This article aims to understand how a marginal approach to mental illness for a short time gained the status of a public health policy. In Russia, as in Europe, psychiatry was established around the institution of an asylum. Since the end of the nineteenth century, some psychiatrists had required that hospital care be complemented with institutions better integrated in the social milieu and aimed at preventive care. After the October Revolution, the Commissariat for Health (Narkomzdrav) made certain decisions to promote psychiatric care outside hospitals. They remained of limited importance during the period of the New Economic Policy, but came to prominence with a decree in 1929. However, the significance of the decree was limited because, within two years, it was displaced by another policy returning to the hospital-centered approach the Narkomzdrav embraced in the 1920s. The primacy of psychiatric services outside the hospital was thus a parenthesis that speaks to the larger question of the role of psychiatrists within the Soviet project. It also raises the issue of the protection granted by a state to an individual who is supposed to participate in the building of a new, collectivist society.