Psychiatric services for the elderly are evolving rapidly. The Government has recently reiterated that this area needs special attention. The reasons for upheaval are well-known: the changing age structure of the population, the historical neglect of the elderly mentally ill and a growing emphasis on community-based approaches in place of traditional institutional solutions. In the London area and elsewhere, adjustment has been complicated by geographical transplantation from old suburban mental hospitals to locally situated units, often within district general hospitals. New specialist services also suffer from the effects of financial stringency and inadequate recruitment. These and other changes have ensured that the process of restructuring services has been difficult. Planners have had few precedents to fall back on, and have been heavily dependent on available guidelines. There has been comparatively little information available about how effectively services work in practice.