For people living with severe mental illness, daily life often involves far more than managing symptoms. Many struggle to find work, maintain relationships, or feel part of their community, even when they receive regular mental health care. New research suggests that without addressing social exclusion directly, treatment alone is unlikely to improve quality of life or long term outcomes.
A major international review published in early 2026 examines how social inclusion affects people with conditions such as psychosis, bipolar disorder, and severe depression. It finds that these individuals experience some of the highest levels of isolation and exclusion of any group with a disability. This pattern appears across countries, regardless of how developed their mental health services are. The findings were published inĀ World Psychiatry.
Social inclusion is defined not simply as being out of hospital, but as being able to take part in activities that people value. This includes employment, education, relationships, and community life. The review highlights that many people with severe mental illness remain unemployed, socially isolated, and lonely, even when their clinical symptoms are managed.
Loneliness emerges as a central issue. Studies show that more than 80% of people with psychosis report feeling lonely, and this loneliness is closely linked to poorer well being and shorter life expectancy. Importantly, loneliness is not just about how often someone sees other people. It reflects whether those connections feel meaningful and supportive.
The research suggests that reducing stigma alone is not enough. While public attitudes towards mental illness have improved in some countries, many people still avoid work, education, or social opportunities because they expect discrimination. This anticipated rejection can be just as damaging as direct experiences of stigma.
The review also challenges assumptions about where social inclusion happens best. In some rural settings, people with severe mental illness are more likely to work and feel included than in cities with extensive mental health services. Flexible work, family involvement, and community roles appear to matter as much as clinical care.
Cultural context plays a major role. In some societies, inclusion centres on independence and individual achievement. In others, it is rooted in family roles, religious participation, or collective responsibility. Programmes that ignore these differences often fail to connect with the people they aim to support.
Employment is highlighted as one of the strongest drivers of inclusion. Having a job not only provides income but also status, routine, and social contact. Supported employment schemes have shown promise, but access remains uneven, particularly for those with complex needs or long periods out of work.
Housing, education, and community activities are also critical. Stable housing reduces hospital use and improves autonomy. Adult education programmes, peer led initiatives, and community based arts or nature activities can help people rebuild confidence and social networks, especially when support is tailored to their needs.
The review concludes that mental health systems must look beyond symptom control. Improving social inclusion requires coordinated action across health services, employers, housing providers, and communities. Without this broader focus, many people with severe mental illness will continue to feel excluded from the lives they want to lead.