Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions

  • Alberto Parabiaghi
  • Chiara Bonetto
  • Mirella Ruggeri
  • Antonio Lasalvia
  • Morven Leese



There is a lack of consensus on the identification of seriously mentally ill patients (SMI). This study investigates the external and predictive validity of an operationalized definition for the severity and persistency of mental illness applied to a sample of service users attending a community mental health service.


The definition is based on the fulfilment of dysfunction (GAF ≤ 50) and illness duration (≥2 yrs) criteria. The study was conducted with a two-year longitudinal design. External and predictive validity of the SMI definition were assessed against the diagnosis of psychosis.


Our data show evidence for an overall high predictive and external validity of the SMI definition and high sensitivity in predicting those with high burden of mental illness.


In order to identify people with high levels of psychiatric burden, the SMI working definition seems to be more useful than that simply based on diagnostic criteria.

Key words

mental health services psychotic disorders  burden of illness  



We are grateful to the patients who participated in the study and to the staff of the South-Verona Community Psychiatric Service for their kind collaboration in the project. This study was supported by a grant of Ministero dell’Istruzione, dell’Università e della Ricerca Scientifica (MIUR), Roma (fondi 60%) to prof. Mirella Ruggeri.


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Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Alberto Parabiaghi
    • 1
    • 2
  • Chiara Bonetto
    • 1
  • Mirella Ruggeri
    • 1
  • Antonio Lasalvia
    • 1
  • Morven Leese
    • 3
  1. 1.Dept. of Medicine and Public Health, Section of Psychiatry and Clinical PsychologyUniversity of VeronaVeronaItaly
  2. di Medicina e Sanità Pubblica Sezione di Psichiatria e di Psicologia ClinicaUniversità di VeronaVeronaItaly
  3. 3.Section of Community Psychiatry (PRiSM) Health Service Research Dept.Institute of Psychiatry, King’s College LondonLondonEngland

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