Abstract

Neighbourhoods are often treated as key determinants of mental health, yet they are ‘thorny matters’: dynamic, contradictory spaces where safety and exclusion coexist. This research centres the lived experiences of people with severe mental illness in the West Bank of the occupied Palestinian territory to examine how neighbourhood conditions are negotiated in practice. While existing literature links socioeconomic deprivation, inequality, and weak social cohesion to poor mental health, less attention has been paid to how structural and interpersonal violence, alongside perceptions of safety, shape inclusion and exclusion. Findings show that participants experienced neighbourhoods as spaces of both continuity and disruption. To manage stigma and maintain safety, many adopted hyper-local lives, relying on immediate kinship networks. These networks could be protective, offering familiarity and shielding, but were equally fragile: gossip, mistrust, and reputational concerns often undermined support. Safety was further destabilised by the broader political context. Israeli military incursions, arrests, and ongoing violence were repeatedly identified as triggers of distress and as forces that constrained mobility and social engagement. Despite these constraints, neighbourhoods also held potential for inclusion. When mental illness was understood and acknowledged, participants reported greater empathy, acceptance, and practical support. These findings highlight neighbourhoods as contested social ecologies, where violence, care, stigma, and belonging intersect, and where mental health is shaped through the ongoing negotiation of these ‘thorny’ conditions.