A 50% random sample of elderly patients (over 60 years) were followed up 4 years after their inception into an extra-mural psychiatric service based on a general hospital. They spent very little time as in-patients, either in the unit or in the mental hospital. There was a high degree of chronicity, additional physical illness and mortality. A method is described of assessing both the objective and subjective burden on a household which evolves when patients do not stay in hospital. Although there was a very high incidence of objective burden, this was not always a matter of subjective complaint by the families. The implications of this discrepancy for this type of service and for further research are discussed.