Serious mental illness (SMI) is a broad term used in a variety of legal, regulatory, and clinical contexts. While the term’s definition may vary across those contexts, generally, the term refers to mental illnesses that are severe, persistent, and potentially disabling. Diagnoses such as schizophrenia, schizoaffective disorder, bipolar disorder, major depression, and others are often included in “serious mental illness.” The term generally refers to mental health problems that remain relatively constant. However, at times, or for certain persons, problems may worsen (even dramatically) triggered by higher levels of stress, disengaging from treatment services, or maybe by nothing easily identifiable. Relief from stress, engagement in treatment, and other constructive activities, and unknown factors may contribute to periods of improvement. While umbrella terms, such as SMI, and even diagnostic labels, like schizophrenia, may have some utility in being a common language, when it comes to individual treatment and prognosis, it is typically most effective to focus on the individual’s current challenges in daily functioning and the problems they identify as causing distress.
People with SMI will likely have a high level of diversity in their treatment needs, across a range of areas, like concentration, self management, self care, or coping with emotions. They may have more treatment needs in common with people who have a different diagnosis than they do with people who have a similar diagnosis. Treatment could be delivered in an individual or group format; often, people have found benefits by participating in both concurrently. Treatment could be done in an inpatient setting, like a hospital, or an outpatient setting, like a community mental health clinic or a private practice. For some people, more intense outpatient services, like a rehabilitative day program may be helpful. Some people find it helpful to live in a place with other people who also have SMI and with staff available to aid in day to day activities. There are also services to help people with SMI participate more fully in community life, such as supported employment, supported housing, and case management.
It is important to note that just like in any profession, the quality of service providers may vary, so it is crucial to be a well-informed consumer. Some helpful questions to ask may include: What is the treatment plan? What challenges in functioning are targeted by the treatment plan? How did providers determine what to prioritize in their treatment planning? How was the person with SMI included in the treatment planning process? How will they evaluate if the treatment plan is working? Do they often treat people with similar difficulties, and what are the common outcomes? Having an SMI can sometimes bring with it a high level of distress, worry, and difficulties handling day to day tasks; this, in turn, can make people vulnerable. Having a trusted family member or friend to help connect to services and evaluate their quality can be indispensable.
Unfortunately, people with SMI are often perceived by others as dangerous or incompetent simply because they have an SMI. These perceptions are misguided, stigmatizing, and may be influenced by inaccurate media portrayals of people with SMI. It is important to remember that the vast majority of people with SMI are not likely to engage in violent behavior; in fact, they are more likely to be the victim of a crime than to commit a crime. Additionally, while some people with SMI may need help making important decisions or managing money (so they have a guardian or payee), the majority of people with SMI successfully manage their affairs independently, with the aid of community services at a level that works for them. Since the associated level of distress and functional impairment in SMIs tend to fluctuate over time, service levels may need to fluctuate as well.
If someone holds stigmatizing beliefs, they may lead to discriminatory behaviors. If you believe that you or a loved one has been discriminated against in any setting, such as housing, employment, or even by a legal decision-maker, contact your local Legal Aid organization. They can guide you through resources for a response, like filing a complaint or even taking legal action. Being discriminated against can also be a hurtful, invalidating experience. Talking about it with a therapist may be helpful; alternatively, speaking with peers can also be helpful. You can find a therapist by using ABCT’s Find a Therapist option, or contacting our group’s listserv manager (Dr. Snyder) to ask our group for a referral in your area. Also, your local NAMI chapter may have peer support groups, family support groups, educational classes, and tips on finding local services for clinical or legal help. Please also check our “Links and Resources” page for additional information, including online resources and book recommendations.
Our founders organized this group to facilitate high-quality research on the best assessment and treatment practices for people with SMI, and expedite the dissemination of that research to providers. Please remember that a diagnosis of an SMI can be the first step on a treatment path leading to recovery. With appropriate treatment and services, people with SMI can and do recover to live self-determined and empowered lives. We hope the resources on this webpage can be helpful to you. Please contact our leadership if we can be of assistance.