About a decade after the enactment of the Community Mental Heal th Centers Act (PL 88-164) in 1963, the American health service delivery system began a period of profound transformation. The nature of that transformation and its impact on the organization and delivery of mental heal th services could hardly have been fully anticipated a quarter of a century ago when dedicated staff at the National Institute of Mental Heal th joined with their colleagues throughout the mental health service delivery system to fashion the blueprint for a national system of community-based comprehensive mental heal th centers. Their vision was c l ea r the federal government would help support and staff the local development of a full range of public high-quality preventive and restorative mental heal th programs and services that would be available to a l l t h e rich and the poor, the young and the old, the resident and the transient, and to the heal thy as well as the acutely and chronically ill, without regard to the severity of their conditionstha t is, to the entire community (Brown & Cain, 1964; Smith & Hobbs, 1966). Even today the vision is an exhilarat ing one, but events of the past 25 years have passed the vision by. Rather than being the keystone of a single high-quality mental heal th service delivery system, community mental heal th centers are increasingly treat ing the poor and the chronically mentally ill (who are disproportionately poor), leaving to the vastly expanded private sector the t reatment of patients who are able to pay for their medical care, physical as well as mental.