As public-sector managed care initiatives have been adopted, a number of serious problems and concerns have arisen. In for-profit care systems, persons who are simultaneously involved in maximizing profits and providing patient care increasingly face conflicts of ethics and interest. Clinical decisions and mental health policy, often influenced by persons with limited clinical expertise, create barriers to access to services. Less skilled personnel are substituted for more qualified providers, and fewer staff are available to provide care. Education of patients is inadequate, and they are often confused about their illness and the range of available services.