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Social integration in global mental health: what is it and how can it be measured? Epidemiology and Psychiatric Sciences, in press. Social integration is now regarded as an important outcome of mental health care. It is achieved through the provision of psychosocial interventions, for example, by long-term community-based residential care or supported employment programmes. These interventions help to avoid negative outcomes for people with severe mental disorders, such as suicide, poverty, human rights violations and incarceration, which are all linked to social marginalization and lack of support and care. However, even if it is generally accepted that psy-chosocial interventions contribute to facilitate the social integration, the evidence about the effectiveness of those interventions remain largely insufficient. In 2010, WHO launched the mhGAP Intervention 'Guide for mental, neurological and substance use disorders in non-specialized health settings' (World Health Organization, 2010). The guide was developed following a rigorous process that included a systematic review of the available evidence for mental health interventions. The review reinforced the fact that there were far fewer studies examining the effectiveness of psycho-social interventions and rehabilitation programmes compared with pharmacological interventions. In addition, the former tended to be of lower quality. It is, thus, obvious that in order to improve the evidence-base around psychosocial and rehabilitation programmes , we need to better define the concept of social integration and devise more reliable ways to measure it. The article by Baumgartner and Susser examines the notion of social integration and its measurement, and calls for the development of measures for cross-cultural use. Unquestionably, the authors have identified an important issue. Indeed, the definition of social integration remains rather vague among psychiatrists, and even more so when mental health workers come from different disciplinary perspectives: the same word is used with different meanings and with a different emphasis. For example, Berger-Schmitt and Noll from the German Centre for Survey Research and Methodology on Social Indicator Development (Berger-Schmitt & Noll, 2000) consider that social integration has to do with the dynamics between social exclusion and social inclusion. Others emphasize poverty as the key element of poor social integration (Atkinson & Marlier, 2009). Ware et al. (2008), from the Harvard Department of Social Medicine, identify social integration with quality of life. This article by Baumgartner and Susser provides a conceptual framework for social integration based on four perspectives: (i) the disability framework promoted by the WHO through the International Classification of …

Two pressing needs: to measure social integration and to re-orient mental health services towards social integration