In the United States, clinical psychologists who provide inpatient mental health services must contend with practices, pressures, and policies that can at times challenge, or be contrary to ethical, psychological practice. Such issues may emerge from numerous sources including insurance companies, administrative hospital committees, institutional policies and procedures, accrediting body standards, the courts, and state commitment laws. Such interferences regularly challenge psychologists’ ability to ethically and professionally establish treatment relationships, choose clinically informed psychological interventions, maintain patient confidentiality, practice within their boundaries of competence, ensure accurate use of psychological data, and protect the rights of psychiatrically unstable and cognitively compromised patients to informed consent. Additionally, the institution’s treatment model, the multidisciplinary treatment team, the differing ethics codes among disciplines, and psychology’s position within the treatment team and organizational hierarchy impact psychologists’ ability to provide autonomous, clinically informed, ethical treatment. Sensitivity to these issues is growing in the inpatient setting through psychologists’ commitment to establishing collaborative relationships with institutional managers, treatment team members, and the legal system, as well as their participation on hospital-wide committees to develop policies reflective of ethical psychological practice.