Downsizing at a large state hospital in Maryland was associated with qualitative changes in the resident population, including a higher density of disruptive or disturbed patients on all operating wards and a reciprocal decrease in the proportion of healthier patients whose presence would have added stability to the social structure. This combination created the illusion that psychiatric patients per se had become more dangerous. More likely, the hospital's reduced accommodations fostered retention of the most disturbed patients in greater concentrations. Overcrowding on the wards was more frequent due to admission pressures and ward closures. Specialized treatment wards were discontinued, and their patients were integrated into the mainstream patient population. Paradoxically, although downsizing may result in fewer patients, the need for staffmay not be reduced, given the qualitative changes in the patient population. A historical overview with ten years of circumstantial evidence implicates downsizing ...