Influence
October 31, 2025

Barriers to Discharge for Nursing Home Residents With Serious Mental Illness

Kathleen Unroe, M.D.

Published in the JAMA Network Open. Here is a link to the article.

Regenstrief Institute authors: Kathleen T. Unroe, M.D., MHA, M.S.

This qualitative study explored why nursing home residents with serious mental illness, such as schizophrenia or bipolar disorder, often remain in long-term care despite being candidates for community living. Through interviews with 15 staff members from eight U.S. nursing homes, researchers identified barriers to discharge at multiple levels. Individual factors included behavioral challenges, medication noncompliance, and refusal to leave. Relational barriers involved limited family support and strained professional relationships. Structural challenges included insurance restrictions, limited community-based psychiatric and substance use treatment options, and transportation issues. Together, these factors contribute to unnecessary long-term stays. The findings highlight the need for coordinated, multi-level strategies to support safe and appropriate transitions to community care for residents with serious mental illness.

Authors: 

Charity M Hoffman 1Hannah C Ratliff 1Sarah L Krein 2 3 4Kierstdea Petzold 3Kathleen T Unroe 5Kali S Thomas 6Molly Turnwald 1Erika Ratliff 1Terrence Gatton 1Donovan T Maust 1 3 4

Affiliations: 

1Department of Psychiatry, University of Michigan, Ann Arbor.

2Department of Internal Medicine, University of Michigan, Ann Arbor.

3Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.

4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.

5Department of Medicine, Geriatrics, Indiana University, Indianapolis.

6Johns Hopkins School of Nursing, Baltimore, Maryland.

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