In this month's issue two articles—one by Yue Li, Ph.D., and another by Sonne P. Lemke, Ph.D., and Jeanne A. Schaefer, Ph.D., R.N.—separately address the increasingly critical issue of nursing home residents with mental disorders and raise questions and concerns about how best to meet future needs. The Omnibus Budget Reconciliation Act (OBRA) of 1987 required that individuals who are appropriately placed and residing in nursing homes receive adequate mental health services. As Dr. Li points out, approximately 17,000 U.S. nursing homes provide care to more than 1.6 million individuals annually, and in the post-OBRA years, mental health services have not been adequately provided in about one in five U.S. nursing homes. There are a number of apparent explanations, including insufficient access to care, lack of clinical expertise, and poor financial and infrastructure supports. Because of the significant psychiatric and medical comorbidity in this population, it has been suggested that the ideal method of delivering mental health services in nursing homes is the inclusion of a mental health specialist on the multidisciplinary team. However, availability of psychiatric consultants is limited in many locations, and geropsychiatric services are especially scarce. Inadequate coverage of mental health services by Medicare and Medicaid, which account for a majority of nursing home payments, does not provide much incentive for mental health specialists to offer services in these settings. In recent years the Food and Drug Administration has mandated warnings about the use of some pharmacologic therapies—notably antipsychotic drugs—in populations with dementia, and nonpharmacologic or behavioral interventions for nursing home residents with mental disorders are generally not reimbursed or poorly reimbursed.