Yet the reality is that for the most part, the services of public mental health systems are not an entitlement in our country. Public services depend on budgetary priorities and appropriations. There are more needs than resources. Having stated the obvious, I will add that it is also incumbent on state mental health systems to ensure that clinical, not fiscal, decisions prevail in individual situations. It is essential that direct care staff and practitioners make sound clinical decisions, incorporating the client in the process. It never ceases to amaze me how creative direct care and clinical staff can be, even when resources are scarce, in mobilizing the resources necessary to meet the needs of a person like Sam.