Mental health policy has evolved haphazardly, reflecting fragmentation of authority, competing ideologies, limitations of current knowledge and technologies, and changes in entitlements and insurance associated with health and welfare programs. While seeking parity with general health services, the mental health sector requires as well a range of health and social services that extends well beyond acute care, particularly for those with severe and persistent illness. Despite recent advances in articulating health, disability, and social services programs, much remains undone. The stigma of mental illness affects both intergovernmental cooperation and public response. Health reform provides an opportunity to address neglected areas and to build a closer connection with general health services. New coalitions of advocates for the mentally ill, the elderly, and persons with disabilities could construct a coherent long-term-treatment orientation that would benefit all.