Given the complex causes of increased mortality in this population, we need multilevel, systemic approaches to address this problem. Because a vast proportion of mental health services are paid for by Medicaid, costs for pharmacy, mental health, and general medical services are often under one payer's roof, which provides an incentive to state Medicaid agencies to pursue more integrated strategies. However, most people with serious mental illnesses can't wait for integration of care programs to reach the setting where they receive care. Although metabolic screening might ideally occur in primary care clinics with strong communications with the prescribing psychiatrist, people with severe mental illness are less likely to use primary care than the general population (3). Community mental health clinics, by virtue of serving more than 3.5 million people with severe mental illness, are effectively the “medical home” for this population (3,4). We join others in the belief that community mental health clinics should be taking a more active role in metabolic screening for this patient population (5).