In mature mental health systems in the United States, community-based programming for people with serious mental illness has become dominant. There is general acceptance of the idea that the community should be the primary locus of care, with the hospital providing interim care when needed. In these systems, local authorities usually provide leadership in planning, financing, and operationalizing programs, and in mandating that organizations work together in a collaborative and integrated manner.

In these mature systems, the questions of interest include where the boundaries of the mental health system lie, the implications and role of managed care in mental health, and the possibilities and utility of user-friendly information systems. Other significant issues are appropriate values in delivery of care, consumer roles in conceptualizing and delivering services, and coercion in community settings.