Three years ago, President Bush established the New Freedom Initiative, dedicated to ensuring that people with disabilities, including those with mental disorders, have “the opportunity to learn and develop skills, engage in productive work, choose where to live and participate in community life.” A key component of the New Freedom initiative was the appointment of an independent, nonpartisan commission charged with assessing America’s mental health system and making recommendations for improvements. The final report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America, released in July 2003, offered hope for millions of Americans and their families who are affected by mental disorders. The Commission found that recovery from mental illness is possible and that promoting recovery — not merely managing symptoms — should be the driving goal of America’s public mental health system. The report made clear that effective and cost-effective treatments exist, and that early identification and intervention can prevent the negative consequences associated with unmet mental health needs. Unfortunately, the Commission also found that the system designed to provide services to people who need mental health care is “fragmented and in disarray, lead[ing] to unnecessary and costly disability, homelessness, school failure and incarceration.” As a result, only a fraction of the people who need services get them, and most individuals cannot access the services that would best increase their independence. The Commission’s final report called for “fundamental transformation” of the mental health system as the only option for meaningful reform. Outlining goals and recommendations to provide a framework for such transformation, the report raised hopes that people who have mental disorders could and would realize the promise of leading more productive and independent lives in their communities. To date, however, there has been little progress in realizing the Commission’s goals or implementing its recommendations. For millions of Americans with mental disorders and their families, the consequences of this inaction have been tragic and sometimes fatal. Since the release of the Commission’s final report. (Authors)