1. Included or not included? A qualitative study exploring mental health service users' experiences of participation and inclusion in their community Dr Elizabeth A.McKay; Grainne Donnellan & Deirdre Mahon: University of Limerick (Ireland) Kirsti Haracz: University of Newcastle (Australia) Dr Thelma Sumsion: University of Western Ontario (Canada) Included or not included? A qualitative study exploring mental health service users' experiences of participation and inclusion in their community. Dr Elizabeth A.McKay; Grainne Donnellan & Deirdre Mahon: University of Limerick (Ireland) Kirsti Haracz: University of Newcastle (Australia) Dr Thelma Sumsion: University of Western Ontario (Canada) 11 Irish participants (7 men and 4 women) 1O Canadian participants (6 men and 4 women) Interviews were conducted through 2009. Range of diagnosis including schizophrenia, bipolar disorder, depression, obsessive compulsive disorder. Age range of participants: 27 – 65 The Iinternational Classification of Functioning (ICF) (WHO, 2001) addresses people’s capacity to engage in activities, their actual participation and the ways their environment inhibits or supports them. It encompasses learning and applying knowledge, self- organisation, communication and mobility. The ICF defines participation as involvement in a life situation. Repper and Perkins (2003) proposed that participation or inclusion should be a key component of recovery from mental health problems. Social inclusion is one of the most cited concepts in mental health literature. It is a concept of equal opportunity, which allows for a person to take part in activities and roles within society (Repper and Perkins 2003). This study is the second phase of an international research project which explored mental health service users’ experiences of social inclusion and exclusion in terms of the environment, activities and participation key components of the ICF framework. IntroductionIntroduction Semi-structured interviews were conducted with mental health services users to explore their experiences of participation and inclusion in their communities. The study utilised the environmental, activities and participation components of the ICF as a framework for enquiry. Ethical approval was gained for all three locations. Participants were drawn from mental health services in Limerick (Ireland), London (Canada) and Newcastle (Australia). Australian data is being collected in 2010. The data was transcribed verbatim and analysed using constant comparative analysis using NVivo. Interim findings from Irish and Canadian participants are reported here. ParticipantsParticipants MethodMethod Findings Five themes emerged from the data analysis. These are briefly presented below. ‘My mental health affects my relationships with others’. Participants highlighted that most had supportive families and friends who were understanding and accepting. Although some had no relationships with family. Some had experienced marital problems or breakdown Some identified that they limited with whom they socialise. Relationships with health professionals were generally experienced as positive although many discussed uncaring and unsupportive staff in their past. ‘There is a public ignorance regarding mental illness’. Stigma and discrimination were still experienced to some extent by participants: particularly in relation to accessing paid employment which was difficult. People still experienced ‘being different’ – this was also highlighted in relation to sexual orientation, being overweight and being physically unwell ‘I go see the movies a lot!’ Participants engaged in their communities and participation was focussed on people, places and past times. Some were volunteers in a range of settings and valued doing things with others. Finance limited participation. Many would like to have part-time paid work however the recession made this more difficult. ‘Some training and support to build up the confidence’. Generally there was consensus that education, housing and transport acted as facilitators to participation. Accessing education was seen as possible. Although only a minority were in education. Housing for the majority was not an issue. Transport systems were generally accessible, buses and walking were the main methods. A few did not drive because of mental health issues. ‘I have a voice in how things are going!’ Participants identified they had a voice in their treatment planning and that this was a positive development. Some participants highlighted their own responsibility for maintaining their mental health for example: structuring their day, engaging in daily occupations, taking their medications and acknowledging that poor life choices affects their mental well being. Limerick, IrelandLondon, Canada Newcastle, Australia ConclusionConclusion The ICF proved a useful framework for exploring participants experiences of social inclusion and exclusion and their unique relationship with activities and participation. Structure and routine were highlighted as significant for recovery as was engagement with day services. A lack of public education and understanding of mental illness still remains and impacts negatively on people’s lives. Limited access to paid employment was experienced as frustrating and led to feelings of inadequacy. To conclude, findings proved to be somewhat contradictory although participants mainly identified being socially included within narrow parameters of mental health services and resources. There was limited engagement with the wider community. Therefore the participants were included with in an excluded community. References Repper, J. & Perkins, R. (2003) Social Inclusion and recovery: A model for mental health practice. Edinburgh: Bailliere Tindall. WHO ( 2001) The International Classification of Functioning, Disability and Health (ICF). Geneva :World Health Organisation.