Why is this such a crucial time for the commission to be undertaking its work? The last decade, as we all know, has seen a growing gap between the resources available for psychiatric treatment and the needs of our patients. Public sector programs have continued closing beds and imposing new restrictions on eligibility for services. Private sector insurance programs almost universally have carved out their mental health care, turning it over to the less-than-tender ministrations of the managed care industry. Managed care’s progressive reductions in payments to practitioners and facilities have forced a steady shrinkage in the number of inpatient units and outpatient clinics, and in the availability of private practitioners who accept insurance coverage in exchange for care. Taken as a whole, these changes have led to a crisis of access in many parts of the country, the consequences of which include tens of thousands of persons with mental illness confined in jails and prisons, acutely ill patients waiting for days in emergency rooms for inpatient beds to become available, and waiting lists of weeks to months for outpatient care.