The role of the general hospital within the psychiatric service delivery network has undergone profound changes in recent years. Current issues in general hospital psychiatry revolve around questions concerning boundaries, target populations, appropriate services, structural characteristics, and deinstitutionalization. Decisions in general hospital psychiatry derive from a series of influences that originate at varing distances from day-to-day hospital operations. Planning should ideally be filtered through the hospital's internal decision-making process in order to ensure a "bottom-up" rather than a "top-down" emphasis in service policy.