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Attitudes toward the mentally ill at the end of the twentieth century still, regrettably, resemble those at the end of the nineteenth, but several gains have been made, particularly in the past 10-15 years, to improve the well-being of persons with mental illness. While stigma remains a primary obstacle, new medications, program innovations, and the consumer movement have contributed significantly to progress in caring for the mentally ill. As we begin the new year, and indeed the new century, it is a fitting time to reflect on what we have recently accomplished, and more importantly, on what priorities lie ahead.

In just the past several years, we have seen a significant expansion of the City's public mental health service system. Since the Reinvestment Act was passed six years ago, funding to the City has led to the development of 280 new programs. We have not just grown in size but we have also made the system more responsive to consumers. Several new programs are designed to give consumers full participation in their recovery.

The Department of Mental Health, Mental Retardation and Alcoholism Services has also achieved success in a number of other areas that deserve mention. The development of a citywide information and referral system, 1(800)-LifeNet, now gives all New Yorkers an important entry point for accessing appropriate services. Two NY/NY housing agreements in the past 10 years created much needed housing for those with severe and persistent mental illness.

New program models that emphasize integrated mental health, substance abuse and primary care are enriching service options. We have also developed a more prudent approach to funding new programs. An outcome-oriented funding approach means that publicly funded mental health programs will be even more accountable for high quality services. And, to foster independence and dignity among consumers, we have also made employment initiatives a higher priority.

Last year we launched the Treatment is Working anti-stigma campaign to promote more accurate and positive images of those with mental illness and to convey the message that people with mental illness can work, want to work, and do work. The poster campaign will run again in the transit system in the coming months, and we will continue to produce other materials that help to improve employment opportunities while promoting this anti-stigma message.

New funding from the State gives us at long last an opportunity to considerably expand the number of community-based case managers, essential foot soldiers in the support system required for many people with mental illness. More resources for housing and support programs for children and their families will also enrich our system. Additionally, the recently passed Kendra's Law will act as a safety net to bring people into treatment who might not otherwise access care.

While these gains create considerable opportunities, they also pose formidable challenges. Going forward, we must strive to build a more robust mental health system that is better coordinated, more accountable, and more relevant to consumers. We must focus on closing the gaps through which too many people with mental illness fall. We must continue to listen to consumers, families and advocates and ensure that our services maximize opportunities for independence while not allowing consumers to have critical needs unmet.

We are still making up for decades of neglect in adequately caring for people with mental illness but in the past ten years, we have made an impressive start. While the fight against stigma is one we will have to wage for many years to come, in the next decade we have the opportunity to not just significantly improve the mental health system in New York City, but also to make it the best in the nation. Why should New Yorkers be satisfied with anything less?