Dorothea Dix strongly believed that the government owes its destitute and defective members shelter and humane treatment. She played a direct role in founding 32 state hospitals. Her strength was that she took the time to notice the pain and suffering of the thousands she observed. Unaware of issues related to least restrictive settings, she felt that a state hospital would be the most therapeutic setting for many patients she encountered.Today observers can witness the same suffering within our communities. State hospitals, well run with collaboration between the private and public sectors, would diminish suffering for many patients. Located on several hundred acres of land near the cities, they could become the ideal therapeutic setting for many longer-term patients. Their programs would be accessible, responsible, and comprehensive, and they would shelter many patients. They could be well run and cost-effective.The hospital's programs could include specialized services for children, adolescents, and the elderly. Sheltered workshops could be developed with the help of private industry. Subsidized public housing could be built on the hospital grounds, with some units set aside for those with emotional handicaps. A psychiatric nursing home could be part of the complex. Moreover, community-like residences could be built on the hospital grounds to avoid a hostile community reaction to patients (7). Many state hospitals could then form affiliations with academic departments of psychiatry, an arrangement that could benefit both parties (8).It costs much money today to run badly administered state hospitals. It would cost a little more to run them well, converting them into centers where long-term treatment, training, and research could be conducted by a dedicated staff interested in treating chronic mental illness.