Abstract
The construct “serious/severe mental illness,” or “SMI,” is a priority within mental health initiatives in the United States. However, there is a lack of clarity regarding its operational definition in policy and practice settings. This study involved an evaluation of “SMI” policy definitions across the 50 United States, five territories, and Washington, D.C. via review of public legislation, department of health (DOH) websites and contacts. Policy definitions were available for 46 (82.2%) locations. Of those definitions, 32 (69.6%) were listed within legislation and 18 (39.1%) used pre-existing organizational or agency definitions. Only nine (19.6%) definitions indicated they were intended to determine eligibility for specific mental health services. Most locations (N = 38; 82.6%) mentioned functional impairment or disability as an eligibility criterion and suggested any psychiatric diagnosis could be considered SMI (N = 34; 73.9%). Results indicate substantial variability in SMI policy definitions across geographic locations with implications for service eligibility, delivery, and receipt.
References
Alcohol, Drug Abuse and Mental Health Services Administration (ADAMHA) Reorganization Act, P.L. § 102–321 (1992). https://www.govinfo.gov/content/pkg/STATUTE-106/pdf/STATUTE-106-Pg323.pdf
Goldman, H. H., & Grob, G. N. (2006). Defining ‘mental illness’ in mental health policy. Health Affairs, 25(3), 737–749. https://doi.org/10.1377/hlthaff.25.3.737
Gonzales, L., Kois, L. E., Chen, C., López-Aybar, L., McCullough, B., & McLaughlin, K. J. (2022). Reliability of “Serious Mental Illness”: A systematic review. Psychiatric Services. https://doi.org/10.1176/appi.ps.202100661
Iowa Administrative Code 441 § 25 (2020). https://www.legis.iowa.gov/docs/ACO/chapter/441.25.pdf
Insel, T. (2013, July 31). Post by former NIMH Director Thomas Insel: Getting serious about mental illnesses. National institute of mental health. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/getting-serious-about-mental-illnesses.shtml
Narrow, W. E., Regier, D. A., Goodman, S. H., Rae, D. S., Roper, M. T., Bourdon, K. H., Hoven, C., & Moore, R. (1998). A comparison of federal definitions of severe mental illness among children and adolescents in four communities. Psychiatric Services, 49(12), 1601–1608. https://doi.org/10.1176/ps.49.12.1601
National Institute of Mental Health. (2022, January). Mental illness. Retrieved February 4, 2022 from https://www.nimh.nih.gov/health/statistics/mental-illness
New Jersey Administrative Code, Title 10 § 37B-1.2 (2021).
New York State Department of Mental Health, n.d. Serious and persistent mental illness. Retrieved June 15, 2022 from https://omh.ny.gov/omhweb/guidance/serious_persistent_mental_illness.html
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1–13. https://doi.org/10.1177/1609406917733847
Ohio Administrative Code Title 5122 § 21–03 (2020).
Parabiaghi, A., Bonetto, C., Ruggeri, M., Lasalvia, A., & Leese, M. (2006). Severe and persistent mental illness: A useful definition for prioritizing community-based mental health service interventions. Social Psychiatry and Psychiatric Epidemiology, 41(6), 457–463. https://doi.org/10.1007/s00127-006-0048-0
Ruggeri, M., Leese, M., Thornicroft, G., Bisoffi, G., & Tansella, M. (2000). Definition and prevalence of severe and persistent mental illness. British Journal of Psychiatry, 177, 149–155. https://doi.org/10.1192/bjp.177.2.149
Schinnar, A. P., Rothbard, A. B., Kanter, R., & Jung, Y. S. (1990). An empirical literature review of definitions of severe and persistent mental illness. American Journal of Psychiatry, 147(12), 1602–1608. https://doi.org/10.1176/ajp.147.12.1602
Substance Abuse and Mental Health Services Administration (2020a, April). Community mental health services block grant. Retrieved August 3, 2022 from https://www.samhsa.gov/grants/block-grants/mhbg
Substance Abuse and Mental Health Services Administration. (2020b, April 30). Mental health and substance use disorders. Retrieved February 4, 2022 from https://www.samhsa.gov/find-help/disorders
Substance Abuse and Mental Health Services Administration (2022, April). Mental health and substance use disorders.. Retrieved August 3, 2022 from https://www.samhsa.gov/find-help/disorders
Wing, J. K. (2004). Severe mental illness. In A. Stevens, J. M. Raferty, & S. Simpson (Eds.), Health care needs assessment: the epidemiologically based needs assessment reviews. Radcliffe Publishing.
Zumstein, N., & Riese, F. (2020). Defining severe and persistent mental illness – a pragmatic utility concept analysis. Frontiers in Psychiatry, 11, 648. https://doi.org/10.3389/fpsyt.2020.00648
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no potential conflicts of interest to disclose.
Research Involving Human and Animal Participants
This research was approved as exempt by the Adelphi University Institutional Review Board as it involved review of publicly available information and did not include human participants.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Gonzales, L., Kanani, A. & Pereyra, A. Policy Definitions for “Serious Mental Illness” Across 56 United States, Districts and Territories. Community Ment Health J 59, 595–599 (2023). https://doi.org/10.1007/s10597-022-01026-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-022-01026-5