Mental health service development in “emerging nations” is determined in part by political ideologies. These require congruent diagnostic and treatment philosophies, and influence decisions about allocating resources and attitudes toward consultants from industrialized nations viewed as exploiters. The dominance of wealthy elites with relatively powerless masses may result in few public resources for health education or services. A historically accepted gulf between the disadvantaged and the affluent who provide the nation's physicians may also increase authoritarianism in the latter and reduce the possibility of collaborative or psychotherapeutic treatment relationships aimed at increased self-determination. Industrialization provides both new opportunities for upward social mobility and increased possibilities of achievement-aspiration discrepancy. Specific issues influencing the nature both of prevailing mental health problems and of service delivery include: migration, literacy, local folk medicine, and the status of the family.