While all health services have a political dimension, service provision for `mental health' is more political than any other ®eld of health care. It is very much about rights and justice, about alienation and inclusion, about power and privilege vis-aÁ-vis professionals and service users, black and white, male and female, etc. When it comes to `race', it is about white supremacy and black powerlessness in terms of what is seen as right and wrong, primitive and advanced, acceptable and `alien' and so on. Although within an ostensibly `medical' framework, mental health systems are more political than medical (see Barker and Stevenson, 2000; Castel, 1988; Ingleby, 2004; Miller and Rose, 1986). Further, the politics of mental health is inevitably located in the general politics of the wider world. The struggle for equity for black and minority ethnic (BME) communities in mental health service provision is a struggle for their human rights, the right to expect public systems to be equal in spite of (cultural) difference, and the right to freedom from racism. Therefore, race-based inequalities and culture-based discrepancies in mental health must be seen in context, both of the historical background of social systems, psychiatry and western psychology and of concomitant problems in other systems in society, such as criminal justice and education. This is the remit of this chapter.