Co-producing social inclusion: the structure/agency conundrum

Accessible summary: • It is widely recognized that social inclusion is an important aspect of recovery for mental health service users and mental health nurses have a role to play in this part of care.• Social inclusion is not well defined and there is little evidence to demonstrate it produces positive outcomes for service users. We have developed a social inclusion framework to help mental health professionals and service users' co-produce social inclusive outcomes.• We recognize the difficulties of increasing social inclusion and have highlighted some of the social, economic and political barriers that may prevent social inclusive outcomes.• It is possible that nurses and others are using much time and energy trying to increase social inclusion, when in fact only governments and other large organizations have the power to make the significant changes required to produce change. There is a raft of policy guidelines indicating that mental health nurses should be increasing the social inclusion of mental health service users. Despite this there is no universally accepted definition of social inclusion and there is a dearth of empirical evidence on the successful outcome of increasing inclusion for mental health service users. Recognizing the lack of clarity surrounding the concept we have a produced a social inclusion framework to assist mental health professionals and service users to co-produce social inclusive outcomes. Although we agree that social inclusion can be a positive aspect of recovery, we question the extent to which mental health nurses and service users in co-production can overcome the social, economic and political structures that have created the social exclusion in the first place. An understanding and appreciation of the structure/agency conundrum is required if mental health nurses are to engage with service users in an attempt to co-produce socially inclusive outcomes.