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Evaluating and improving the appropriateness of treatment for schizophrenia.

For years clinical experts and advocacy organizations such as the National Alliance for the Mentally Ill have raised questions regarding the care being provided to individuals with schizophrenia by publicly funded organizations. Although systematic studies of quality are rare, evidence has suggested that outcomes in typical settings may be much worse than those in research projects that provide state-ofthe-art treatment. Relapse rates, for instance, can often be lowered to 0‐20% per year in efficacy studies but may be severalfold higher in typical settings.1 Recently, such apprehension has intensified due to the dissemination of “managed care” methods into the public sector. Although such new financing systems are designed to improve access and efficiency, concerns have been raised that they may place severely ill individuals at increased risk for poor outcomes. 2,3