Over-all admission rates to mental hospitals from this urban health district are extremely high as compared to most published data about defined populations. We believe that this is attributable to several factors. First, the area is one of high density apartment residences; second, the usually published data do not include admissions to readily accessible acute psychiatric services without certification procedures; and third, the high level of acceptability or utilization of psychiatric hospitalization by the New York City population. The degree to which such services are occupied with the treatment of acute crises associated with alcohol in men and with the management of suicidal behavior in women is particularly striking. Any clinical service to be offered to such a metropolitan district must be prepared to deal with a large volume of severe psychiatric emergencies.