Humanistic mental health strategies and antipsychotic stewardship to reduce unnecessary medications in a nursing home: A longitudinal quality improvement study

Background: Despite regulatory efforts to curtail overuse, antipsychotics remain frequently prescribed in nursing homes for managing behavioral and psychological symptoms of dementia, particularly among residents with complex comorbidities. This study examines the long-term outcomes of a psychiatry-led antipsychotic stewardship initiative in a specialized nursing facility. The program integrated structured psychopharmacological reviews, targeted psychosocial interventions, and the introduction of a Mental Health Assistant (MHA) role to reduce pharmacological dependency. Methods: A single-arm, longitudinal quality improvement initiative was conducted from 2010 to 2023 at a 500-bed New York City public nursing home serving residents with dementia, serious mental illness (SMI), and traumatic brain injury (TBI). The intervention included: (1) adherence to evidence-based prescribing protocols, (2) monthly psychiatrist-led audits, (3) comprehensive staff training in nonpharmacological behavioral strategies, and (4) the addition of MHAs in 2022 to address residents’ unmet psychosocial needs. Key outcome metrics included antipsychotic prescribing rates, frequency of behavioral incidents, and comparative resident outcomes benchmarked against national data. Results: Among residents with behavioral health diagnoses identified between 2010 and 2023 ( n = 467), antipsychotic prescribing rates declined from 55% to 5.8% – well below the national average of 14.2% – with no increase in behavioral disturbances or substitution with other psychotropics. MHAs played a transformative role by reframing distress behaviors as expressions of unmet needs. Conclusions: This study demonstrates that a multidisciplinary, person-centered approach, emphasizing psychosocial interventions, can achieve sustained reductions in antipsychotic use. The successful integration of MHAs underscores the value of addressing psychosocial determinants over defaulting to medication, offering a scalable model for long-term care facilities.