Disparities in the Geography of Mental Health: Implications for Social Work Christopher G. Hudson This article reviews recent theory and research on geographic disparities in mental health and their implications for social work. It focuses on work emerging from the fields of mental health geography, psychiatric epidemiology, and social work, arguing that a wide range of spatial disparities in mental health are important to understand but that of greatest relevance are inequities, or disparities, that violate fundamental norms of fairness and social justice. Research is reviewed on geographic variations in subjective well-being and mental health, on personality (using the five-factor model), and on psychopathology as well as several studies on the disparate implementation of mental health policy and services. Criti- cal is the need to simultaneously assess, on the one hand, differential patterns of mental health conditions and, on the other, the services and policies designed to address them— the fact that considering only one dimension often leads to unintended consequences. Many of the most outstanding disparities have been found to exist at the local level, between towns and neighborhoods, and are based on socioeconomic conditions. This review concludes by discussing the implications of geographic disparities in mental health for allocation decisions and for social work practice, including decisions about the most ef ficacious mix of services at both the community and clinical practice levels. KEY WORDS: geography of mental health; health disparities; quality of life; spatiality; subjective well-being S ocial work’s person-in-environment per- spective requires that practitioners consider the social and physical environment—its problems, supports, and opportunities—and, spe- cifically, individuals’ goodness of fit with it. Yet the development of models for understanding the multiple and complex environments that clients regularly interact with remain underdeveloped. In recent years, the fields of social ecology, geogra- phy of mental health, and psychiatric epidemiolo- gy have made substantial progress in the conceptualization and study of the spatial dimen- sions of mental health (see Jones, 2007; Philo, 2005), particularly in understanding the disparities and inequities inherent in the role of place in the etiology and progression of a range of mental dis- orders and the effectiveness of policies and services intended to address such disparities. Studies such as Wilkinson’s (2005) The Impact of Inequality have provided persuasive evidence that the cultural and mental health dimensions of inequality are more important for health and well-being than eco- nomic inequality. In addition, the recent debates stimulated by President Obama’s health care ini- tiative have highlighted long-standing disparities in access to health care in the United States. This article aims to provide an introduction to key the- ories of geographic disparities in mental health, recent research on what these disparities are telling us, and their implications for social policy and social work practice (at both the micro and the macro level). THEORETICAL CONSIDERATIONS Unlike in most developed nations, in which the term inequities is commonly used, in the United States, the term disparities is more frequently used in the study of distributional issues in health care (Carter-Pokras & Baquet, 2002). This more inclu- sive term has traditionally connoted systematic group differences in the prevalence or care of health conditions that may result from a wide variety of causes, only some of which are unjust or unfair. In a similar manner, inequalities connotes simple differences—for example, in the risk of Alzheimer’s between demographic groups— without normative judgment about causes and re- sponsibilities. In contrast, inequities refers to types of disparities that are avoidable and unfair. Health disparities are often identified on the basis of the doi: 10.1093/sw/sws001 © 2012 National Association of Social Workers 1 Social Work Advance Access published August 21, 2012