As aging and disease structure has changed mainly in accordance with adult disease, general medical treatment has been expected to take a role as a part of the "Comprehensive Care" that contributes to improve the quality of life. The similar paradigm change is needed for the treatment for the people with severe mental illness. The goal of this change is to realize the dissemination of prevention, early intervention, and comprehensive treatment in the community for the people with severe mental illness. The challenge for this change is reform on traditional structure of hospital based treatment and immaturity of staff skill. This article discuss the recent reforms of "Day care" and outreach team in National Center of Neurology and Psychiatry, focusing on these system-wide change and improvement of clinical skills of the staff. The key points of reforms are summarized as follows: (1) strongly focusing on the consumers' needs in their daily life, (2) establishing case management by the mental health staff, and (3) transforming the hierarchy system from in which psychiatrists are at the top of the multidisciplinary team to in which all staff are as equal members of the team. Some areas for necessary improvement required for the future are indicated in the end of this article.
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