Lecture Notes on Serious Mental Illness (SMI)

Definition and Terminology

• Serious Mental Illness (SMI): Psychiatric conditions, often biological in origin, affecting quality of life and functioning when untreated.
• Terminology: "Serious" and "severe" used interchangeably by mental health leaders.
• Organizations: NIMH, SAMHSA, NAMI use "Serious Mental Illness"; WHO refers to them as "Severe Mental Disorders".

Prevalence and Impact

• SMI Disorders: Mood disorders, personality disorders, psychotic disorders, schizophrenia subtypes.
• Statistics: In 2017, 11.4 million US adults (4.6% of adults) had an SMI (NIMH, 2021).
• Demographics: Fig. 32.1 shows prevalence based on demographics.

Characteristics and Challenges

• Lifelong Disorders: Often have early onset, often in late teens.
• Recovery and Cycles: Successful recovery possible, but cycles of recovery and decompensation occur.
• Associated Challenges: Victimization, coexisting medical conditions, shorter life expectancy.
• Daily Functioning: Impact on ADLs, social interaction, work, relationships.

Social and Healthcare Challenges

• Healthcare Access: Reduced access impacts recovery; homelessness affects quality of life.
• Social Stigma: Stigma creates negative images and healthcare disparities.

Terminology in Care

• "Clients": Term used for people with SMI, indicating active participation in treatment.

SMI Across the Lifespan

• Older Adults: Institutionalization common in past, now shifting to community-based care.
• Younger Adults: Shorter hospital stays, focus on community treatment.

Development and Management

• Chronic Illness: Similar to chronic physical illnesses, overwhelming coping ability.
• Rehabilitation vs. Recovery: Shift from managing deficits to emphasizing recovery and quality of life.

Issues for People with SMI

• Finding Meaning: Importance of setting new goals for life satisfaction.
• Comorbid Conditions: Hypertension, obesity, diabetes, and increased risk of premature death.
• Substance Use: High rates of comorbidity with substance abuse.

Social Problems

• Stigma and Isolation: Leads to shame, anger, and social withdrawal.
• Victimization: People with SMI are often victims of violence rather than perpetrators.

Economic and Housing Challenges

• Unemployment: High rates due to cognitive impairments and stigma.
• Housing Instability: Limited options, risk of eviction, and homelessness.

Treatment Challenges

• Anosognosia: Inability to recognize illness; significant barrier to treatment.
• Nonadherence and Side Effects: Nonadherence common due to various factors including side effects.

Community and Support

• Comprehensive Community Treatment: Essential for independent functioning, often fragmented.
• Community Services: Include case management, day programs, psychotherapy, crisis intervention.

Evidence-Based Treatments

• Assertive Community Treatment (ACT): Multidisciplinary teams providing comprehensive services.
• Cognitive Behavioral Therapy (CBT): Helps manage symptoms and improve social functioning.

Family and Social Support

• Family Involvement: Key predictor of recovery; family programs like NAMI’s Family-to-Family.
• Peer Support: Involves support from peers, enhancing recovery and coping skills.

Current Issues

• Outpatient Commitment: Controversial, provides mandatory treatment in the community.
• Criminalization: People with SMI often face incarceration due to lack of treatment.

Conclusion

• Key Points: Highlight the complexities and challenges of SMI, emphasize recovery, and the importance of community and support systems.