To the Editor: The November issue includes a timely review by Thomas and Rickwood (1) of residential alternatives to psychiatric hospitalization for patients who need acute care. Their main conclusion was that care provided in these settings can improve symptoms at least as well as care provided in psychiatric hospitals and that the alternative settings appear to be cost-effective. At a time when saving money is becoming increasingly important, it is essential to look closely at these findings. The authors noted the enormous variation among these services. They also remarked that the studies they reviewed did not provide much detail about the patients and the actual treatment and support provided. A recent review of nonresidential alternatives to psychiatric hospitalization also mentioned the omission of such details (2), and we agree with the authors that these aspects should be investigated further.