Edinburgh Napier University

  Reducing inequalities in health, including mental health, is of high priority in many national policies. However, it is not yet known how mental health nurses might respond to these policies. Using examples from the available evidence, we argue that the causes of mental health inequalities are complex and thought to arise from fundamental divisions in society. These divisions are formed by social relationships, which areinfluenced by deep social structures, such as the economy or culture. The extensive range of social determinants means that there is no single explanation of why inequalities in mental health might occur. It also suggests that these determinants may act synergistically to create pockets of inequity where health needs are most complex. This poses difficult challenges for mental health nurses who undoubtedly have a key role in addressing mental health inequalities, although their role is likely to be restricted to service redesign and delivery. Mental health nurses are unlikely to address some of the deeper structural determinants of mental health inequalities, such as poverty, which can only be tackled through government-led reforms. Furthermore, we must be mindful of the possibility that services offered by mental nurses may have an uneven uptake across social classes, which in turn could serve to maintain or worsen mental health inequalities. Therefore, a key question for mental health nursing, policy and training is whether these limitations are clearly recognized.