The field of mental health involves many ethical issues. As health care systems change to meet the demands of managed care it will be important to address these issues. At one academic center, a new service recently created to expand psychiatric care has been developed and implemented with ongoing attention to several common and important ethical concerns. A practical approach to the provision of mental health care services in light of issues such as confidentiality, informed consent, treatment refusal, commitment, and the suicidal patient is discussed.