A unique experiment in managed mental health care utilizing a comprehensive capitation model is underway in Rochester, New York. Building on the strengths of a well-developed community service system, the Integrated Mental Health (IMH) project is attempting to bring quality community care to chronically mentally ill patients whose primary source of care has previously been public institutions. The experiment seeks to demonstrate that, for the majority of seriously and persistently mentally ill patients, functioning can be improved in a system in which limited resources are consolidated and follow individual clients, and responsibility and accountability for patient outcomes is clearly assigned (Babigian and Reed, 1987a, 198713). Goals and DesignThe IMH plan has a number of advantages over more conventionally financed public mental health programs. The plan sets a fixed rate per client per year, and the funds go with the patient. Each year, the fixed rate is adjusted for inflation. By contrast, most public mental health systems have fixed budgets but without assignment of resources to indi-43 D . Mechanic and L. H. Aiken (eds.). hying for Sm'ces: Promlccs and PitfalL of Capifation.

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Use of the paradigm shifts advocated by futurists and the supporters of total quality management can facilitate access to new options for mental health systems. New views and innovative systems, however, become difficult to maintain in the context of increasingly rapid and unexpected change occurring in the environment. One strategy that can be employed is the use of leverage, a term usually associated with finance or politics.