Determinants of equality and equity for special populations served by public mental health systems

Within the publicly funded mental health service delivery system, debate continues over what constitutes a fair and just system for special populations. To determine a system's fairness, the author proposes a conceptual framework in which two standards of fairness--equality and equity--are applied to three dimensions of a mental health system: utilization of services, funding for services, and access to services. An equal system assumes that rates of mental illness and needs for treatment are the same for all subgroups of the general population; funds are allocated and services are offered accordingly. An equitable system assumes that special populations have different rates of mental illness and different treatment needs; funds are allocated and programs are designed based on the recognition of these differences. The author argues that the publicly funded mental health service system must establish equitable, rather than equal, services for special populations.