Nursing homes and chronic mental patients

Nursing homes play an important and controversial role in the community-based care of chronic mental patients. Confronting the reality of this role can help us recognize problems in the rationales for deinstitutionalization and community care. Problems with three concepts that were central to deinstitutionalization are examined--the total institution, institutional neurosis, and social reintegration. Furthermore, two concepts are presented that were overlooked in the haste to initiate deinstitutionalization--custody, asylum, and treatment functions in society; and the role of patient expectations. Finally, suggestions are made about how nursing homes can play a more constructive role in mental health policy.