This text, by a well regarded writing team, examines the relationship between the knowledge base of mental health professionals, evidence about inequalities and mental health service utilisation. Starting with a critical appraisal of traditional psychiatric epidemiology, it moves into an exploration of the inequalities created by familial and neighbourhood influences, service contact and challenges during the life span. Controversies in mental health debates, about violence and different forms of psychiatric treatment, are discussed within a framework of social inequalities.