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This chapter discusses consumption disparities in outpatient mental health services among a diverse insured working population. It first observes that despite paying equal insurance premiums and enjoying equal insurance coverage, lower-income and non-white workers consume fewer insurance benefits than their white and higher-income coworkers. It finds no evidence, however, that this disparity leads to adverse health outcomes. It additionally finds that non-whites and low-income individuals are more likely than their white and high-income counterparts to obtain mental health care from general practitioners rather than mental healthcare providers, and nearly twice as likely not to follow up with a mental health provider after hospitalization with a mental health diagnosis. These findings suggest that low-income and non-white individuals might be paying for health services that primarily benefit their white and more affluent coworkers. Many of these regressive consequences can be attributed to mental health insurance carve-outs, which are a product of the fragmented delivery of health care.

The introduction outlines the approach adopted within the book, and the main lines of argument, explaining why the decision has been taken to focus on healthcare professionals’ efforts to educate the public, rather than public opinion. Analysing recent British mental health anti-stigma campaigns, the introduction identifies common characteristics in terms of messages, objectives and difficulties encountered. It contextualises the book’s approach in relation to recent debates as to how the history of psychiatry and mental healthcare should be written, and provides a brief overview of key pieces of legislation which affected mental healthcare in the period under study. The introduction outlines how the plurality of groups working within the field of mental health, wielding divergent levels of power and status, affected discourses. A brief analysis of the concepts of stigma and discrimination is provided.

This chapter explores mental healthcare politics, demonstrating the impact of the economic and political climate on professional strategies, and revealing the interconnected fates of different professional groups. It focuses on psychiatric nurses and psychiatric social workers, examining how these two occupational groups represented mental illness and sought to obtain public support as they attempted to establish a distinct role in the field of mental healthcare. As mental healthcare policy and practice evolved, these occupational groups had to adapt to find a new role. Revealing the challenges facing insecure professional groups who tried to balance their interests with those of their patients, the chapter argues that we need to examine the relative power and status of different occupational groups, and consider efforts to destigmatise mental illness within the context of the broader goals of that occupation.

This chapter examines the history of race within American psychotherapy, through the prism of a largely-forgotten institution dedicated to psychiatric treatment founded on antiracist principles. Founded soon after World War II by writer Richard Wright and psychiatrist and social critic Fredric Wertham, Harlem, New York’s Lafargue Mental Hygiene Clinic linked black psychic well-being to social transformation and sought to redirect the fundamental orientation of psychotherapy towards the social bases of mental illness and health. Both a precursor and challenge to recent models of combating health disparities through cultural competence in mental healthcare, Lafargue represents a landmark in African American encounters with psychiatry and the behavioral sciences.

Trucking is one of the most dangerous jobs, and truckers also see many fatalities while working. At the same time, few have health insurance, most can’t schedule mental health care, and mental illness is stigmatized in their culture anyway. Thus, they live with trauma, and regulations compound, rather than mitigate, this situation.