Deinstitutionalization and the growth of community care further challenged the role of the hospital. At the time, in response to a series of studies focused on length of hospital stay and alternatives to inpatient care, we asked, "If less is more, is none optimal?" The appropriate answer at the time was "No," but the optimal form of 24-hour care was anything but clear. It is not clear that "your hospitals" should be "our hospitals," unless patients need the intensive, high-technology environment of the modern general hospital. Some people with acute mental disorders require a general hospital setting. Not all patients who need 24-hour supervision or confinement, however, need that level of care. For some patients, freestanding psychiatric hospitals, affiliated with academic centers, are a more appropriate, lower-cost alternative to the general hospital. For many others, 24-hour alternatives may be more appropriate than the acute care hospital.