Introduction

Throughout history, health (or, more specifically, poor health) and exclusion have been intrinsically linked. From the leper, to those inflicted with venereal disease, to the mad confined to ‘Ships of fools’, to the poor and the homeless, ‘the game of exclusion’, as Foucault (1972: 6) called it, has linked these two concepts, with the result that over the centuries, people have been confined in buildings or places where they all have been treated in ‘oddly similar fashion[s]’. These social inequalities in health arise because of inequalities in the conditions of daily life and because of the fundamental drivers that give rise to them, that is, inequalities in power, money and resources (Wilkinson and Marmot, 2003). Mental health is a key component to this process of exclusion.

The World Health Organization defines mental health as ‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ (WHO, 2011). Mental health (or, more specifically, mental ill health) is a significant societal problem in the UK, accounting for 23% of the total burden of ill health; it is also the largest cause of disability. Annually, ￡2 billion is spent on social care for people with mental health problems and the cost of mental health to the economy in England alone has been estimated at ￡105 billion, with treatment costs expected to double over the next 20 years (HMG and DH, 2011).

Poor mental health is both a contributor to and a consequence of exclusion. It is well established as a significant risk factor for poorer health and economic and social outcomes (the level of adversity of these outcomes varying with the disorder and socio-economic status of the individual in question), as well as a direct cause of mortality and morbidity (Friedli, 2009; IHME, 2013).

Good mental health is a vital component of an individual's capabilities, resilience and capability to adapt; it enables them to manage adversity and reach their full potential. Good mental health and resilience are fundamental to our physical health, relationships, education and work.