The Welfare Workforce is a thought-provoking exploration of mental health care in the United States and beyond. Although all the affluent democracies pursued deinstitutionalization, some failed to provide adequate services, while others overcame challenges of stigma and limited resources and successfully expanded care. Isabel M. Perera examines the role of the “welfare workforce” in providing social services to those who cannot demand them. Drawing on extensive research in four countries – the United States, France, Norway, and Sweden – Perera sheds light on post-industrial politics and the critical part played by those who work for the welfare state. A must-read for anyone interested in mental health care, social services, and the politics of welfare, The Welfare Workforce challenges conventional wisdom and offers new insights into the complex factors that contribute to the success or failure of mental health care systems. This title is also available as Open Access on Cambridge Core.

Finalist, 2026 European Studies Book Award, Council for European Studies

Winner, 2026 European Studies Book Award, Council for European Studies

Winner, 2026 Charles H. Levine Memorial Book Prize, International Political Science Association

Winner, 2026 Politics of Marginalization and Inclusion Award, American Political Science Association

‘So many intriguing puzzles here. Why do governments provide services to those who cannot request them, such as the severely mentally ill? Why do countries with similar health systems or welfare states diverge when it comes to mental health policy? Perera’s fascinating, one-of-a-kind analysis focusing on welfare state workers and public managers is a seminal contribution not just to the study of mental health but also to the comparative study of social policy.’

Andrea Louise Campbell - Arthur and Ruth Sloan Professor of Political Science, Massachusetts Institute of Technology

‘An incredibly important and original book. Perera persuasively shows that understanding the contemporary welfare state requires understanding the organization of its workforce in theorizing how different worker–management relationships shape the politics of welfare. The result is a beautifully written and insightful take on the evolution of mental healthcare in advanced democracies, and one that opens a new lens on one of the most central, and largely unexamined, parts of the modern state.’

Jane Gingrich - Professor of Social Policy, University of Oxford

‘Masterfully marshaling comparative evidence and reasoning, Perera proves that because the mentally ill are a politically silent minority, and because more populous and economically powerful interest groups have little at stake, the agents, causal pathways, and outcomes in mental health policy deviate strikingly from patterns of change across countries in more extensively researched welfare state arenas.’

Peter Swenson - Charlotte Marion Saden Professor of Political Science, Yale University

‘A seminal exploration into the true impact of how ‘welfare workers’, as a broader and more complex group, shape the health care experiences of constituents who lack the agency to demand services for themselves.’

Donavon Johnson Source: Perspectives on Politics

‘… Isabel Perera’s exceptional book … brings mental health policy into conversation with politics of the welfare state, and in so doing, upends our theoretical understandings. … Perera’s book sets up an important puzzle - why do similarly situated countries take drastically divergent paths when they deinstitutionalize mental health? Her answer is straight-forward, powerful, and convincing: it is the level of investment in the welfare workforce … that determines whether political coalitions between workers and managers emerge and act as powerful and persistent policy feedback loops that put the system on one path or the other. The book is extraordinarily well argued, researched, deliberate, and considerate of alternative explanations. … ‘The Welfare Workforce’ has given us much to ponder and research for years to come.’

Colleen M. Grogan Source: Political Science Quarterly

‘The Welfare Workforce is an impressive study that begins by measuring variation among psychiatric beds and community care facilities across 16 wealthy democracies based on available comparative data from 2011. Perera then delves deeply into the variations among the four cases by including a historical and political science perspective based on careful review of relevant theory, archival research, and interviews with key informants. … Perera's book sheds much light on the convergent and divergent characteristics of mental health care services in four countries …’

Victor G. Rodwin Source: Journal of Health Politics, Policy and Law

‘The Welfare Workforce is a compelling contribution that illuminates how mental health services have developed (and might evolve) in advanced democracies. In an era where the “service arm” of the welfare state (care and support programs) has become as central as its traditional “transfer arm” of cash benefits, this perspective is relevant and timely. This is particularly true in the field of mental health, where building lasting and effective care systems remains a challenge, with mental disorders continuing to rank among the top ten causes of global disease burden (GBD 2019 Mental Disorders Collaborators, 2022). By showing how robust public alliances can sustain and expand care even under fiscal constraints, the book demonstrates that good services and good jobs can go hand in hand.’

Debra Lanfranconi Source: Swiss Political Science Review (SPSR)