In 2001 the Institute for Community Living, Inc. (ICL), a nonprofit behavioral health care network, established a primary care clinic in Brooklyn to provide adults with serious mental illness residing in supportive housing easy access to general medical services. Three years later, an evaluation indicated that, despite engagement strategies yielding an annual physical examination rate of 85%, adherence to treatment and lifestyle regimens for controllable cardiovascular risk factors remained low (dyslipidemia, >40%; heavy smokers, 69%; obesity, 60%; and poorly controlled type 2 diabetes, 69%). In response, ICL reviewed the roles of the clinic, its consumers, and its mental health coproviders in supporting service plans. Foremost, it determined that stakeholders did not prioritize equally the treatment of often asymptomatic but serious chronic medical conditions. Most consumers poorly understood or ignored their conditions; supportive housing case managers often lacked training to support regimen adherence; and clinic staff, supportive housing case managers, and mental health coproviders communicated inadequately to ensure service coordination and integration.