Objective: The health, personal life, and attitudes of case managers providing intensive services to severely mentally ill clients were evaluated to see bow the managers changed over their first 18 months on the job. The authors report here on changes on major variables related to health status and job attitudes. Methods: A cohort of 82 case managers newly hired during the first year of New York State's intensive case management program was followed for 18 months. A battery of measures of health, life events, life satisfaction, social support, job situation, and job attitude was administered by mail questionnaire at job entry and at three, 12, and 18 months to case managers who remained employed in the program. Results: Approximately 80 percent of the eligible (still-employed) case managers responded at each time point; 64 were still employed at the end of the study. Over time they experienced increasing amounts of job stress and emotional exhaustion, depersonalized clients more, and reported significantly more stress-related physical symptoms and depressive symptoms. However, their sense of personal accomplishment and their job satisfaction remained stable. Conclusions: Case managers appeared able to overcome job pressures and persevere in their professional commitment. What difficulties they had appeared to level off after one year, at least among those who continued in their positions. Although the findings do not indicate that case managers need intensive help, early support and preventive intervention for job difficulties would be helpful.