Obtaining care for severe and persistent mental illness has been a challenge because each service area has its own special purpose and funding mechanisms whereas those with severe and persistent mental illnesses need a broad array of services. Hence there has been much effort to produce service integration. Cuddeback and Morrissey review the experiences of service integration and consider four major innovations (Community Mental Health Centers; the Community Support Program and its spin-off, the Child and Adolescent Service System Program; the Program on Chronic Mental Illness; and efforts to introduce managed mental health care). Recent demonstration programs to integrate services have been subjected to comprehensive outcome evaluations. The research from two of these demonstrations produced similar findings; there was strong evidence for service system change and improvement, but little consistent evidence for improved client-level outcomes. The authors include a discussion of the evidence-based practice movement. The chapter concludes by describing opportunities for further research. Without a national policy for health and welfare programs, it is difficult to see how the various needs of those with severe and persistent mental illnesses will be met. Students may want to list the number of agencies in their own communities who provide services to those with severe and persistent mental illnesses, and question providers about gaps in such services as well as issues of coordination.