This article is about the role of the Israeli District Psychiatrist (DP), and explains how the DP came into being. The content is based upon documentation and the personal experience of the first author (M.K.) and reflects the views of both authors. The establishment of the DP model is deeply rooted in the history of mental health services in Israel. The authors illuminate philosophies and actual events leading to legislation of mental health laws, upon which the authority of the DP is based. The current laws broaden the scope of the District Psychiatrist's authority. In spite of a clear conflict of interest, the additional function of the DP as a director of the local psychiatric hospital governed by the Ministry of Health continued for 40 years, until the end of the 20th century. The new situation, backed by additional modern legislation, enables the DP to play a major role in the reforms that have characterized the mental health field in Israel over the past five years. Legislative attempts to reduce the authority of the District Psychiatrists have failed. In the emerging era of privatization and free enterprise, the position of the DP as a protector of patient rights for adequate treatment has become more prominent as has the conflict between the DP and service providers.