When I discuss residential care psychiatry and who should do it, I do so on the basis of my own experiences working in large homes containing ten or more residents. In small homes with just a few residents, it is possible to practice residential care psychiatry as one does in office settings-primarily in one-on-one situations in the luxury of a private room with the additional luxury of an allotted interval of time dedicated to an individual patient. This is one way to practice residential care psychiatry, but it is basically office psychiatry practiced in a residential care facility setting. My experiences in residential care facility psychiatry have been principally in large homes where the physical limitations were such as to discourage private sessions and where the time pressures were such that dedications of prolonged periods of time to selected patients were not practicable. Thus my comments about residential care psychiatry should be understood in that context. When I describe residential care facilities, I am focusing on large homes with many patients, most of whom have serious and severe mental illness of long duration and where the time demands were such so as to not allow the twenty-five-minute hour, much less the fifty-minute hour.