It is increasingly important for mental health occupational therapists to monitor trends in reimbursement for mental health care in order to ensure adequate and equitable coverage of occupational therapy services. Federal and state funds for treatment of mental illness are being divided among an increasing number of mental health professionals. Private insurers are limiting direct coverage to those services that can supply cost and utilization information. This paper reviews present coverage for occupational therapy in mental health programs. Collection of efficacy and cost benefit data, establishment of separate billing procedures, and participation in the formation of public policies for treatment of the mentally ill should be primary activities pursued by occupational therapists to expand coverage of occupational therapy services in psychiatric settings.