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What is Serious Mental Illness and How Do We Address Treatment Concerns?
Anita Lakes, Licensed Psychological Practitioner
Today after conducting a clinical evaluation for a client, I began thinking about how many people in our community live with a serious mental illness and how these illnesses are misunderstood. This seemed like the perfect topic to kick off what I hope to be a regular series for our webpage.
According to the Diagnostic and Statistical Manual 5 Text Revision (DSM-5-TR), the source for all mental health diagnoses, a mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (DSM 5-TR, p14). So, if this is how we define a mental disorder how do we define a serious mental illness? While this seems like it would be an easy question to answer, it is not.
The National Institute of Mental Health (NIMH) defines serious mental illness as a mental, behavioral, or emotional disorder resulting in functional impairment, which substantially interferes with or limits one or more major life activities. It seems that both definitions are making the same (or relatively close to the same) statement. The Department of Behavioral Health and Intellectual Disabilities in Kentucky has attempted to narrow down the criteria for serious mental illness. One must be age 18 or over, carry specific diagnoses, show functional impairment in two or more life domains, and meet guidelines for the duration of impairment.
We must consider the elements that make up these criteria to appropriately guide clients, friends, and family members to the appropriate treatment resource. Age is an easy one as is the duration of impairment. To meet the criteria of age you only must be older than 18. Duration criteria states that clinically significant symptoms of mental illness must have persisted for a continuous period of two years, the individual must have been hospitalized more than once in the past two years, or there is a history of one or more episodes with marked disability and the illness is expected to continue for two years. Easy-peasy, right?
Diagnoses considered to meet this criterion include Schizophrenia Spectrum and Other Psychotic Disorders, Bipolar and Related Disorders, Depressive Disorders, and Post Traumatic Stress Disorders. Diagnosis alone does not mean that this criterion has been met, however. The thing that separates serious mental illness from any mental illness is the severity of the symptoms. Often when people think of disorders such as Schizophrenia, what comes to mind are those individuals who experience severe symptoms and functional impairment. Functional impairment in the mental health world means a mental, social, or cognitive condition or deficit that keeps the person from being able to complete tasks and activities of daily living which reduces their ability to maintain self-care and independent living. These are people who have trouble buying groceries because the voices they hear make them too paranoid to go to the store, who cannot engage in healthy relationships because the delusions they experience make them believe their partner is an FBI agent trying to arrest them, or they lose their housing due to yelling at the voices they hear all night long.
As we are thinking about how different individuals have different symptoms, we should also be looking at how differently each of these diagnoses present. Someone with a diagnosis of schizophrenia is not going to have the same type of symptoms as someone diagnosed with PTSD. Why does this matter? The type of training that providers need to address the symptoms and necessary treatment for individuals with these diagnoses are completely different. A program that works with individuals who experience Schizophrenia will focus on illness management and recovery skills, whereas someone working with those who experience PTSD will focus more on cognitive behavioral skills. A person with PTSD should not be referred to a program that specializes in the treatment of Schizophrenia Spectrum Disorders because the treatment process will not be fully effective. Our focus should be on getting the right treatment for the right people with the right program.
As you can see, the topic of Serious Mental Illness is a very complicated one. Each time I think about the individuals that we serve I am touched at just how resilient and resourceful they are as they navigate this thing called life. I hope that through this writing it helps you to understand just what Serious Mental Illness is and how complicated the system for evaluation has become. I hope to see you next month when we talk about disability determination.