A serious and chronic problem that confronts mentally ill people and mental health professionals is the inability of society to provide the requisite resources for adequate care-giving systems. This difficulty has been evident for almost two hundred years. The present paper summarizes the major causal processes as these were revealed in the course of a case study of a mental health centre and its catchment area in Nova Scotia. These barriers to adequate care systems are then considered in historical perspective in order to illustrate how they function more generally. The historical perspective reveals a further handicap in the fact that experiences gained in one reform movement are not transmitted and utilized in subsequent efforts.