Must this ideal program be hospital based? What if the treatment system cannot afford it? Stein and Test's assertive community treatment model (2) was created to provide just this sort of intervention in a community setting rather than in a hospital, and it has been demonstrated to be cost-effective (3). When assertive community treatment was designed, essentially the hospital team was deinstitutionalized and the full array of treatment and rehabilitation services was made available to a cohort of patients in the community with the high staff-to-patient ratio of a hospital. Assertive community treatment is a team model, taking advantage of the expertise of different professionals and paraprofessionals. Because the care providers operate as a team, rather than as a group of individuals, the chances for burnout are minimized. Assertive community treatment involves meeting the patient on his or her own turf, persistently and assertively offering assistance, and using motivational approaches and coercion when indicated. This approach has been demonstrated to be an effective intervention for most individuals with severe and persistent mental disorders. Clearly, Sam has been offered a great many services. However, it is unclear whether the services were ever coordinated and provided by an assertive community treatment team. If not, Sam deserves such a trial.