Abstract:  This article examines social inclusion in the context of the deinstitutionalisation of mental health care. It draws on a scientific evaluation of the Belgian reform of mental health care (2010), designed to assess the influence of organisational mechanisms on the social and care trajectories of service users. The findings highlight the ongoing challenge for mental health systems to support the inclusion of service users within the community, and the increasingly difficult access to mental health care for people with complex and chronic mental health problems. Drawing from Systems Theory (Luhmann, 2013) and the analysis of subjective experiences, this article delves into the complex processes of social inclusion using the empirically-grounded concepts of the patient role and the impatient role. By acknowledging the relational dimensions of social inclusion, this article argues that complementarities between two faces of the mental health system are key to achieving inclusion beyond the walls of institutions and within society at large.

Keywords:  deinstitutionalisation; ethnography; mental health care; social inclusion; systems theory

Published:   20 March 2020

Issue:   Vol 8, No 1 (2020): Institutions of Inclusion and Exclusion