Did you know that approximately 15 million people in the UK are at risk of poverty and severe social exclusion? People experience social exclusion when they get cut off from society, which can happen for various reasons. This could happen consciously where biases and discrimination exist. Or it could be an unintentional symptom of broken systems within society.
Another startling statistic is that more than half of people in the UK have experienced some form of social exclusion in the past year, leading to an epidemic of adverse outcomes such as mental health conditions and poor general well-being.
According to the World Health Organization, the prevalence of social exclusion is a multi-faceted problem involving several factors. Exclusion happens across economic, political, social and cultural lines. It can affect individuals, entire households, and entire communities. As with many things, social exclusion exists on a spectrum but is typically characterised by unequal access to resources that can lead to health inequalities and other consequences.
Older people, in particular, can suffer ill health across both their physical health and mental health as a result. This is because social exclusion makes older people more vulnerable to age-related illnesses. They are less likely to have social networks for well-being support. They’re more likely to face ageist attitudes, too, and may struggle with forming social relationships.
These potential consequences make it essential to understand what the underlying causes of social exclusion and psychiatry are, how they can cause mental illness and have an impact on physical health status, and how we can start to tackle this pervasive societal issue and work towards social inclusion instead.
Exploring how social exclusion happens in society
Social exclusion isn’t just about feeling lonely. It’s a far more severe public health issue. At its simplest, it’s about having unequal access to society. But it could also mean being completely cut off from support networks, health care, mental health services, social care and society.
There are so many ways that social exclusion can happen. A policy definition released by the Office of the Deputy Prime Minister in the United Kingdom identified several risk factors and attributions linked to and can contribute to social exclusion. These include:
- Poor health.
- Family breakdown.
- Poor housing.
- Poor skills.
- Low incomes.
- High crime.
These socioeconomic factors can be exacerbated when people are disadvantaged based on their:
- Economic status.
When multiple factors interlink, the level of social exclusion a person experiences can become detrimental to their health outcomes. For instance, an older person with disabilities and poor health without a support network due to a family breakdown may experience a poorer quality of life as a result of all of these affiliations contributing to social exclusion.
Social exclusion can trigger mental health problems in people in several ways. Loneliness, for instance, can be a risk factor for mental health issues and have a negative impact on mental health outcomes in general. This systematic review suggests it can lead to severe mental disorders like depression, sleep problems, personality disorders and even Alzheimer’s disease.
Certain mental illnesses, like schizophrenia, can even cause social isolation. On the other hand, schizophrenic patients who experience loneliness and social isolation are more likely to have worsened psychosis symptoms, experience low self-esteem, and generally have poor mental health. It’s a vicious cycle.
The results of a questionnaire published on PubMed also found that “Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination.” A study by G. Thornicroft et al. suggested that “Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier.” These insights shed light on the complex nature of social inclusion challenges for individuals with mental health problems.
Loneliness and social exclusion are closely interlinked. A 2022 longitudinal study looking at social exclusion and loneliness in older people in Nordic countries found that certain social exclusion factors can be predictors of loneliness.
Some conclusions were logical. For instance, people with no emotional support and infrequent social contact had lower social capital and, in turn, were more likely to be lonely.
However, several other factors typically used to define social exclusion were also linked to loneliness. These included:
- Disenfranchisement, and in particular, not voting in national elections.
- Low neighbourhood safety.
- Low income.
Given that loneliness and social exclusion can be social determinants of health, we must find ways to tackle these pervasive issues. Collaboration between health professionals and community organisations is crucial in addressing the healthcare disparities contributing to social exclusion.
Governments, charities, and other organisations typically have policies to tackle social exclusion, especially given its impact on the health system.
The Labour government in the UK established the Social Exclusion Unit in 1997 to ensure the delivery of services and other social support to the most disadvantaged members of society.
This was later subsumed by the Social Exclusion Task Force, which provided the government with social policy advice designed to tackle social exclusion through mental health policies and economic policies that focused on helping people with complex needs.
The SETF was abolished in 2010, and its functions, instead, were absorbed by the Office for Civil Society.
The general population today still feels the impacts of the social exclusion work done by governments decades ago. The UK’s minimum wage, for instance, was first introduced in 1999, primarily to tackle the negative effect of social exclusion on young people and older people alike. Effective policies must prioritise participatory decision-making to combat social exclusion and promote social justice.
Charities and organisations like AgeUK, the Joseph Rowntree Foundation, and NPC have projects designed to tackle social exclusion, often through community-based programs encouraging social interaction.
In 2020, the VINCI Foundation in the UK provided £200k in grants to help tackle social exclusion. Projects included the Harrow-based Independence at Home initiative geared towards people with disabilities and long-term illnesses.
The project is about empowerment and social inclusion. It helps people buy specialist equipment that allows them to participate in society, i.e. visit shops and participate in social activities. This, in turn, helps with health promotion and mental health care too.
However, not all programs work well for older people. AgeUK, for instance, conducted a cohort study and found that socially excluded older people often live with complex health impairments. Where community health and social services providers exist, older service users often report that they don’t meet their needs; i.e. they may offer recovery strategies such as help with finding a job, where this is irrelevant to retired older people.
At AgeGroup, this includes products like AgeMeet, a safe place online where older people can meet and interact with one another. There is also AgeFriendly, a directory designed to connect older people with age-friendly businesses. For older people who need more support, AgeGroup is developing AgeGuardian, designed to help caretakers support their older loved ones with financial tasks.
The goal is to empower older people to embrace their elder years while dispelling ageist attitudes confidently.