The Commission's strong and often reiterated support for a much greater role for the states in bringing about substantial improvements in mental health services across America causes me some concern. The report recommends greater flexibility for the states, in effect positioning them as the dominant if not superordinate authority over the organization and administration of mental health services. As a former federal government mental health official, I have experienced firsthand, along with many others, the major differences in expertise, ideology, and values between state mental health systems. For a managed behavioral health organization with programs and members across the country, significant differences between states in regulatory requirements, policies and procedures, and the like are a source of confusion and complexity with no apparent benefit. A number of the national corporations with which we work are of a similar mind. Development of greater uniformity between the states and higher standards in states where they are needed is an important and necessary endeavor.