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Objectives: The aims of the study were to evaluate the natural and avoidable mortality among the elderly male psychiatric patients with long-stay care. We also examined the associated risk factors for natural death in those patients. Methods: We estimated the standardized mortality ratios (SMRs) for natural and avoidable deaths of 731 elderly male psychiatric patients in long-stay care in a psychiatric hospital in Taiwan compared with those in the general population. The causes of death were confi rmed using the digital data of the Department of Health Death Certifi cation System, Taiwan. To identify the late-life risk factors associated with natural death, we used a nested case-control design, and assessed the risk factors during one year before death in 108 decedents and 108 age-matched surviving controls. Results: Compared with those in the general population, the risks of natural and avoidable deaths in the cohort were increased by 135% (SMR = 2.35, 95% confi dence interval = 1.94-2.85) and 221% (SMR = 3.21, 95% CI = 2.36- 4.27), respectively. Fifty-seven of the decedents (52.7%) died of avoidable causes. The results of multivariate analysis showed that natural death was signifi cantly associated with bed/chair-ridden status (p < 0.05), having lower body mass index (p < 0.05), history of cerebrovascular disease (p < 0.05), and increased chronic physical comorbidities (p < 0.05). There were no signifi cant associations with psychiatric diagnosis or type of antipsychotics. Conclusion: The elderly male psychiatric patients under long-stay care had higher natural and avoidable mortality than those in the general populations. The risk factors for natural death in these patients could be related to poorer ambulatory status, under-weight malnutrition, old stroke, and multiple physical comorbidities.