This article discusses the significant transformation that is occurring in conceptualizing serious mental illness (SMI) and its treatment. Three key areas of that transformation are discussed: a change from a pathology perspective of people, their dysfunction, and treatment to a competence perspective; new ways of understanding the relationship between biology and human experience; and changes in the notions of causality in SMI. Significant advances are also occurring in the development of empirically validated pharmacological and psychosocial interventions, in the identification of the critical components of an effective service delivery system, and in the discovery of significant recovery rates for people with SMI. Finally, some implications for psychologists' practitioner roles, for public-private partnerships in organized health care systems, and for the role of state psychological associations are noted.During the past 10 years, dramatic advances have taken place in psychology's understanding and treatment of, attitudes toward, and service delivery for people with serious mental illness (SMI). This article, the first in the special section, focuses on some of the new ways psychology now understands SMI and provides service delivery, the exciting advances in effective

Psychologists working in the public sector should, in addition to providing direct services, advocate for systems change. Although many consumers treated in the public sector face a constellation of severe life problems, working to improve the system of care is more difficult than providing treatment. Improving the quality of life of consumers of publicly funded mental health services requires that psychologists become advocates. Four prerequisites to systems change, plus coalition building, legislative advocacy, the work of state psychological associations, and forming alliances between psychologists and nonpsychological community organizations such as Rotary International, are described. In conclusion, 12 orienting ideas are listed for psychologists who want to advocate for social, institutional, and political change.

Until this year, laws concerning medical staff membership for psychologists were permissive in California. These laws also were applied differently in the public and private sectors. Psychologists practicing in state-run facilities were systematically excluded from membership, while their counterparts in private practice often were granted access. In the middle 1980s, public service psychologists began using organized labor to gain entry to medical staff in state-run facilities. When collective bargaining failed, some psychologists left organized labor and began working within the California Psychological Association to seek legislative recourse. The legislative route was ultimately successful but only after support was garnered from labor as well. The California experience shows that state psychological associations are vehicles to advance psychology in the public sector and that support from organized labor can be critical.

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