Deinstitutionalization taught us that without efforts to manage mental health care, many providers gravitate toward treating those who are less ill, patients are often denied access to services, and coordination of care is rare. So we public-sector managers learned and took action. Slowly, over the past several decades, basic services were funded, and the range of services was expanded. Case management emerged as a strategy for securing access to care and coordinating treatment. Assertive community treatment was introduced and proved an effective method for integrating care within a single treatment team. Local mental health authorities were developed to establish single-point accountability for the provision and coordination of care. Consumers were engaged to shape the services being offered. Many problems remained, but there was a commitment and a vision.