In this month's lead article, David Mechanic, Ph.D., reviews lessons he has learned from 45 years in the mental health field. He focuses on five areas—research, managed care, parity, integration of services, and employment of persons with mental illness. Dr. Mechanic points out that parity needs managed care: providing mental health care in the context of a carefully managed benefit ensures that parity results in only modest additional cost. He describes hopeful efforts over the years to integrate services and acknowledges the extraordinary difficulty of doing so. Yet many proven strategies for improving continuity of care are not technically difficult, he notes. Dr. Mechanic praises research showing that supported employment is more effective than traditional vocational rehabilitation, but he notes that many of the professionals who make decisions affecting rehabilitation opportunities have failed to hear this message. What is the foremost lesson he has learned? "In every endeavor I've been involved in, I repeatedly have been impressed by the difference caring makes" (see page 1227).