The organization of a psychiatric specialist service integrated in primary care is described. One of the aims was to replace admissions to the mental hospital with consultation and treatment within primary care. An 18% reduction of admissions was achieved over a 2-year period. The staff at the local mental hospital to a large extent controlled the number of admissions. Lack of cooperation from part of the staff made a greater reduction of admissions difficult. It is argued that in order to achieve a true shift from institutional to community psychiatry, the use of the hospital beds should be monitored from the community level.