Antipsychotic medication reduction and the severely mentally ill population

President Biden’s State of the Union address last week targeted several aspects of the long-term care industry, most of which have received more attention than his mention of reducing the inappropriate use of antipsychotic medications.

As a long-term care psychologist who has closely observed the trend of increasing numbers of residents with severe mental illness who require antipsychotic medications, I’m concerned that attempts to reduce antipsychotics might disregard the needs of these residents.

An effort to comply with, and enforce, regulations around antipsychotic use must be conducted with a recognition that there are many residents who need these medications in order to maintain their emotional stability, with an emphasis on the term, “inappropriate use,” rather than on “reducing antipsychotics.”

My concern is heightened because the industry and its regulators can appear to have a lack of awareness about, or a plan to manage, this growing population. Ironically, this echoes a frequent feature of mental illness — anosognosia, or the lack of awareness of having a mental illness. (Though by the time they arrive at our doors with several decades of experience with mental health problems, these residents are generally long past anosognosia and can often tell us how to manage their own illnesses.)

According to data tracked by, the number of severely mentally ill residents has more than doubled in almost every state between 2000 and 2020. Given the changes wrought by COVID-19 (i.e., empty beds), that number will likely be higher once the 2021 data comes in.

Necessary, but insufficient

Maintaining the use of antipsychotic medications is essential for this group of residents, for them as individuals and for the safe management of the living environment, but in and of itself, it is not sufficient care.

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