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What is inclusion health?

Taking a psychologically informed approach with the guiding principle of harm reduction is necessary for treating marginalised patients.

Here, we discuss and explain the importance of caring for patients who are often on the margins of society, which is known as inclusion health.

Why this matters

Providing healthcare and services to those who are excluded and on the margins of society is vitally important. Those who are often seen as being excluded from society often have unfortunate situations such as homelessness, substance use and, are part of the criminal justice system. Poverty and poor mental health are often universally seen across individuals in these circumstances.

What are ACEs?

Adverse childhood experiences (ACEs), especially those that include poverty, neglect, physical and emotional abuse, and/or incarceration of parents, cause significant long-term effects in terms of health and social outcomes. These effects can manifest into a number of situations including:

Suicide
IV drug use
Alcohol dependence
Depression

The impact of homelessness on disease

Homelessness results in a large burden of disease with 86% of homeless individuals having, on average, 3 chronic long-term physical conditions before 40 years of age. Homelessness can result in a very premature loss of life at an average of 46 years for men and 41 years for women.

These patients often have increased hospital admissions which has increased financial implications. Providing services specifically for these patients is important and relies heavily on establishing good relationships and being psychologically informed. ACEs have a significant disruptive impact on patients which often results in difficulty trusting others. This highlights the importance of understanding what has happened to the individual rather than pointing out what is wrong. Harm reduction is a key aspect of providing services for these patients, such as the opioid substitute treatment for IV drug users. Intermediary care units allow for a less clinical setting which frees up spaces in hospitals and has links with appropriate housing and community support groups.

Conclusion

Overall, relationships are essential, and taking a psychologically informed approach with the guiding principle of harm reduction is necessary for treating patients who are often excluded by society.