Discharge From Assisted Living and Skilled Nursing Facilities for Individuals With Mental Illness: A Scoping Review

OBJECTIVES: To assess and synthesize what is known about the barriers, facilitators, impact of federal and state policies, and clinical outcomes related to discharge for individuals with mental illness (MI) from skilled nursing facilities (SNFs) and assisted living communities (ALCs). DESIGN: Scoping review. SETTING AND PARTICIPANTS: Studies on individuals residing in SNFs or ALCs. METHODS: PubMed, CINAHL, and PsycInfo were searched (June 9, 2025-July 14, 2025). Titles and abstracts (n = 728) were independently screened by 2 reviewers with consensus resolution. Reference lists, connected paper searches, and ongoing literature monitoring were used to identify additional studies. Twenty-nine full-text articles were screened, and 16 were included. Data on discharge outcomes and facilitators and barriers were independently extracted and thematically coded by 2 reviewers. RESULTS: Most evidence focused on SNFs, with very limited research examining discharge from ALCs. What ALC research did exist was over 15 years old. Included studies suggest that individuals with MI experience lower rates of community discharge and face barriers, including limited community-based mental health services, reduced social and relational supports, and fragmented coordination between facility providers and behavioral health systems. However, these studies had notable methodological limitations, including the lack of diagnostic stratification, small sample sizes, and single-state or single-facility designs. Some facilitators were identified-mainly through qualitative studies-including supportive housing, access to community mental health programs, and interdisciplinary discharge planning. No studies empirically evaluated the impact of state or federal policies on discharge. Little evidence exists on postdischarge clinical outcomes among individuals with MI discharged from SNFs, and no studies have explored postdischarge clinical outcomes following ALC stays. CONCLUSIONS AND IMPLICATIONS: Evidence on discharge from SNFs and ALCs for individuals with MI is limited. Research is needed to further elucidate trends in discharge trajectories, evaluate policy impacts, identify effective discharge supports, and understand postdischarge outcomes in this population.