An art therapy department can play a unique part in improving the quality of life of people who live in large psychiatric hospitals. This chapter hopes to convey aspects of what is involved when working with long-stay residents; it is derived from practice at Glenside Hospital, Bristol and from an awareness of established departments in the south west. Before discussing the specific contribution of art therapy, it is necessary to understand something of the background and the day-to-day living conditions of this population.