This article is based on the examination of seven old age psychiatry services in England in 1991, and it addresses the main issues in the organization of community-orientated clinical services for elderly people with mental disorders. The current practice of old age psychiatry places much emphasis on assessment of patients at home wherever possible. Domiciliary assessments were performed by all the services, but there were marked differences in emphasis. The most controversial issue was whether all patients should initially be seen by a psychiatrist or whether assessments by non-medical professionals were acceptable. Several areas of recent development in old age psychiatry are also discussed.