Who gets psychotherapeutic aid in a population at risk of reexperiencing mental health problems? The study samples included 499, 18–65 year-old, nonretarded, formerly hospitalized mental patients living in 234 of California’s sheltered-care facilities. The sample of residents and facilities were representative of their respective statewide populations. At the time of the study 28.9% of the residents were receiving some form of psychotherapeutic aid. The study finds that the environmental context of sheltered-care, including the facility’s philosophy of care and the composition of its resident group, is a powerful determinant of treatment status—more important than such individual characteristics as chronicity or degree of psychopathology. This finding is especially pronounced for women and older residents.