There is a dearth of solid scientific data on the effectiveness of regular psychiatric outpatient care. Models for psychiatric community treatment rose from pioneering work, but these models have been tested in a reletively small number of high quality randomized and controlled trials. Some of psychiatric hospital care could be replaced by day-hospital care and use of hospital treatment may be decreased among some of the patients with severe psychiatric disorders by using home-based care by mental health teams. Early intervention in psychosis may provide possibilities to decrease need of hospital care. Closure of psychiatric hospitals is unlikely to lead to the development of community care. High quality care necessitates follow-up of effectiveness and, additionally, good working conditions, where treatment may be applied according to the best information available.