Area variation studies rarely focus on perceptions of service system performance in their comparative analyses. Using an instrument designed specifically for assessing key stakeholders' perceptions of the performance of mental health service delivery systems, this study compared three areas in Massachusetts that differ significantly with regard to service system structure and resource allocation. Despite these differences, key stakeholders' perceptions of service adequacy, availability, quality, and coordination did not vary substantially, although the findings suggest that to some extent organizational structure may have more effect than resource availability and allocation on perceptions of key stakeholders within the three systems. These differences were also of far less magnitude than differences in hospitalization rates and other more traditional measures of service system performance. The authors argue that stakeholders' perceptions should be considered, along with other standard performance measures, in evaluating service system performance.