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AN UNPLEASANT TRUTH confronting the mental health professions is that psychotherapeutic care of the poor is markedly inadequate. In a major study of this problem, which found significantly higher incidence and prevalence of psychoses at the lowest socioeconomic level in New Haven, it is tersely put that the lowest socioeconomic stratum "needs help most—social and psychiatric—and gets it least. 13 The difficulty lies not merely in the inability of the underprivileged to pay for treatment or obtain it free of cost. Even more disturbing is the apparent ineffectiveness of such treatment once it has been secured. According to the findings of another large scale research, "Within the universe of patient-therapist relationships, the chances of a succesful outcome … seem to vary considerably among the several socioeconomic segments of the patient population in a range from about 7 in 10 of the top segment to 3 in 10 of the bottom one." 84 A successful outcome was defined here in terms of social functioning as rated independently by two psychiatrists. 34
What is the source of the trouble? The answer most often given by experts involved in working with the lower class patient population is, "the middle class character of the mental health movement and the associated inappropriate nature of the services offered to low income people." 32 New departures in treatment designed to suit the needs of the poor, are the solutions they propose. Another widespread