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Among 46 Chinese and mostly manic-depressive (85%) outpatients attending a lithium clinic in Hong Kong, virtually no patients had low serum (0%) or erythrocyte (2%) folate. Their mean folate levels did not differ from lithium-free outpatients. Although serum folate correlated negatively with lithium dose (P less than 0.002) and serum level (P less than 0.01), lithium treatment probably did not by itself cause low folate. Folate level was not related to diagnosis, duration of mental illness, other drug usage or spot affective morbidity. Patients with a good response to lithium in the previous one year had a higher mean serum folate level than those with unsatisfactory response (P less than 0.05). These data suggest that folate deficiency is uncommon among Chinese psychiatric outpatients, but support recent evidence that folate at high concentrations enhances lithium prophylaxis.