Philosophy:Serious mental illness

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Short description: Mental health condition that seriously impairs life activities

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] Four common examples of SMI include bipolar disorders, 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]

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 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."[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]

References

  1. ↑ 1.0 1.1 "What is Serious Mental Illness?". SMI Adviser. American Psychiatric Association. https://smiadviser.org/about/serious-mental-illness. 
  2. ↑ 2.0 2.1 2.2 2.3 "NIMH » Mental Illness". National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154790. 
  3. ↑ Sánchez J, Wadsworth JS, Frain MP, Umucu E, Chan F. "Psychiatric Symptoms, Psychosocial Factors, and Life Satisfaction Among Persons With Serious Mental Illness: A Path Analysis". The Journal of Nervous and Mental Disease. August 2020; 208(8):600-607. doi: 10.1097/NMD.0000000000001166. PMID: 32205775.
  4. ↑ Dunn EC, Wewiorski NJ, Rogers ES (2010) "A qualitative investigation of individual and contextual factors associated with vocational recovery among people with serious mental illness". American Journal of Orthopsychiatry. 80:185–194.
  5. ↑ Sánchez J, Wadsworth JS, Frain MP, Umucu E, Chan F. Psychiatric Symptoms, Psychosocial Factors, and Life Satisfaction Among Persons With Serious Mental Illness: A Path Analysis. J Nerv Ment Dis. 2020 Aug;208(8):600-607. doi: 10.1097/NMD.0000000000001166. PMID: 32205775.
  6. ↑ Sánchez J, Chan F, Yaghmaian R, Johnson ET, Pfaller JS, Umucu E (2016a) Assessing community functioning and independent living skills of individuals with severe mental illness. J Appl Rehabil Couns. 47:6–14.
  7. ↑ Tschopp MK, Frain M (2009) Psychiatric rehabilitation. In Chan F, Silva Cardoso E, Chronister JA (Eds), Understanding psychosocial adjustment to chronic illness and disability: A handbook for evidence-based practitioners in rehabilitation (pp 371–398). New York, NY: Springer Publishing Company
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Compton, Michael; Kelley, Mary; Pope, Alicia; Smith, Kelly; Broussard, Beth; Reed, Thomas; DiPolito, June; Druss, Benjamin et al. (2016). "Opening doors to recovery: Recidivism and recovery among persons with serious mental illnesses". Psychiatric Services 67 (2): 169–175. doi:10.1176/appi.ps.201300482. PMID 26467907. 
  9. ↑ Naber D, Moritz S, Lambert M, Pajonk FG, Holzbach R, Mass R, Andresen B (2001) Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs. Schizophr Res. 50:
  10. ↑ Browne S, Roe M, Lane A, Gervin M, Morris M, Kinsella A, Larkin C, Callaghan EO (1996) Quality of life in schizophrenia: Relationship to sociodemographic factors, symptomatology and tardive dyskinesia. Acta Psychiatr Scand. 94:118–124.
  11. ↑ Huang RR, Chen YS, Chen CC, Chou FH, Su SF, Chen MC, Kuo MH, Chang LH (2012) Quality of life and its associated factors among patients with two common types of chronic mental illness living in Kaohsiung City. Psychiatry Clin Neurosci. 66:482–490
  12. ↑ Rossell SL, Coakes J, Shapleske J, Woodruff PW, David AS (2003) Insight: Its relationship with cognitive function, brain volume and symptoms in schizophrenia. Psychol Med. 33:111–119.
  13. ↑ Sánchez J, Wadsworth JS, Frain MP, Umucu E, Chan F. Psychiatric Symptoms, Psychosocial Factors, and Life Satisfaction Among Persons With Serious Mental Illness: A Path Analysis. J Nerv Ment Dis. 2020 Aug;208(8):600-607. doi: 10.1097/NMD.0000000000001166. PMID: 32205775.
  14. ↑ 14.0 14.1 14.2 Clarke, Gregory N.; Herinckx, Heidi A.; Kinney, Ronald F.; Paulson, Robert I.; Cutler, David L.; Lewis, Karen; Oxman, Evie (2000-09-01). "Psychiatric Hospitalizations, Arrests, Emergency Room Visits, and Homelessness of Clients with Serious and Persistent Mental Illness: Findings from a Randomized Trial of Two ACT Programs vs. Usual Care" (in en). Mental Health Services Research 2 (3): 155–164. doi:10.1023/A:1010141826867. ISSN 1573-6636. PMID 11256724. https://doi.org/10.1023/A:1010141826867. 
  15. ↑ 15.0 15.1 15.2 Hendrie, Hugh C.; Lindgren, Donald; Hay, Donald P.; Lane, Kathleen A.; Gao, Sujuan; Purnell, Christianna; Munger, Stephanie; Smith, Faye et al. (2013-12-01). "Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses" (in en). The American Journal of Geriatric Psychiatry 21 (12): 1267–1276. doi:10.1016/j.jagp.2013.01.056. ISSN 1064-7481. PMID 24206938. 
  16. ↑ Jayatilleke, Nishamali; Hayes, Richard D.; Chang, Chin-Kuo; Stewart, Robert (December 2018). "Acute general hospital admissions in people with serious mental illness". Psychological Medicine 48 (16): 2676–2683. doi:10.1017/S0033291718000284. ISSN 0033-2917. PMID 29486806. 
  17. ↑ Davydow, Dimitry S.; Ribe, Anette R.; Pedersen, Henrik S.; Fenger-Grøn, Morten; Cerimele, Joseph M.; Vedsted, Peter; Vestergaard, Mogens (2016-01-01). "Serious Mental Illness and Risk for Hospitalizations and Rehospitalizations for Ambulatory Care-sensitive Conditions in Denmark". Medical Care 54 (1): 90–97. doi:10.1097/MLR.0000000000000448. PMID 26492210. https://www.ingentaconnect.com/content/wk/mcar/2016/00000054/00000001/art00015. 
  18. ↑ Newcomer, John W. (2005-12-01). "Second-Generation (Atypical) Antipsychotics and Metabolic Effects" (in en). CNS Drugs 19 (1): 1–93. doi:10.2165/00023210-200519001-00001. ISSN 1179-1934. PMID 15998156. https://doi.org/10.2165/00023210-200519001-00001. 
  19. ↑ Lipscombe, Lorraine L.; Lévesque, Linda; Gruneir, Andrea; Fischer, Hadas D.; Juurlink, David N.; Gill, Sudeep S.; Herrmann, Nathan; Hux, Janet E. et al. (2009-07-27). "Antipsychotic drugs and hyperglycemia in older patients with diabetes". Archives of Internal Medicine 169 (14): 1282–1289. doi:10.1001/archinternmed.2009.207. ISSN 1538-3679. PMID 19636029. 
  20. ↑ Sandy (2014-08-27). "First versus second generation". https://library.neura.edu.au/schizophrenia/treatments/physical/pharmaceutical/second-generation-antipsychotics/first-versus-second-generation/. 
  21. ↑ Chwastiak, Lydia A.; Davydow, Dimitry S.; McKibbin, Christine L.; Schur, Ellen; Burley, Mason; McDonell, Michael G.; Roll, John; Daratha, Kenn B. (2014). "The effect of serious mental illness on the risk of rehospitalization among patients with diabetes". Psychosomatics 55 (2): 134–143. doi:10.1016/j.psym.2013.08.012. ISSN 1545-7206. PMID 24367898. 
  22. ↑ Susser, E; Valencia, E; Conover, S; Felix, A; Tsai, W Y; Wyatt, R J (1997). "Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter.". American Journal of Public Health 87 (2): 256–26 2. doi:10.2105/ajph.87.2.256. ISSN 0090-0036. PMID 9103106. 
  23. ↑ van Vugt MD, Kroon H, Delespaul PA, Mulder CL (2012) Consumer-providers in assertive community treatment programs: Associations with client outcomes. Psychiatr Serv. 63:477–481.
  24. ↑ Sánchez J, Rosenthal DA, Tansey TN, Frain MP, Bezyak JL (2016c) Predicting quality of life in adults with severe mental illness: Extending the international classification of functioning, disability, and health. Rehabil Psychol. 61:19–31
  25. ↑ Klein AR, Cnaan RA, Whitecraft J (1998) Significance of peer social support for dually diagnosed clients: Findings from a pilot study. Res Soc Work Pract. 8: 529–551.
  26. ↑ Aldersey HM, Whitley R (2015) Family influence in recovery from severe mental illness. Community Ment Health J. 51:467–476.
  27. ↑ Pinfold V (2000) ‘Building up safe havens … all around the world’: Users' experiences of living in the community with mental health problems. Health Place. 6: 201–212
  28. ↑ Sánchez J, Pfaller JS, Sung C, Bezyak JL, Iwanaga K, Chen SM, Chan F (2017) Factorial validity of the perceived empathic and social self-efficacy scale for adults with serious mental illness: A brief report—Erratum. Aust J Rehabil Couns. 23:1
  29. ↑ Sánchez J, Pfaller JS, Sung C, Bezyak JL, Iwanaga K, Chen SM, Chan F (2016b) Factorial validity of the perceived empathic and social self-efficacy scale for adults with serious mental illness: A brief report. Aus J Rehabil Couns. 22:135–146.
  30. ↑ Sánchez J, Wadsworth JS, Frain MP, Umucu E, Chan F. Psychiatric Symptoms, Psychosocial Factors, and Life Satisfaction Among Persons With Serious Mental Illness: A Path Analysis. J Nerv Ment Dis. 2020 Aug;208(8):600-607. doi: 10.1097/NMD.0000000000001166. PMID: 32205775.
  31. ↑ 31.0 31.1 31.2 "CoC Homeless Populations and Subpopulations Reports - HUD Exchange". https://www.hudexchange.info/programs/coc/coc-homeless-populations-and-subpopulations-reports/. 
  32. ↑ "Housing and Shelter" (in en). https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/housing-shelter. 
  33. ↑ 33.0 33.1 Lilanthi Balasuriya, M. D.; Eliza Buelt, M. D.; Jack Tsai, PhD (29 May 2020). The Never-Ending Loop: Homelessness, Psychiatric Disorder, and Mortality. Vol 37, Issue 5. 37. https://www.psychiatrictimes.com/view/never-ending-loop-homelessness-psychiatric-disorder-and-mortality. Retrieved 2020-10-14. 
  34. ↑ 34.0 34.1 34.2 34.3 Aubry, Tim; Goering, Paula; Veldhuizen, Scott; Adair, Carol E.; Bourque, Jimmy; Distasio, Jino; Latimer, Eric; Stergiopoulos, Vicky et al. (2015-12-01). "A Multiple-City RCT of Housing First With Assertive Community Treatment for Homeless Canadians With Serious Mental Illness". Psychiatric Services 67 (3): 275–281. doi:10.1176/appi.ps.201400587. ISSN 1075-2730. PMID 26620289. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201400587. 
  35. ↑ 35.0 35.1 35.2 Corrigan, Patrick W; Watson, Amy C (2002). "Understanding the impact of stigma on people with mental illness". World Psychiatry 1 (1): 16–20. ISSN 1723-8617. PMID 16946807. 
  36. ↑ 36.0 36.1 Corrigan, Patrick W.; Rao, Deepa (2012). "On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change". Canadian Journal of Psychiatry 57 (8): 464–469. doi:10.1177/070674371205700804. ISSN 0706-7437. PMID 22854028. 
  37. ↑ Rüsch, Nicolas; Müller, Mario; Lay, Barbara; Corrigan, Patrick W.; Zahn, Roland; Schönenberger, Thekla; Bleiker, Marco; Lengler, Silke et al. (2014-02-01). "Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness" (in en). European Archives of Psychiatry and Clinical Neuroscience 264 (1): 35–43. doi:10.1007/s00406-013-0412-5. ISSN 1433-8491. PMID 23689838. https://doi.org/10.1007/s00406-013-0412-5. 
  38. ↑ Sánchez J, Wadsworth JS, Frain MP, Umucu E, Chan F. Psychiatric Symptoms, Psychosocial Factors, and Life Satisfaction Among Persons With Serious Mental Illness: A Path Analysis. J Nerv Ment Dis. 2020 Aug;208(8):600-607. doi: 10.1097/NMD.0000000000001166. PMID: 32205775.
  39. ↑ Emmerson LC, Granholm E, Link PC, McQuaid JR, Jeste DV (2009) Insight and treatment outcome with cognitive-behavioral social skills training for older people with schizophrenia. Journal of Rehabilitation Research and Development. 46:1053–1058.
  40. ↑ Corrigan, Patrick W.; Larson, Jonathon E.; Rüsch, Nicolas (2009). "Self-stigma and the 'why try' effect: impact on life goals and evidence-based practices". World Psychiatry 8 (2): 75–81. doi:10.1002/j.2051-5545.2009.tb00218.x. ISSN 1723-8617. PMID 19516923. 



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