The author discusses some of the barriers encountered in attempting to transform New York City's fragmented mental health services into a comprehensive, nondiscriminatory, and accessible system. Among the barriers he identifies are the belief that more money alone will solve the problem; the uneven distribution of funds among the boroughs of the city and the resistance of existing agencies to redistribution; and the way in which reimbursement patterns shape the kinds of services provided. He believes the single most effective stimulus to the development of an integrated system of care would be a requirement that eligibility for reimbursement under Medicaid be based on a facility's participation in a comprehensive system of care. He emphasizes the need to remove social, rehabilitation, and other services from under the mental health umbrella and to obtain other sources of funding for them; the need for local governance of services; and the need to provide work opportunities for the more seriously disabled.