We examine whether community mental health care centers (CMHCs) differ in their ability to serve at-risk populations, including clients with dual diagnoses for substance abuse, comorbid disabilities, and particularly severe functional impairment. Our analysis uses data from Indiana ’s public mental health system. Although at-risk clients experience, on average, worse outcomes than other clients, we find that some CMHCs achieve statistically significantly better outcomes than others. Although this information is useful to consumers and providers who wish to identify the most effective providers and treatment models for at-risk clients, it is not generated in standard performance assessments.