Psychiatric Nursing Homes
Psychiatric Nursing Homes

The prevalence of SMI (Serious Mental Illness) in psychiatric nursing homes has increased over the past two decades. Research suggests that this increased prevalence has resulted in reductions in the level and mix of nurse staffing and the increased hospitalization of non-SMI nursing home residents. These findings have important implications for policy and care practices around the treatment of SMI patients in psychiatric nursing homes.

A first step to administering quality care in a psychiatric nursing home is the proper pre-admission screening and placement of SMI residents.

In addition to monitoring the appropriate placement of individuals with SMI in psychiatric nursing homes, policy makers might also influence the distribution of SMI residents across specific nursing homes. Many nursing home residents with SMI currently receive care in nursing homes specializing in the treatment of persons with SMI. This type of arrangement only makes sense if these specialized facilities are able to better meet SMI patients' needs than is the case for facilities that care of a relatively fewer SMI patients. However, findings do suggest that an increase in the share of residents with mental illnesses increased the rate of hospitalization among non-SMI residents. This result is consistent with the studies hypothesising that direct care staff devotes more of its fixed time to providing care to residents with SMI, resulting in less effort available for residents without SMI. Thus, in considering policies to “mainstream” the care of residents with SMI, the outcomes of non-SMI patients must also be considered.

The treatment of individuals with mental illness has been an important feature of psychiatric nursing home care since the early days of the deinstitutionalization movement. With the accelerated downsizing and closure of state-run long-stay psychiatric hospitals during the 1960s and 1970s spurred on by deinstitutionalization policies, many persons with mental illnesses were transferred to psychiatric nursing homes and other residential settings. The number of elderly persons in psychiatric hospitals was estimated to have decreased by about 40 percent during that period, while the number of mentally ill in psychiatric nursing homes increased by over 100 percent. Even states that developed comprehensive community mental health services were often ill-equipped to provide community-based alternative placements for persons who had lived for many years in state-run psychiatric facilities. Today, approximately one-fourth of newly admitted nursing home residents have a mental illness as defined by schizophrenia, bipolar disorder, depression, and anxiety disorder and 2–3 percent have a serious mental illness (SMI) with a diagnosis of schizophrenia or bipolar disorder.

The growing number of persons with mental illness entering nursing homes greatly strained existing systems of care. Reports of grossly inadequate nursing home care and resident abuse surfaced in the years following deinstitutionalization. Nevertheless, the quality of nursing home care for SMI residents has continued to be an area of concern.

One issue that has not been previously studied is whether psychiatric nursing homes that care for a greater share of individuals with SMI provide worse quality for other non SMI residents or not. The share of SMI individuals may negatively affect facility quality via reimbursement, facility market power, and labor involved. Specifically, short-term psychiatric hospitals are one of the most important sources of SMI patients for psychiatric nursing homes. Thus, we exploit the idea that nursing homes located near these psychiatric hospitals increased their SMI share over time at a greater rate than those located further away.

Mental hospitals stemmed in India from the era of lunatic asylums – a concept that was British and European in its conception. The whole purpose of the concept of a mental hospital was to segregate the mentally ill from the community and not treat them as normal but rather proscribe from the community. Most mental hospitals in India were built in the British and pre-British eras when the emphasis was never on community-based treatments and in that era, psychiatric patients were viewed as a danger and menace to society. 

Mental hospitals are an integral part of mental health services in India. It is an interesting story how mental hospitals have responded to the challenges of contemporary period they were built in. It is beyond doubt that it is a progressive journey along with advances in mental health both in India and internationally. As in other countries, mental hospitals in India have responded to the social challenges, disparities, and poor resources of workforce and fiscal investment. We believe that psychiatric nursing homes have an important and perhaps a central role in mental health services in India. Its modernization to address issues of long-term stay, burden on caregivers, stigma, research and teaching including undergraduate and postgraduate training, new curriculum, and training for non-psychiatric professionals and primary care physicians are necessary components of the role of psychiatric nursing homes/ mental hospitals and responsibilities of both government and private sectors. Last but not the least, it should be obligatory for psychiatric nursing homes & mental hospitals to ensure that evidence-based treatments are implemented and that the standard of care and respect of civil and human rights of the patients and families are ensured while involving the relatives’/caregivers’/people's participation in its functioning.

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mental health services, mental health services, psychiatric nursing homes, psychiatric nursing homes, Serious Mental Illness, Serious Mental Illness, SMI, SMI, Rehabilitation, Rehabilitation, psychiatric hospitals , psychiatric hospitals ,

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