The author reviews the leadership changes that have taken place in mental health organizations and the factors that have influenced these changes as the mental health field has developed. The administrators of the early mental hospitals were physicians and laymen. By the mid 1840s, the physician-administrator had become dominant, but this changed with the social values of the 1960s and the growth of community mental health centers. Most recent has been the movement into leadership positions by professional administrators without clinical training. The author suggests that the mental health leaders of the 1980s must understand that administration is substantially modified by the subject matter and the values of the mental health field. He feels that the administrator must never lose touch with the experience of being a patient.