Severe and Persistent Mental Illness

Severe and Persistent Mental Illness

While millions of U.S. adults are impacted by a mental health disorder each year, those with a severe and persistent mental illness (SPMI) represent about 2.8% of the population. A severe and persistent mental illness includes such disorders as schizophrenia, bipolar disorder, schizoaffective disorder, autism, obsessive-compulsive disorder, and major depressive disorder. These are considered SPMI due to the profound effects they have on all aspects of life, such as employment, family relations, interpersonal relationships, and education over the course of a lifetime.

Severe and persistent mental illnesses tend to be chronic in nature, requiring lifelong management and both psychiatric and social interventions to optimize daily functioning and to help achieve some quality of life. In the majority of individuals with a diagnosed SPMI, serious impairment and subsequent disability in daily functioning has occurred. The individual may experience psychotic features, neglect personal hygiene, express cognitive deficiencies, and exhibit erratic or unusual behaviors. These symptoms present challenges to the family members who are caring for them.

The family is usually the core support system for someone with a SPMI. Because serious mental illness is destabilizing to the family, it is helpful for the family to be involved in a cohesive effort to understand the psychiatric rehabilitation process. These family-based interventions can help family members to learn ways of minimizing stressors or conflicts in the home, as these can further exacerbate the symptoms of SPMI. Along with the family, a range of social services can provide treatment, rehabilitation, and various types of community support for the individual.

What Are the Types of Severe and Persistent Mental Illnesses?

When a mental health disorder becomes so serious that it causes extreme disruption in relationships, work, and daily functioning, and is not resolved through the usual levels of psychiatric care, it is termed a severe and persistent mental illness. There are several types of mental health conditions that fall under this umbrella, including:

Schizophrenia. Schizophrenia is a serious mental health disorder that features hallucinations and delusions, and a general detachment from reality.

Schizoaffective disorder. Schizoaffective disorder is a combination of schizophrenia and a mood disorder, such as depression or bipolar disorder.

Bipolar disorder. Bipolar disorder features extreme mood swings that alternate between depressive and manic episodes.

Autism. Autism spectrum disorder is a disorder of the ability to communicate or relate with others.

Obsessive-compulsive disorder. Obsessive-compulsive disorder (OCD) features obsessive fear-based thoughts coupled with compulsive behaviors that attempt to reduce the resulting anxiety.

Major depression. Severe depression features persistent feelings of despair and hopelessness, extreme fatigue, sleep disruptions, loss of interest in life, and suicidal thoughts.

Some of the symptoms of severe mental illness include:

    • Persistent feelings of being watched
    • Increasingly disorganized thinking
    • Mental confusion
    • Detached from reality
    • Extreme mood swings
    • Insomnia, nightmares
    • Auditory and visual hallucinations
    • Delusional thoughts
    • Garbled or disorganized speech or writing
    • Socially inappropriate behavior
    • Avoidance of social situations, isolation
    • Decline in academic or work performance
    • Unusual body positioning or movement


  • Unusual preoccupation and fears centered on a person or situation
  • Irrational or angry behaviors, physical assault
  • Inability to concentrate
  • Memory problems
  • Loss of interest in appearance and hygiene
  • Personality changes


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When any of these mental health disorders deteriorate to the point when the individual’s life is endangered, or they become a danger to another, it is necessary to use crisis intervention methods. This usually means that the individual is admitted to a hospital setting where they will receive acute stabilization care and intensive treatment. During this acute phase, the individual will be closely monitored, medications will be adjusted, and targeted psychotherapy will be conducted. Once the acute phase has stabilized, the individual will likely enroll in a residential program where they will receive targeted treatment for several weeks.

Treatment for Individuals with SPMI

There is hope for individuals who struggle with SPMI. With a multi-disciplinary approach, social services and a strong family support system, individuals with SPMI can manage the symptoms and achieve a better quality of life. Interventions include:

Treatment of schizophrenia will involve an integrated approach that includes several mental health and support professionals. These include the psychiatrist that will design and oversee treatment, a psychologist, a social worker, and a psychiatric nurse. A case manager will be tasked with coordinating the various services. Schizophrenia treatment includes:

Medication. Psychotropics are the core treatment element for SPMI. Antipsychotics are the primary category used for treating schizophrenia and schizoaffective disorder, including such medications as Abilify, Latuda, Rexulti, Vraylar, and Clozaril. Depending on the patient’s level of compliance, a long acting injectable antipsychotic may be indication. Antipsychotics may also be used to treat autism. For bipolar disorder, lithium is the most commonly prescribed therapy, often in conjunction with an anticonvulsant. In addition to the antipsychotics, antidepressants and anti-anxiety may also be prescribed, depending on the features of the illness. For major depression and OCD, antidepressant therapy is the norm.

Psychotherapy. While medication represents the cornerstone for treating SPMI, individuals can also benefit from the application of certain psychotherapies. Depending on the mental illness these include cognitive behavioral therapy (CBT), psychodynamic therapy, exposure therapy, and cognitive enhancement therapy (CET).

Psychosocial interventions. To improve overall functioning and quality of life, helping the individual with SPMI learn to integrate with the community and become somewhat autonomous is integral to overall recovery. Psychosocial therapies include:

  • Family therapy. Families benefit from support and education that assists them in managing daily life within the family unit, while also providing support for the loved one with SPMI. Case management coordinates the family with various social services that will help reduce the caregiving burden.
  • Social skills training. These everyday skills can help the individual with communication skills training.
  • Assertive community treatment. Personalized services that help the individual with daily challenges, such as problem solving or taking medication on time.
  • Social recovery therapy. Involves assisting the individual to adopt a positive view of the future through collaborative goal setting.
  • Vocational skill building. This might involve job counseling, such as teaching the individual how to seek out and prepare for employment.

Social Services for SPMI

Assertive community treatment (ACT) is a popular model for social and community involvement for supporting the individual with severe mental illness. The primary goal of the ACT model is to create the foundational skills and services that will culminate with the patient becoming more autonomous. The services provided through ACT include outpatient treatment, continuing rehabilitation, and social support. These are offered by an interdisciplinary team that is community-based.

Everyone feels better about themselves when they feel productive and self-reliant, including individuals who suffer from severe and persistent mental illness. The ACT services can help them function at a more optimum level at daily tasks or at a job. With the ongoing support available, even when there are setbacks, these community-based services, including crisis-management services, can reduce the need for hospitalizations.

Family Interventions for SPMI

Families who are tasked with caring for their mentally ill loved one often suffer a great deal of distress. Their loved one may exhibit hostile or abusive, even assaultive, behaviors. They may have extreme mood swings and be quite unpredictable. The family may struggle to get their loved one to comply with the treatment protocols. Embarrassing or offensive behavior may lead the family to become isolated due to the social stigma that could result.

These reasons exemplify why it is essential that families of a loved one with SPMI are also supported. Families need emotional support, as well as direct instruction on how to best manage the particular events that could result from the mental illness. Families also need to be able to access social services to assist their loved one and take some of the pressure of the family caregivers. These services will also assist the individual with SPMI to become more autonomous in daily life functioning.

Severe and Persistent Mental Illness and Quality of Life

An important study out of the U.K. explored the concept of quality of life within the mentally ill population. Healthy individuals have a subjective view of what constitutes quality of life, and therefore also imposes an assumed view of what quality of life would mean to someone with SPMI. The authors of the study looked at several domains of life that are usually considered when determining how a person feels about their quality of life. These included the domains of well-being and ill-being; control, autonomy and choice; self-perception; belonging; and hope and hopelessness. They discovered through their research that standard measures do not adequately address the complex ways that quality of life is measured for, or the domains that are important to, people with severe mental illness.

The authors concluded that positive quality of life includes feelings of well-being, control and autonomy, a sense of belonging, a positive sense of self, and participation in enjoyable and meaningful activities. On the other hand, a poor quality of life among individuals with mental illness includes feeling a lack of control, being stigmatized or rejected, not included or accepted, a negative perception of self, and difficulty with day-to-day functioning. The complexities of the SPMI present challenges for these individuals who also deserve to enjoy quality of life.

Mental Health Hope Provides Treatment Options for SPMI

Mental Health Hope is an online mental health resource for individuals needing some guidance in pursuing treatment for a psychiatric condition. Our expert mental health specialists can offer workable solutions for those with a loved one struggling with SPMI. Let our knowledgeable team assist you in finding the important resources that can lead to a successful treatment outcome. Call Mental Health Hope for your free confidential assessment today at (877) 967-9274.

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