Mental Health Nurses As Promoters Of Social Exclusion



Mental Health Nurses As Promoters Of Social Exclusion

Introduction

The unit's working philosophy states that the team has adopted a framework of social inclusion as a direction of practice for this service consistent with contemporary mental health practice policy agenda. It is apparent that a commitment to including individuals in the local community and tackling the many-faceted elements of social disadvantage is embodied within the outreach service. However, despite the good intentions of the unit team and their forward-thinking philosophies, it has become evident from personal observation and informal discussion with users of the service that, remaining at the centre of their daily life, is the residential rehabilitation unit. Furthermore, the vast majority of these individuals remains out of work or education, and repeatedly expresses the stigma and discrimination they experience at the hands of the local community. These are areas of an individual's life, which have been identified by the governments' Social Exclusion Unit (as indicators of social exclusion.

Discussion

Despite the in-depth consideration of this philosophy, it did raise a number of practical and ethical issues. These issues mostly surrounded conducting the research in a familiar practice area and the researcher being known to the participants in the role of a student nurse. Within the focus groups, in order to address the objectives of the study, the researcher prompted the participants to be critical of their own practice and the service they were delivering. This was inevitably uncomfortable for her as she questioned the practices of individuals who were considerably more experienced than herself. Thought was also given to how this enquiry would impact upon the future working relationship between researcher and staff (Hannigan & Cutcliffe 2002).

The decision of what stance to adopt within the group was also difficult. Issues regarding how the researcher was perceived were challenging. The need for questioning and challenging automatically drew the researcher into adopting an 'insider' role, whereby she felt to be included in the discussion. However, there was an element of the researcher exploiting her existing relationship with staff in order to gain more in-depth; this led to feelings of guilt. Similarly, while acting as an observer, the researcher was aware again that she was using her previous involvement with the team to become metaphorically invisible to participants (Szasz 1974).

The four categories that emerged from the analysis - defining the concept, the community, the residential rehabilitation unit team and the outreach service - were considered in the light of the literature. Determining a definition of social inclusion from the results of the study revealed contradictions between participants spoken and their underlying attitudes as revealed through indirect prompting within the focus group discussions. The presence of these contradictory views represents the underlying dilemma faced by mental health practitioners that lie in their contrasting roles of providing care on the one hand and enforcing social control on the other (Szasz 1974). At the current time in the UK, there is much focus upon risk, risk-assessment and compliance ...