The third theme is systems integration. In his 1985 review of public psychiatry, Talbott decried the "fragmentation of the psychiatric delivery nonsystem" and pleaded for the development of "a unified systems approach." In the following decades, hundreds of millions of dollars were spent on three large service demonstration projects that tested systematic solutions to this problem, but none found evidence that such systemwide integration efforts yielded clinical benefits (3,4,5). Last year, the transmittal letter of the final report of the President's New Freedom Commission on Mental Health echoed Talbott's claims, "for too many Americans with mental illnesses, the mental health services and supports they need remain fragmented, disconnected, and often inadequate." But the Commission did not recommend global, top-down approaches to the problem. Rather, it focused on the need for recovery-oriented services at the client level, echoing Talbott's exhortations that policy and practice be guided by a "focus on the patient."