Research has shown that many patients with severe mental illness have significant medical illnesses and unmet needs for medical care. The growth of carve-out arrangements for mental health services under managed care has raised concerns that these patients will find medical care even less accessible. Six papers in this month's issue focus attention on this problem. Barbara Dickey, Ph.D., and her colleagues found that Medicaid beneficiaries with a psychotic illness have a higher treated prevalence of certain disorders, including diabetes, hypertension, and heart disease (see page 861). Michael B. Blank, Ph.D., and coauthors, who also used Medicaid data, showed that having a serious mental illness is associated with a significantly increased risk of HIV infection and other medical conditions (see page 868). Julie Cradock-O'Leary, Ph.D., and colleagues found that patients with mental illnesses in the Veterans Affairs system make fewer visits for medical care than other VA patients; the largest differences they found were for patients with severe mental illness (see page 874). Faith B. Dickerson, Ph.D., and coauthors found high rates of obesity and cigarette smoking and underuse of mammography among older women with schizophrenia (see page 882). Gail L. Daumit, M.D., M.H.S., and colleagues found that very few psychiatrists provide preventive medical services such as counseling about weight or sexually transmitted diseases (see page 884). Finally, Richard W. Goldberg, Ph.D., and coauthors showed that persons with severe mental illness can reliably report their use of medical services (see page 879).