Barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems. A qualitative scoping review

Background: People with concurrent mental health and substance use problems are among the most socially excluded groups in our society, yet little attention has been paid to what socially excluded people see as central to promoting their social inclusion. The aim of this qualitative scoping review is to provide an overview of barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems, based on first-person perspectives, to help guide future research, policies, and practice. Methods: We explored first-person perspectives on social inclusion among people with concurrent mental health and substance use problems, employing Arksey and O’Malleys framework. We searched Medline, PsycINFO, Embase, Scopus, Cinahl, and other sources for studies published between January 2000 and September 2023. We employed content analysis and followed the PRISMA checklist. Results: We included 55 articles included in our review and identified sub themes of: Intrapersonal baseline (identity, belonging), Components of social inclusion (relationships, meaningful activities, employment, economy), and Systemic failure or success (housing, public health and welfare services, the criminal justice system). Conclusion: Social inclusion is rarely studied outside the context of direct services. Our results point to knowledge gaps in addressing social inclusion in a broad, societal context; implementing gaps in services; and developing policies to assure the fundamental needs and human rights of socially excluded persons.