Social Exclusion of People with Severe Mental Illness in Switzerland: Results from a Nationwide Representative Health Survey

Aims: People with severe mental illness (SMI) have a high risk of living socially excluded from the mainstream society. Policy initiatives and health systems aim to improve the social situation of people who suffer from mental health disabilities. The aim of this study was to explore the extent of social exclusion of people with SMI in Switzerland.

Methods: Data from the Swiss Health Survey (SHS) 2012 was used to compare the social exclusion magnitude of people with SMI with those suffering from severe physical illness, common mental illness and the general population. Variables from the SHS question set and from the indices set were used to represent several dimensions of social exclusion (employment and income, social network and social activities, health problems). Logistic regression was used to analyse exclusion differences between the above named groups. Analyses were adjusted for age and gender.

Results: With the exception of Instrumental Activities of Daily Living, we found a gradient of social exclusion that showed people with SMI to be more excluded than the comparison groups. Loneliness and poverty were widespread among people with SMI. Logistic regression analyses on each individual exclusion indicator revealed that people with SMI and people with severe physical illness were similarly excluded on many indicators, whereas people with common mental illness and the general population were much more socially included.

Conclusions: In contrast to political and health system goals, many people with SMI suffer from social exclusion. Social policy and clinical support should increase the efforts to counter exclusionary trends, especially in terms of loneliness and poverty.