Social Inclusion and Mental Health: Understanding Poverty, Inequality and Social Exclusion By Jed Boardman, Helen Killaspy and Gillian Mezey 2nd edn. Cambridge University Press. 2023. £39.99 (pb). 410 pp. ISBN 9781911623595

Coming 13 years after the original, this is the second edition of Social Inclusion and Mental Health. All three of its UK authors were part of the original quartet. Jed Boardman is a clinical and academic psychiatrist with special interest in social policy, Helen Killaspy a professor of rehabilitation psychiatry and Gillian Mezey an emeritus professor of forensic psychiatry. Although the number of pages in the new edition is almost identical to the original, the smaller print has ensured a much fuller volume. Its strengths include thorough conceptual analysis of the terms used, extensive references to scholarly and policy publications, significant attention to historical developments and direct quotations of experiences of people with ‘mental health conditions’ (the authors’ preferred term). These last are moving and give heart to the work.

The book is divided into three sections, entitled ‘Social exclusion, poverty, and inequality’, ‘Participation of people with mental health conditions’ and ‘Including people’. Overlaps and distinctions between issues such as social exclusion, poverty and deprivation and the interactions between them are examined in thoughtful detail. There is close attention to evidence, with due exposure of contradictory findings where this is the case, and acknowledgment of the multiple and sometimes competing perspectives involved. Useful terms discussed include ‘syndemics’ and ‘multiple exclusion’. My reading of their evidence is that the opposite to exclusion is not inclusion but participation. This rightly acknowledges that the individual person is not just determined by his or her circumstances but is also an active agent interacting with others and shaping the world they live in. There are separate chapters on participation in socially valued activities, civic participation and participation in specific groups as well on inequalities and access to material resources and physical and mental health services. A heartening feature of the volume is highlighting the dynamic nature of peoples’ social conditions. For example, most people move out of poverty over time (but some groups may find it more difficult to do so and some may slip back). The book is primarily focused on the UK, but there are references to North America and Oceania as well as low- and middle-income countries.

In the final section the authors attempt a synthesis of their findings with a view to future action. I particularly appreciated their development of a ‘descriptive model’ in the light of evidence they have presented (pp. 335–9). This both does justice to complexity and is clearly articulated. Figure 16.2 ‘Mental health problems and social exclusion: a descriptive model’ should be displayed in every psychiatric ward and consultation room, as both a reminder of issues too frequently ignored or skimmed over and as stimulus to socially inclusive practice, especially in the case of people with more severe mental health conditions. Community development, community integration, connecting people, social prescribing, supported accommodation, supported employment and tackling stigma are highlighted as key inclusive practices. Supported employment commands the strongest evidence but is hampered by several social and political factors, including professional scepticism.

With respect to any criticisms, the small print, concision of expression and amount of data relayed can try the concentration of the reader occasionally, but the book is clearly written and the motivated mental health professional will have no difficulty in persevering. Perhaps the more substantive criticism is that although the authors are strong on evidence and policy and, indeed, actively advocate for practical changes, they steer away from politics. The word ‘neoliberalism’ appears only once in the index, although its increasingly adverse effects are extensively displayed in the text. It may be argued that this was the authors’ intention and, indeed, it may be appropriate. However, based on their work it is difficult to see how we can do better in the future than the poor results in recent decades if we confine ourselves this way. Professional political neutrality seems an idea whose time has passed, not least because of the evidence that has accumulated in recent decades on the relationship between political economy, sustainability and mental health.