Background: Therapists seeing poor clients may ask if countries with greater income equality have less mental illness. If so, how should therapists respond?

Material: A review of epidemiological studies, theories of inequality and democratic reform movements in psychiatry and psychology leads to four arguments.

Discussion: (1) Increasing income equality improves the health of societies. (2) An elite opposes greater equality, partly by persuading the majority to consent to the existing order. (3) Therapists may inadvertently help in this persuasive effort. (4) However, therapists in democratic traditions create systems of care that support movements for greater income equality.