and opinion papers
Le Boutillier and Croucher 201051	Mental health service users		Opinion paper	To present an alternative to the polarised view of social inclusion	Social inclusion is a multidimensional virtuous circle aimed at improving rights of access to the social and economic world, new opportunities, recovery of social identity and meaningful life and also reduced impact of disability on everyday life	As a multidimensional system		social exclusion, occupational justice, occupational balance, occupational alienation, occupational deprivation
Cobigo and Stuart56 2010	Mental health service users		Review	To review recent research on approaches to improving social inclusion for people with mental disabilities	Social inclusion is when one feels accepted and recognised as an individual beyond the disability; has positive personal relationships with family, friends and acquaintances; is actively involved in recreation, leisure, and other social activities; has appropriate living accommodations; has healthy employment; and has appropriate formal (service system) and informal (family and caregiver) supports	As an acceptance, human rights, outcome of interventions issue		stigma, discrimination, legislation, community support, disability rights, justice, human rights
Cáceres et al 200855	Global literature on Men who have sex with men (MSM) with HIV		Review	To analyse reasons for continued risk of HIV and its consequences in MSM globally	‘A social inclusion perspective on HIV prevention and AIDS care implies the adoption of a broad range of strategies to understand and confront social vulnerability’ (p11)	As a perspective to addressing vulnerability		social exclusion— describes the alienation or disenfranchisement that certain individuals or groups experience within society—stigma discrimination, prejudice, human rights, poverty, migration, employment participation, sexuality
Lloyd et al 200666	Mental health service users		Review	To describe a selected number of activities that promote social inclusion	Social inclusion involves being able to rejoin or participate in leisure, friendship and work communities	Participating and accessing services and opportunities		connectedness and interdependence
Farone 200670	Mental health service users, with a focus on schizophrenia		Review	To examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in schizophrenia	Social inclusion discussed but not defined	A link to mental and emotional well-being		community integration, community inclusion, social integration, stigma, social support, social networks
Evans and Repper 200057	Mental health service users		Review	To challenge common misconceptions surrounding employment, work and mental health problems of mental health service users	Social inclusion is defined as a need, aspiration and citizenship issue among mental health service users Social inclusion as an outcome of work participation.	A social need An outcome of work participation		social exclusion, stigma, unemployment, poverty
Mandiberg 201253	People with psychiatric disabilities		Commentary	To describe the failure of social inclusion as a concept and present an alternative approach through community development	Social inclusion refers to full participation in the broader community for people with severe mental illnesses	As experience of participation in the broader community		work integration, community development, social enterprises
Townsend 201252	Mental health service users Canada	Lectureship		To propose for an interdisciplinary knowledge exchange with a critical occupational perspective on the question: What lessons on boundaries and bridges to adult mental health can be drawn by connecting the capabilities and occupational frameworks of justice?	Occupational justice as the enjoyment of the 'occupational rights' of all people to engage and be socially included in their desired occupations, and thereby to contribute positively to their own well-being and the well-being of their communities	As a human rights, capabilities and justice issue	occupational rights, occupational possibilities, occupational deprivation, alienation, imbalance and marginalisation
Harrison and Sellers 200850	Mental health service users and mental health team UK	Opinion Paper		To explore the implications and challenges for occupational therapy roles in mental health services regarding socially inclusive practice and to discuss policy that is designed to broaden professional roles	Occupational justice identifies inequalities in opportunities to participate in occupations	As a human rights issue about participation in occupations As a policy issue	social exclusion, participation, poverty, occupational deprivation
Hamer 201758	Mental health service users	Review		To discuss how social inclusion for mental health service users can be enhanced through occupational justice and the protection of their rights as citizens to have meaningful employment.	Social inclusion can be defined as the extent to which people are confident about and able to exercise their rights and participate, by choice, in the ordinary activities of citizens Occupational justice stated but not defined	As a human right issue	social exclusion, stigma, occupational justice, employment participation, poverty
Pettican and Bryant 200754	Mental health service users	Theoretical analysis		To explore the potential of occupational justice and its related concepts. To provide the occupational therapy profession with a theoretical justification for occupational therapists adopting an occupation-focused role in community mental health teams	Social inclusion is a drive aiming to overcome discrimination and stigma faced by people with mental health problems, in order to facilitate their having equal access to mainstream employment, education and leisure opportunities. Occupational justice is recognising and providing for the occupational needs of individuals and communities as part of a fair and empowering society	Social inclusion conceptualised as a policy drive issue As a justice and human rights issue As an occupational participation issue	occupational deprivation, occupational imbalance, occupational alienation, social justice

FSSs, floating support services.