Improving Mental Health Care contains 26 chapters divided into three sections. The first section, "Challenges," presents fiscal and organizational forces that affect mental health clinicians today. The chapters in this section provide an excellent introduction to contractual and clinical challenges. I thought that more discussion could have been devoted to the serious, pervasive quality problems that are found in the care of psychiatric disorders. Nationally, rates of treatment of depression and anxiety remain moderate to low. In the public sector, effective treatments such as assertive community treatment, family services, and use of clozapine are provided to only a small minority of patients who would benefit from them. However, these problems predate managed care, and any net effect of managed care on quality has certainly been small relative to these ongoing quality problems.