For several decades, the search for alternatives to inpatient care has claimed the attention of mental health researchers and policy makers. The cost of care in a high-tech, 21st century hospital and the reluctance of payers to underwrite treatment that may not be necessary or effective have resulted in the "logic" of the briefest possible hospital stay, even for medical-surgical patients. In the Open Forum in this issue, Ira D. Glick, M.D., and colleagues argue that ultrashort stays for psychiatric inpatients may do more harm than good by diminishing opportunities for a sustained recovery and eroding the therapeutic alliance with patients and families. In the absence of an evidence base on the outcomes of ultrashort stays—and as the nation implements health care reform—clinicians have an ethical obligation to promote what they consider to be best practice, the authors note. They outline a three-phase model of inpatient care, with specific principles to guide length-of-stay decisions and requirements for staffing. "Our model is not new or revolutionary. … However, it is our effort to address a problem that is vexing and enduring" (page 206). In Taking Issue, Howard H. Goldman, M.D., Ph.D., highlights the problem's enduring nature, the troubling role that confinement continues to play in inpatient care, and the lack of evidence to guide policy and practice in offering alternatives to hospital care (page 117). Provision of a range of community-based services to avert the need for inpatient care is a much-desired alternative. In an analysis of Medicaid claims over three years for adults with a mental disorder, Tanya Nicole Wancheck, Ph.D., J.D., and colleagues found that greater use of community-based services, but not a greater variety of available services, was associated with fewer inpatient days (page 194). The closure of a large tertiary psychiatric hospital in Vancouver provided James D. Livingston, Ph.D., and colleagues with an opportunity to examine whether careful policy implementation could prevent discharged long-term patients from ending up in other institutional sectors, such as correctional facilities, general hospitals, and mental health boarding homes (page 200).