The Shame of the States, published in 1948, exposed the shocking conditions at 20 state mental hospitals and was one of the factors contributing to the deinstitutionalization movement. Forty-two years later, deinstitutionalization itself was labeled the second shame of the states, in part because of the lack of adequate services in many communities and the related rise in homelessness and incarceration among persons with mental illness. In this issue, Carol T. Mowbray, Ph.D., and her coauthors argue that implementation of managed behavioral care in the public sector threatens to become the third shame of the states unless policy makers, planners, and all stakeholders learn from the failures of deinstitutionalization. The authors discuss parallels between the course of that movement and the growth of managed care. They describe the benefits and the negative effects of each movement and present recommendations for improving public-sector managed care on the basis of lessons learned from deinstitutionalization (see page 157).