The development of additional mental health services at the community level had both positive and negative consequences. On the positive side, some services became available for persons with less severe mental illness who had never been institutionalized. On the negative side, the multiplicity of services and the growing complexity of the mental health system made it difficult for persons with severe mental illness to successfully negotiate and access necessary services (Mechanic 1991). Even worse, it became clear that many seriously ill persons, particularly those with schizophrenia, showed little initiative in seek- ing out psychiatric services, were unable to advocate for themselves, and were difficult to engage in community- based services. Instead of services in the community being easier to access, they proved to be more difficult for patients who formerly would have been served in the hospital (Bachrach 1982; Lamb 1982).