Comments on the article by J. C. Fortney et al describing their relatively unsuccessful efforts to implement improved care for patients with complex mood disorders in safety net clinics. It is unusual for scientists to submit papers describing their unsuccessful studies and even more unusual for journals to publish them. More importantly, Fortney and this journal have provided us with an unusually detailed and thoughtful description of many of the factors that may have contributed to this result. Few studies actually provide this close a look at what was done to implement the desired changes.