Background/Aims Individuals with serious mental illnesses can experience significant disability, affecting ability to guide and adhere to treatment and navigate systems. Needs for a range of services are common, yet despite recent efforts to improve care quality, persistent challenges blunt or derail reforms. Obstacles include: difficulties changing the focus of care from acute symptom control/relapse prevention to patient-centered/recovery-focused care; constructing coherent, integrated services; coordinating care while managing multiple, fluctuating funding streams; and high staff turnover that produces poor continuity of care. Our goal is to provide guidance for future comparative effectiveness and patient-centered outcomes research (CER, PCOR) to improve individual-level patient-centered outcomes (PCOs).