Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions
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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 wordsmental 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.
- 2.American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders DSM-III-R, 3rd edn., revised, APA, Washington, DCGoogle Scholar
- 7.Feinstein AR (2002) Principles of Medical Statistics. Chapman & Hall/CRC, Boca Raton, FloridaGoogle Scholar
- 16.National Institute of Mental Health (1987) Towards a model for a comprehensive community-based mental health system, NIMH, Washington, DCGoogle Scholar
- 19.Rothbard AB, Schinnar AP, Goldman HH (1996) The pursuit of a definition for severe and persistent mental illness. In: Soreff SM (ed) Handbook for the treatment of the seriously mentally ill, Kirkland Hogrefe and Huber Publisher, WashingtonGoogle Scholar
- 28.Tansella M, Amaddeo F, Burti L, Ruggeri M (1998) Community-based mental health care in Verona, Italy. In: Goldberg D, Thornicroft G (eds) Mental Health in our Future Cities, Psychology Press, HoveGoogle Scholar
- 29.Thornicroft G, Tansella M (1999) The mental health matrix. A manual to improve services, Cambridge University Press, CambridgeGoogle Scholar
- 30.Ventura J, Green M, Schaner A, Liberman R (1993) Training and quality assurance with the Brief Psychiatric Rating Scale. The ‘drift busters’. Int J Methods Psychiatr Res 3:221–244Google Scholar
- 31.World Health Organization (1988) Disability Assessment Schedule (DAS-II), World Health Organization, GenevaGoogle Scholar