What is "serious mental illness" (SMI)?

This is a term that I have seen used a lot, but I can't find a consistent definition for it. Insurance companies make a list of disorders that are "serious"-OCD, major depression, bipolar, etc. but this hardly seems like a good definition as these illnesses all hit with varying severities. I've seen SMI defined as a GAF below 60 for at least a year, but why 60? I've also seen elaborate criteria:someone with SMI has a DSM disorder that currently causes moderate impairment in 4 life activities, or severe difficulties in 2 life activities, or extreme problems with 1. Or they could have 2 moderate problems for at least 1 year, or 1 severe issue for the same period.

Why does it matter? While 25% (yes, 25%!) of the US population will have a MH problem in any given year, most of the cost and suffering related to MI is dumped on the 7% that have SMI. We need to understand SMI to understand that statistic, and that seems like an important statistic to understand.

How do you define SMI?

A serious mental illness is one that concerns you.

Well, that is a good question Secretum. Perhaps the consideration of serious may be considering the possibility of being SI from these illnesses and that they should be taken seriously.

Open Eyes

Anything interfering with the things you like to do or need to do.

The proposed DSM-V is attempting to include scales to measure severity for certain disorders and it will be interesting to see if insurance companies stick to their own ideas or follow the scales. I think it's an odd question because to me, all mental illnesses are serious for the affected individual and it downplays non-serious mental illnesses.

I agree with Oxi. Isn't it true that in order to be diagnosed with a mental illness the individual must have significant impairment in the majority of symptoms for the disorder? I would say that, as with any illness, there is a severity in range. However, just because one has a milder form of an illness they are still be impaired to the point that medical intervention is necessary. In any case, the severity of any illness really depends upon how the individual experiences it. For instance, some people have a really high tolerance for pain. Their 5 is somebody else's 10. Does that mean that although they are only stating their pain is at a level 5 of 10 that their pain is any less severe than the other patient who is experiencing a 10 of 10? We could probably discuss this til the end of the earth and never come up with a clear definition. Great topic though! I appreciate the opportunity to think intellectually.

Love and Hugs,
Tara

To be honest, I've always wondered about this too, as I see the term used in the media and occassionally by the medical profession, but I've never seen a precise definition.

This is only my own bias, so I really hope I don't offend anyone - that is not my intent, but when I hear the term, I tend to think of schizophrenia first and then bipolar as to me they are from a medical management point of view more difficult to treat and when are untreated can often be very disruptive to a person's life. I know depression and anxiety can seriously mess up your life, but I believe those to be more treatable conditions, that can in some cases actually be cured / sent into remission, whereas with bipolar and schizophrenia you have it for life - you are optimally managing the symptoms.

I was very taken aback about a year ago when my pdoc suggested that a job might be too challenging for me, as I had just recoverred from a "serious" mental illness. I had been hospitalized for a month for depression - but I was out of the hospital, my symptoms were in remission, and I didn't feel like my life was in any negative way effected. Similarly we were talking relapse and coping in my aftercare group and another guy and I were both expressing frustration with our coping - we're functioning but it's not great - me mainly due to stress at the moment. The nurse said, well in addition to addiction you both suffer from severe mental illness which complicates things. I wondered, is that how people see me?

Personally I don't like the term and wished it wouldn't be used.

splitimage

One definition:

SERIOUS MENTAL ILLNESS
Pursuant to section 1912(c) of the Public Health Service Act, adults with serious mental illness SMI are persons: (1) age 18 and over and (2) who currently have, or at any time during the past year had a diagnosable mental behavioral or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM-IV or their ICD-9-CM equivalent (and subsequent revisions) with the exception of DSM-IV "V" codes, substance use disorders, and developmental disorders, which are excluded, unless they co-occur with another diagnosable serious mental illness. (3) That has resulted in functional impairment, which substantially interferes with or limits one or more major life activities. Federal Register Volume 58 No. 96 published Thursday May 20, 1993 pages 29422 through 29425.

http://www.networktherapy.com/library/dictionary.asp#S

More importantly, how do the statisticians define "severe mental illness"? After all, their statistics are based on that definition, not whatever one we choose to use. Do the different surveys and studies even agree on one definition of "severe mental illness"? If not, do the different definitions skew the results of the studies? How do we know which statistic is "correct" without a universally agreed upon definition of that which is studied? How can "severe mental illness" even be defined? Is it a measurable thing, like amount of water? Or is it a concept, human constructed, which is immeasurable, like degree of religious belief?

I think I had too much coffee...

http://archpsyc.ama-assn.org/cgi/content/full/60/2/184

Here (New York, USA) Serious mental disorder usually refers to any mental disorder that causes the persons functioning (daily living skills and abilities) or IQ go down,

Example a behavior disorder becomes "serious" when the child's behavior prevents the child from focusing in school, causes the child to become a danger to their self or others.

Another example Depression becomes "serious" when a person depression symptoms cause them to lose time at work, cant interact with family members and is suicidal.

SMI is a term that is used differently for different towns, states, cities, countries and differently among insurance companies, mental health agencies and other health care agencies.

to find out what it means where you are you can contact your insurance company, your medical doctor and any mental health treatment providers you may have. they can all tell you what and how they are using the term.