Nursing homes: The new total institution in mental-health policy

Recent opinion suggest that the de facto mental-health policy in this country is institutionalization, rhetoric to the contrary notwithstanding. The nursing-home industry is the center of that policy. More patients with chronic psychiatric disorders may reside in, and more mental-health money may go to, nursing homes than to any other mental-health setting. Starting from Goffman's classic definition of the central feature of a total institution, the present study documents, through a random sample of mental-health facilities, that nursing homes are virtually indistinguishable from hospitals on some characteristics that define a total institution and that both hospitals and nursing homes are clearly distinguishable from a variety of outpatient mental-health settings. In view of the magnitude of the role played by nursing homes in the care of mental patients, it is concluded that the nursing home is the new total institution of mental-health policy.