There is now a sprawling set of important accounts of modern interventions in mental illness. Many historians have focused on experiments in pharmacology, or case studies in treatment. A new book about 20th-century approaches to mental health and innovation provides a welcome challenge to our thinking about solutions to mental health in our present.

The relatively obscured history of social medicine – coming out of the political left and the radical medicine of the USA in the post-Second World War era – offers different ways to think about mental illness. This is the starting point for Matthew Smith's The First Resort. He focuses on specific episodes in applied social psychiatry in mid-20th-century America, interpreting studies of urban populations, class and mental illness in the 1950s and 1960s. In 1939 sociologists Robert Faris and Warren Dunham led the way in establishing ‘the link between deprivation and mental illness’ using data from the Chicago area (p. 13). The immigrants and mobile peoples of the 19th century formed the core demography of a growing urban population with all the problems of poverty and psychosocial inheritance of the deprived.

Smith promotes debate about the concept of a universal basic income (UBI) as a way to combat the growing tide of mental illness. This vision lies at the heart of his impressive book. Smith shows the origins of social psychiatry as depicted through social surveys, observation and analysis of mental health patient epidemiology, and historical causes of the poor health of populations in large US cities and in one rural case study of Nova Scotia. The main case studies in this book focus on the possibilities of the commitment to better mental health through prevention in the early 1960s. As in Britain and other places, the mental hospitals in the USA were overflowing, placing a financial burden on the public system; prevention through attention to community support for people with mental struggles was pronounced as a solution by John F. Kennedy's Democrat-led government in 1963.

These case studies include the Midtown Manhattan Study, an interdisciplinary research project about ‘mental health in the metropolis’ which ran for almost a decade from 1952. The study showed that socioeconomic status ‘had a major bearing on mental health’ (p. 187). Around this time, in 1961, critical urban geographer Jane Jacobs was examining the ‘life and death’ of American cities. We now talk about the ‘social determinants of health’, drawing attention to the impact of disadvantage, precarity, the housing crisis, addiction and homelessness, as well as the impact of the COVID-19 pandemic, as inextricably bound up with periods of mental ill health as a result of intergenerational poverty. Smith contends that social psychiatry has been overlooked and marginalised by historians. He is correct to point out that primary research on this topic is limited and that the historiography of social psychiatry is muted; some emerging studies of community psychiatry (as distinct from antipsychiatry) do shed light on the possibilities of telling a new story of socially aware interpretations of mental illness.

Smith does not disavow the need for a complex array of understandings of mental illness, from the biomedical to the available diagnoses enshrined in the DSM (p. 12). The concluding section of his book is a lesson in reflecting on historical change. He shows how the competing concepts of mental illness which offered solutions also diluted the messages and political potential of social psychiatry, which seemed ‘tame, even conservative’ when positioned alongside more radical critiques or possibilities for cure (pp. 248–9). Instead, what we gain from The First Resort is a powerful argument for the need to recognise a role for preventive mental healthcare. This comes through recognising the context for mental illness occurring in populations (and individuals) who experience ‘poverty, inequality, and social disintegration’ (p. 16).