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New Back Wards in the Community

Leonard J. Schmidt, MD; Adina M. Reinhardt, PhD; Robert L. Kane, MD; Donna M. Olsen, PhD

Arch Gen Psychiatry. 1977;34(6):687-691.

Abstract
• The reduction in state hospital populations in the last two decades is most often attributed to psychotropic medication and community mental health centers. The role the proprietary nursing home has played in this reduction has not been adequately studied. Using data routinely collected for Medicaid utilization review, we studied characteristics of psychiatric nursing home patients in Utah. One third of the nursing home patients had a psychiatric diagnosis; more than half of this group were classified as psychotic. Most psychotic patients were significantly younger than their nonpsychiatric counterparts. Nonpsychiatric patients received a higher mean number of psychoactive drugs than did psychiatric or mentally retarded patients. Over time, all groups of patients showed an increase in prescribed psychoactive medication and a decrease in activity. The consequences of this pattern of care raise serious questions about our current reliance on nursing homes for the care of the psychiatric patient.

Author Affiliations
From the Departments of Psychiatry (Dr Schmidt) and Family and Community Medicine (Drs Kane and Olsen), University of Utah College of Medicine; the University of Utah College of Nursing (Dr Reinhardt); and the Salt Lake Community Mental Health Center (Drs Schmidt and Reinhardt), Salt Lake City.

Footnotes
Accepted for publication Feb 17, 1976.

Reprint requests to Salt Lake Veterans Administration Hospital, 500 Foothill Blvd, Salt Late City, UT 84148 (Dr Schmidt).

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