Serious Mental Illness

Serious Mental Illness

Mental health disorders that are mostly biological in nature. Affect functioning and quality of life. Usually chronic and life long.

Serious Mental Illness diagnoses

Schizophrenia, Bipolar 1 disorder, sometimes major depression, OCD, PTSD, mood disorders, psychotic disorders, personality disorders.

Challenges of living with SMI

Maintaining employment, securing housing, completing ADL’s, comorbid medical conditions often related to psychiatric medication and lack of self care, substance use/abuse, managing finances, stigma, maintaining family and social relationships, depression/increased risk for suicide.

Comorbid physical conditions

Increased risk of diabetes, hypertension, heart disease, and obesity. 3 times greater risk of premature death than the general population. Physical complaints can be ignored or minimized. Unusual access to care and inadequate insurance coverage.

Substance use associated with serious mental illness

Primarily alcohol and marijuana, may be a way to self medicate, increases risk of relapse, 80% of individuals with schizophrenia are smokers, nicotine can affect how psychiatric medications are metabolized.

Social issues with serious mental illness

Boredom, lack of goals, difficulty finding meaning and fulfillment in life, loneliness/isolation/stigma, caregiver burnout, at inceased risk of victimization/being used and taken advantage of by others.

Economic issues associated with serious mental illness

85% are unemployed, may be unable to manage their own funds or make poor choices related to spending, medications needed to treat illness can be expensive, difficulty accessing resources for assistance.

Anosognosia

Inability to recognize the illness due to the illness, common in SMI

Treatment for SMI

Community providers, case management, day programs, crisis intervention/mobile crisis, housing programs, PHP, IOP, multi service centers, ACT, vocational rehab.

Guardianship

Appointing someone to make decisions for the client

Rep payee

Manages the client’s finances

Psychiatric advanced directive

Completed by the client when in remission stating treatment they want during a relapse of illness

Outpatient commitment

Controversial and not available in all states

Deinstitutionalization

Shifting care of psychiatric patients from state institutions to the community. Long-term patients often became institutionalized with difficulty functioning after release due to dependency. Lack of community resources to manage patients after release. Leading to incarceration and homelessness.

Assessment

Risk to self or others, ability to manage ADLs, treatment adherence, signs of relapse, physical health issues.

Intervention

Therapeutic relationships, support groups, and education, involve the client in developing the treatment plan.

Nursing diagnoses

Impaired social interaction, impaired verbal communication, caregiver role strain.