At the start of the 21st century, America is indeed confronting a crisis in mental health care, as Dr. Appelbaum points out. But the problem is even deeper and less tractable than his analysis suggests. For one thing, the crisis is clearly chronic, not just a current issue. Did America not confront a similar mental health crisis 150 years ago? For another, it is not just a problem within the mental health and health care systems, unless these systems are defined broadly. For example, we have come to understand that homelessness cannot be solved with treatment alone: affordable housing must be available. Finally, it is becoming apparent that some of the toughest problems are the results of well-intentioned—even well-executed—reforms. There is a crisis, but the way out is not simple, quick, or obvious.