There is now very little room for doubt that care of older people will be a major consumer of health and social services resources in the UK for the foreseeable future. Similar pressures, including effective coordination of care delivery with training, have also been identified in other countries., A perfectly valid desire to have individualized packages of care for people in their own homes contrasts strongly with the need to achieve economies of scale by providing care for more and more older adults with mental health problems in residential and nursing care settings.