AbstractAlthough areas of clinical service in Nova Scotia appear to be expending beyond traditional mental health, there has been little study of the degree to which organizational structures have evolved to keep pace. This study surveyed clinical settings in the province to determine the nature of the psychological services offered and to examine their organizational context. In general, although offering innovative services, most psychologists continue to work out of traditional structures.The roles of clinical psychologists working in hospitals have been evolving (see, for example, Lesse, 1986; Dunn, 1986; Arnett, Martin, Streiner, & Goodman, 1987). Psychologists have been emerging as independent professionals who provide a wide range of services to numerous hospital areas (e.g., pain management, cardiology, oncology) in the absence of supervision by other professionals such as psychiatrists. These changes have been variously attributed to: the development of the fields of psychology and behavioural medicine, the conscious pursuit by psychologists of increased autonomy, an increased emphasis in hospitals on cost - containment, an associated emphasis on outpatient work and on professionals who can offer services most cost - effectively, increased hospital and consumer awareness of the need and relevance of psychological services, better training of psychologists for independent functioning (Dunn, 1986), the abdication of psychotherapy to non - therapists by an increasingly biologically - focused psychiatry, the decreased need of specialties for psychiatric services specifically as the former increasingly administer psychotropic medications on their own (Lesse, 1986), and an increased emphasis on psychoeducation for both patients and hospital staff (Parker, Karol, and Doerfler, 1983).The expansion of services has not always been accompanied by changes in organizational and administrative structures which might better facilitate their delivery. Despite suggestions for psychologists to increase the rate of academic cross - appointments, gain full voting status on staff associations, provide direct input to hospital - wide policies (Dunn, 1986), and assume coordinator positions of medical units such as pain management clinics (Parker et al., 1983), progress has been slow. In a survey of 340 Canadian general hospitals, Arnett et al. (1987) found disappointingly low rates of involvement by psychologists in areas of practice, research, or teaching outside of their own immediate departmental or divisional affairs. Many departments, moreover, although nominally autonomous, were dependent on funding from departments (usually psychiatry) and had no direct links to central administration except through these departments. Arnett et al. (1987) concluded that many psychologists worked under supervision either implicitly or explicitly.PROBLEMS FOR PSYCHOLOGYThese findings have some important implications. For example, it is possible that certain administrative structures, in which psychologists work under psychiatrists, could make it more difficult to develop psychology services. The argument can be made that mental health is the mandate or priority and that resources are not to be used up with the worried well but physically ill. This argument probably carries most weight with administrators when dollars are less plentiful. Moreover, when psychology has been funded through psychiatry, then the medical side may be unwilling to give up money for psychologists who have been seen as foreign, perhaps unnecessary, and, best of all, not coming out of budgets. Finally, if psychologists remain isolated from other professionals (medical and otherwise), then there is little opportunity either to influence hospital policies in a broader sense or to develop relationships with others who might aid psychologists in the creation of innovative services. …