Not only do national population trends mean more older people in American cities, but older people tend to move to cities from outlying areas. Probably those most likely to need medical care are most likely to move. The increasing number of older people will require a revolution in our organization to provide care. Urban mental health services must be made a part of total medical care and brought to the patient wherever he is, especially in the home. Keeping the patient's home intact is a major factor in maintaining both his mental and physical health.