Mental health care in America is a system in need of reform. Many social challenges related to mental illness continue to persist despite substantive government investment. These include elevated suicide and overdose rates, mass shootings, homelessness, and the high rate of mental illness among the incarcerated. According to some survey evidence, the American public now has a more negative view of the mentally ill than decades ago.

The public mental health-care system’s inability to address serious mental illness has forced mental health responsibilities onto many other public programs and agencies, such as criminal justice and transit. This compromises those systems’ ability to focus on their own core missions.

A more effective mental health system would be one that exercised more responsibility over untreated serious mental illness.

This report will articulate the concept that should guide mental health-care reform, called a Continuum of Care: • Continuum of Care is a system of programs and services that are community-based, community-oriented, and oriented toward serious mental illness. It’s a system that assists seriously mentally ill individuals before, during, and after crisis.

• The Continuum of Care is anchored in residential programs. The number of hospital beds in a given community—including, but not limited to, psychiatric hospital beds—is its core component.

• To stabilize mentally ill individuals in crisis, the programs constituting a Continuum of Care system must somehow function as that: a system. Any given community needs multiple programs to care for the variety of psychiatric disorders that exist and, especially, to care for people in different stages of recovery. But these programs must coordinate with one another to work toward, measure, and account for defined intended outcomes.