Serious mental illness

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Serious mental illness (SMI) is characterized as any mental health condition that impairs seriously or severely from one to several significant life activities, including day to day functioning. [1] [2] [3] [4] Five common examples of SMI include bipolar disorders, borderline personality disorder, psychotic disorders (i.e. schizophrenia), post-traumatic stress disorders, and major depressive disorders. [1] People having SMI experience symptoms that prevent them from having experiences that contribute to a good quality of life, due to social, physical, and psychological limitations of their illnesses. [5] [6] [7] In 2021, there was a 5.5% prevalence rate of U.S. adults diagnosed with SMI, with the highest percentage being in the 18 to 25 year-old group (11.4%). [2] Also in the study, 65.4% of the 5.5% diagnosed adults with SMI received mental health care services. [2]

Contents

SMI is a subset of AMI, an abbreviation for any mental illness. [2]

Hospitalizations

Many people living with SMI experience institutional recidivism, which is the process of being admitted and readmitted into the hospital. [8] This cycle is due in part to a lack of support being available for people living with SMI after being released from the hospital, frequent encounters between them and the police, as well as miscommunication between clinicians and police officers. [8] There are also instances where poor insight into one's mental illness has resulted in increased psychiatric symptoms which ultimately leads to hospitalization and a lower quality of life generally. [9] [10] [11] [12] [13] Highly symptomatic patients are more likely to seek emergency room services. [14] Patients with schizophrenia have the lowest risk of being hospitalized, likely due to frequent encounters with case managers to manage the chronic and persistent symptoms of schizophrenia. [14]

To reduce the occurrence of institutional recidivism, the Georgia chapter of the National Alliance on Mental Illness (NAMI) created the Opening Doors to Recovery (ODR) program. [8] ODR established a treatment team of licensed mental health professionals, peer specialists, and family peer specialists (a family member of someone who has SMI) to reduce institutional recidivism by providing treatment, ensuring safe housing, and supporting their recovery. [8] SMI patients who were enrolled in ODR had less hospitalizations and fewer days in the hospital compared to their hospitalizations prior to enrollment. [8]

Older adults with SMI are more likely to seek medical services and have longer hospital stays than patients who regularly see a doctor. [15] People with SMI seek medical services for a variety of non-mental health conditions, including diabetes, coronary artery disease, congestive heart failure, urinary conditions, pneumonia, chronic obstructive pulmonary disease, thyroid disease, digestive conditions and cancer. [15] [16] [17] This may be due to psychosomatic factors, as well as poor lifestyle habits associated with reduced mental health such as smoking, poor diet, and lack of exercise. [18] People with SMI typically take antipsychotic medications to manage their condition, however, second-generation antipsychotics can cause poor glycemic control for patients with diabetes, furthering complications in this population. [19] Second-generation antipsychotics, also known as atypical antipsychotics are medications used to effectively treat the positive (e.g. hallucinations and delusions) and negative (e.g. flat affect and lack of motivation) symptoms of schizophrenia. [20] This means that people with both SMI and diabetes are more frequently readmitted to hospitals one month after their initial hospitalization. [21] Notably, patients with SMI have increasing reports of falls and substance abuse, including alcoholism. [15]

Homelessness

Adults with SMI are 25 to 50 percent more likely to experience homelessness compared to the general population. [22] One predictor of homelessness is poor therapeutic alliance with case managers. [14] Adults with SMI often lack social support from family, friends and the community, which can put them at risk for experiencing homelessness. [23] [24] [25] [26] [27] [28] [29] [30] In 2019, the U.S. Department of Housing and Urban Development reported that there are 52,243 people living with SMI who were living on the street. [31] During that time, 15,153 people with SMI were in transitional housing, which is temporary housing when people are transitioning from emergency shelters to permanent housing. [31] [32] 48,783 people with SMI were living in emergency shelters. [31] People with SMI who experience homelessness have even greater difficulty accessing mental health and primary care services due to cost, lack of transportation, and lack of consistent access to a charged cell phone. [33] These difficulties can add additional stress, which may be why people with SMI experience a high rate of suicidal ideation and suicide attempts. When surveyed, 8% of people with SMI who were homeless reported that they had made a suicide attempt in the past 30 days. [33]

Researchers found that the housing first approach to ending homelessness improved quality of life and psychosocial functioning faster than treatment as usual, also known as standard treatment. [34] In addition, researchers found that SMI patients remained homeless for longer and had fewer housing stability when receiving mental health services in the absence of receiving housing. [34] Combining housing first with Assertive Community Treatment leads to improved quality of life one year after initially starting housing first compared to just receiving outpatient mental health services. [34] Additionally, housing first reduced number of days hospitalized and number of emergency room visits for people with SMI. [34]

Stigma

People with SMI often experience stigma due to frequently stigmatizing representations of people with SMI in the media that portrays them as violent, criminals, and accountable for their condition because of weak character. [35] People with SMI experience two kinds of stigma; public stigma and self-stigma. Public stigma refers to negative beliefs/perceptions that the public has about SMI; such as people with SMI should be feared, are irresponsible, that they should be responsible for their life decisions, and that they are childlike, needing constant care. [35] Self-stigma refers to prejudice that an individual with SMI may feel about themselves, such as "I am dangerous. I am afraid of myself. I am worthless.". This can also manifest as an internalization of public stigma. [36] [35] In a study conducted on patients who were involuntarily hospitalized, researchers found that poor quality of life and low self-esteem could be predicted by high levels of self-stigma and fewer experiences of empowerment. [37] Self-stigma can be reduced by increasing empowerment in individuals with SMI through counseling and/or peer support and other self-disclosing of their own struggles with mental illness. [36] People who suffer from SMI can reduce the amount of stigma that they experience by maintaining insight into their condition with the assistance of social supports. [38] [39] Consumer services, such as drop-in centers, peer support, mentoring services, and educational programs can increase empowerment in individuals with SMI. [40]

Related Research Articles

<span class="mw-page-title-main">Antipsychotic</span> Class of medications

Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized variously by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially mood disorders, anxiety disorders, and obsessive–compulsive disorder.

Outpatient commitment—also called assisted outpatient treatment (AOT) or community treatment orders (CTO)—refers to a civil court procedure wherein a legal process orders an individual diagnosed with a severe mental disorder to adhere to an outpatient treatment plan designed to prevent further deterioration or recurrence that is harmful to themselves or others.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

Avolition or amotivation, as a symptom of various forms of psychopathology, is the decrease in the ability to initiate and persist in self-directed purposeful activities. Such activities that appear to be neglected usually include routine activities, including hobbies, going to work or school, and most notably, engaging in social activities. A person experiencing avolition may stay at home for long periods of time, rather than seeking out work or peer relations. It is a disorder of diminished motivation.

<span class="mw-page-title-main">Rosenhan experiment</span> Experiment to determine the validity of psychiatric diagnosis

The Rosenhan experiment or Thud experiment was an experiment regarding the validity of psychiatric diagnosis. For the experiment, participants submitted themselves for evaluation at various psychiatric institutions and feigned hallucinations in order to be accepted, but acted normally from then onward. Each was diagnosed with a psychiatric disorder and given antipsychotic medication. The study was arranged by psychologist David Rosenhan, a Stanford University professor, and published by the journal Science in 1973 with the title On Being Sane In Insane Places.

Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time, but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

Psychoeducation is an evidence-based therapeutic intervention for patients and their loved ones that provides information and support to better understand and cope with illness. Psychoeducation is most often associated with serious mental illness, including dementia, schizophrenia, clinical depression, anxiety disorders, eating disorders, bipolar and personality disorders. The term has also been used for programs that address physical illnesses, such as cancer.

Dual diagnosis is the condition of having a mental illness and a comorbid substance use disorder. There is considerable debate surrounding the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness and substance use disorder, or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

The management of schizophrenia usually involves many aspects including psychological, pharmacological, social, educational, and employment-related interventions directed to recovery, and reducing the impact of schizophrenia on quality of life, social functioning, and longevity.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Post-schizophrenic depression is a "depressive episode arising in the aftermath of a schizophrenic illness where some low-level schizophrenic symptoms may still be present." Someone that has post-schizophrenic depression experiences both symptoms of depression and can also continue showing mild symptoms of schizophrenia. Unfortunately, depression is a common symptom found in patients with schizophrenia and can fly under the radar for years before others become aware of its presence in a patient. However, very little research has been done on the subject, meaning there are few answers to how it should be systematically diagnosed, treated, or what course the illness will take. Some scientists would entirely deny the existence of post-schizophrenic depression, insisting it is a phase in schizophrenia as a whole. As of late, post-schizophrenic depression has become officially recognized as a syndrome and is considered a sub-type of schizophrenia.

Schizophrenia and tobacco smoking have been historically associated. Smoking is known to harm the health of people with schizophrenia.

Sex differences in schizophrenia are widely reported. Men and women exhibit different rates of incidence and prevalence, age at onset, symptom expression, course of illness, and response to treatment. Reviews of the literature suggest that understanding the implications of sex differences on schizophrenia may help inform individualized treatment and positively affect outcomes.

<span class="mw-page-title-main">Homelessness and mental health</span>

In a study in Western societies, homeless people have a higher prevalence of mental illness when compared to the general population. They also are more likely to suffer from alcoholism and drug dependency. A 2009 US study, estimated that 20–25% of homeless people, compared with 6% of the non-homeless, have severe mental illness. Others estimate that up to one-third of the homeless have a mental illness. In January 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the United States. Depending on the age group in question and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the American homeless—140,000 individuals—were seriously mentally ill at any given point in time. 45% percent of the homeless—250,000 individuals—had any mental illness. More would be labeled homeless if these were annual counts rather than point-in-time counts.

Numerous studies around the world have found a relationship between socioeconomic status and mental health. There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model.

References

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