Treating the Least Well Off

In Reply: I cannot speak for all the participants at our conference, but I certainly agree with both premises of Dr. Thompson's letter: first, that the application of the principles we invoked in our consensus statement should not be limited to systems serving low-income or disadvantaged people, or even to people with mental illness, and, second, that they deserve application across health care systems and across strata of our society.

Although some, but not all, of the participants at the consensus conference have been involved with preserving services such as assertive community treatment, methadone maintenance, and psychosocial rehabilitation in public mental health systems and we referred to the "trench warfare" of organizational decision making as an example, there was no intention to restrict the arenas in which these principles should be applied.

As Dr. Thompson observes in his comment on the contentiousness of the politics of redistributing monies, the processes and challenges of applying these principles vary considerably across sectors and levels of political process, but the animating issues remain much the same.