Inequality, the New Right and mental health care delivery in the United States in the Reagan era

Abstract

This essay draws upon research on mental health treatment and provision in the San Francisco Bay Area in 1988, and is part ofa wider US-UK com parative study. The main concern is to examine the linkages between pub lic policy and inequalities in mental health care delivery in one local area. In opposition to the concept of the welfare state, a primary stance of the New Right and of the Reagan administration has been the belief in the necessity ofsocial hierarchies based on wealth. The consequences of poli cies predicated on these beliefs were studied at a local mental health sys tem, where it was found that economic factors strongly influence access to and experience in the system. Principally through drawing upon data from 42 in-depth focussed interviews with mental health professionals in the San Francisco Bay Area, I examine how the poor are excluded from treat ment, how patients are dumped from the private sector, and how a com plex triage system in both public and private treatment settings has come into being.