Treatment Advocacy Center (TAC) uses “SMI” to stand for severe mental illness, an umbrella term that includes the most serious of psychiatric disorders that puts an individual at greatest risk for anosognosia, having their mental illness criminalized, or experiencing a preventable tragedy such as victimization or suicide. This includes schizophrenia spectrum disorders, severe bipolar disorder, and major depression with psychotic features.
million adults in the United States with SMI.
million adults 18-65 living with a schizophrenia spectrum disorder.
of adults have Bipolar I disorder in past year.
of individuals with SMI receive treatment in a given year.
Severe vs. Serious Mental Illness
Serious mental illness is a broader term than severe mental illness and is usually defined by impairment, rather than by specific illnesses. Its definition was first created by the Center for Mental Health Services in the 1990s to distribute mental health block grants based on need in each state.
While definitions may vary slightly by organization or locality, the National Institute of Mental Health defines serious mental illness as “a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.” Therefore, serious mental illness is often a broader term that includes a wider variety of psychiatric disorders.
Severe mental illness is a narrower term that Treatment Advocacy Center uses to define the population we serve. This term was first created by the National Advisory Mental Health Council in 1993 and is defined through diagnosis, disability, and duration.
Treatment Advocacy Center’s definition of severe mental illness includes schizophrenia, schizoaffective disorder, schizophreniform disorder, bipolar I disorder, and major depression with psychotic features. These disorders often include psychosis as a component.
This population is at the greatest risk for criminal legal system involvement, homelessness, psychiatric hospitalization, and involuntary treatment. Approximately half of people with severe mental illness experience anosognosia, or lack of insight, that impairs their ability to understand their illness.
Click on the arrows below to learn some SMI terms & TAC definitions.
Psychosis is a state some individuals experience where they lose contact with external reality. Delusions, hallucinations, disorganized behavior, and incoherent speech are common symptoms. While experiencing psychosis, a person may feel very anxious or confused. They also may experience a loss of motivation and social withdrawal.
Several disorders have psychosis as a symptom. These disorders can be categorized as either affective psychosis or non-affective psychosis.
- Affective Psychosis: happens in the context of a mood disorder (bipolar disorder and major depressive disorder). Individuals with affective psychosis will only have psychosis symptoms during a manic or depressive episode. The psychosis symptoms do not occur outside of mood disorder episodes.
- Non-affective Psychosis: Non-affective psychosis happens in the context of a schizophrenia spectrum disorder or other psychotic disorder with no associated mood disorder.
Individuals with schizoaffective disorder have symptoms of schizophrenia and psychosis that occur in absence of a mood disorder episode, but mood disorder symptoms are present for the majority of the active and residual phases of the illness.
Schizophrenia spectrum disorders are a class of psychiatric disorders that are characterized by the presence of psychosis symptoms and a disconnection from reality. Schizophrenia is now considered to be on a spectrum, rather than having specific subtypes, which better classifies the continuum of symptoms a person may experience. Schizophrenia spectrum disorders include schizophrenia, schizoaffective disorder, and schizophreniform disorder.
Symptoms may include:
- Positive symptoms, such as delusions, hallucinations, disorganized speech, and behavior.
- Negative symptoms, such as struggling to take care of oneself, social withdrawal, flat affect, trouble with speech, and lack of pleasure.
- Cognitive symptoms, such as difficulty remembering things, organizing thoughts, and directing attention.
More than half (60%) of people with a SSD also have anosognosia, meaning that they lack insight into their illness.
Bipolar I disorder, the more severe form of bipolar disorder, is a mood disorder that consists of episodes of both mania and depression.
Bipolar I disorder consists of mania episodes that last for seven days or more, as well as depressive episodes that usually last two weeks or more. Mixed-episodes are also possible, which means an individual experiences depressive and manic symptoms at the same time.
Symptoms of mania may include:
- Changes in thought patterns (e.g. racing or disjointed thoughts, increased focus on religion, flights of ideas).
- Impaired judgement (e.g. extreme impulsiveness or risk taking, inappropriate humor, reckless spending).
- Mood changes (e.g. grandiosity, extreme excitability, sudden shifts to extreme irritability), speech disruptions (e.g. rapid and pressured speech, persistent rambling).
- Sudden changes in energy (e.g. sleeping very little, restlessness, persistent movement, sudden increase in goal-oriented activities).
Some individuals may experience psychosis while experiencing a manic or depressive episode.
Anosognosia, or lack of insight, refers to a symptom of severe mental illness that impairs a person’s ability to understand or perceive their own illness. Anosognosia is thought to be the most common reason for not seeking or maintaining treatment for people with SMI.
Some studies of anosognosia suggest that this is a result of anatomical damage in the part of the brain that is involved in self-reflection. This condition can also be seen in some individuals with Alzheimer’s disease, after a stroke, and other neurological conditions.
Family Resources
If you or a loved one has been diagnosed with a severe mental illness and want to learn more, please visit the Joan C. Scott Family Resource Center page for psychoeducation and support.