The history of reform and the origins of unrest in America are briefly reviewed. Concurrent reform streams of the past are examined in terms of an emerging awareness of the relationship between racism and poverty and social environment. The mental health and social welfare movements paralleled this recognition, but did not lead the new reform. There were no fundamental changes in practice until the civil rights revolution shocked them into awareness. Recently, these groups have viewed poverty and racism as the major mental health problems. This paper emphasizes the need, in the light of history and research, for consciously directed social change. Environment, it is contended, must be altered. New frames of mental health practices now rest on the interdependence of psychological and social matters. The paper concludes that reform has effected a new climate and, resultantly, some new institutional forms. It also questions whether the commitment to improve the quality of life and seek the objectives of social reform can be broadened into a national one. (TL)