A 1977 survey of public attitudes toward psychiatry found that the quality of institutional psychiatry was one of several factors associated with negative attitudes toward the field. Noting the shortage of psychiatrists in public institutions, the author questions whether the public associates psychiatrists with conditions in the institutions despite their lack of involvement, or because of it. He believes that the inadequate care provided in many public facilities is a result of a tacit social contract between the public and private sectors that enables private institutions to maintain their fiscal integrity and their quality of care by moving undesirable patients to public institutions that provide inadequate care. Although the problems with the system extend beyond psychiatry and the mental health field, he suggests that psychiatrists could force some positive changes by refusing as a profession to practice in institutions that provide inadequate care, and by supporting the delivery of public services by nongovernmental bodies. The ultimate answer, he believes, lies in research into more effective treatment for mental illness that would make such institutions unnecessary.