With the process of closing psychiatric hospitals and establishing community-based alternatives more than 20 years old in the United States, psychiatric practice there is in the post-deinstitutionalisation age. In Britain we are now starting on this same path. Against this background, I attended the annual conference convened by the journal Hospital and Community Psychiatry in October 1987. Held in Boston, in the same week that Major Koch of New York sanctioned the compulsory reinstitutionalisation of homeless mentally ill people from the streets of Manhattan, the conference emphasised four themes: homelessness, outreach programmes, systems of case management, and compulsory out-patient treatment.