T RADITIONAL METHODS of delivering psychiatric services are being critically scrutinized, largely because mental health professionals are becoming increasingly aware that they alone cannot treat the large numbers of patients requiring help. Outpatient clinics, burdened with lengthy waiting lists, were among the first to respond to the pressures for more efficient means of giving service. One of their major solutions was to evolve the team concept, expanding the roles of all clinic workers. Their experience showed that the psychiatrist was not the only team member competent to evaluate patients and plan treatment. Mental hospitals, on the other hand, have usually been slower to examine how their staff policies affect their programs’ effectiveness. One reason may be that the hospitals have been startlingly successful almost in spite of themselves. The advent of the psychotropic drugs and the ensuing decrease in resident populations virtually eliminated the pressures for serious self-examination. However, with rising admission and readmission rates and the accumulation of chronic patients even in short-term, reasonably well-staffed facilities, the hospitals’ sense of success is rapidly diminishing. But self-examination will again be delayed, I believe, because with the emergence of community psychiatry, the future of the hospitals is unclear. They may be faced with serious losses of professional manpower to the community mental health centers, and left with the capacity to provide little more than the physical necessities for patients. Evaluation and organizational changes at such a time are a luxury. Nevertheless, in recent years some hospitals have attempted to make more imaginative use of their lower and middle echelons of staff, encouraging them to make decisions previously reserved for higher-level staff. Usually, as in the mental health clinics, the staff psychiatrists serve mainly in a consultative capacity. The nursing service in particular, being the only clinical department involved with patients round the clock, has been permitted to assume more responsibility. We began to make broader use of personnel at the Fallsview Mental Health Center in 1967, as a result of a staff shortage. Until then, we had operated in the traditional team manner, with duties distributed according to discipline. Our center, formerly Summit County Receiving Hospital, is a short-term state facility; we admit more than 1400 patients a year, and the average stay is 30 days. We have 150 inpatient beds in five 30-bed geographic units, each of them operated by a psychiatric team.