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With Mental Illness, ‘Serious’ Is A Slippery Term

When the federal government released an important compendium of mental health data this week, the headlines proclaimed that 1 in 5 Americans over 18 had a diagnosable mental illness in the past year, and 1 in 20 had a “serious mental illness.”

But what does “serious mental illness” mean, anyway, and what are its connotations and implications when it comes to treatment? It’s a question worth asking, because it’s used differently in different contexts.

6 Comments to
With Mental Illness, ‘Serious’ Is A Slippery Term

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  1. Maybe the government’s impairment definition is meant to be applied to people without regard to whether they take drugs. Meaning, would the person be impaired if they weren’t on medication?

  2. Well Kaitlin, I’m not sure I recognize a point to your post, but I will add a few things. If we really look at our society we can find one out of “everyone” having a mental disorder of one kind or another. Which doesn’t diminish those who struggle in any way. I struggle daily, and recently had to go to jail and a psych ward to recognize I do have the balls and bluster to change my life…my thinking. I have my own blog, it’s for the youth too, and it’s called THE BI-POLAR AMERICAN.
    I don’t take a stand on medication I do however talk about all the issues surrounding a bi-polar life. Well, my bi-polar life and that of my friends. I may not be popular for my thoughts on the matter, but I say we take responsibility, realize we are not victims,and use our chemically unique systems to our advantage.
    I’m hell on wheels and would not want to be anything else. I won’t argue, but I believe we all have a place in this world.
    I have a serious mental illness and people have suggested that I need to be chemically restrained. Do I make the world uncomfortable…a bit. Thanks for listening.

  3. I should add that the reason the federal government defines serious mental illness in the first place – that is, the reason the term is significant – is that it distributes block grants to the states which the states then use to provide serious to people with SMI. The equivalent, by the way, for people under age 18, is “serious emotional disturbance,” which is used to determine eligibility, for example, for special services in school.

  4. Even the National Alliance on Mental Illness, or NAMI, the chief US advocacy group for —the— mentally ill, skirts the issue a bit. …

    NAMI at times ( some of its members) is an advocate of “the” mentally ill, that phrase was once in its name. It has been removed.

    Harold A. Maio
    [email protected]

  5. Nicely written and thought out. I think the funding implications are also important. Most advocates and agencies engage in mission-creep: in order to claim the biggest constituency they use the broadest definitions. This has led to reverse prioritization whereby the highest functioning are sent to the front of the line for services and most severely disabled go to jails, prisons, shelters and morgues. Anyone ever died in your family? Then you’ve got ‘trauma’ and go to front of line for services. Schizophrenia? The jail is over there. I wrote Mental Health Kills Mentally Ill about this here
    Great post.

    • I don’t have direct experience with public mental health services, but mission-creep certainly seems common from what I’ve read and heard. Federal funding, while vital, can create unintended consequences and perverse incentives in many arenas, and certainly mental health policy is not immune. But why would wanting to claim the largest constituency to get more federal funds inevitably lead to sending the highest-functioning to the front of the line?

  6. I think the important thing is to realize that very “serious” suffering and impairment can occur with the more extreme manifestations of conditions that are not considered the “worst” mental illnesses. Major depression, OCD and panic attacks are not just minor annoyances, they can be horrifying and crippling.

  7. Great article!

    Another issue with using meds as the determinant is that some conditions have identified medications that help and others don’t. Dissociative disorders generally do not have medications (though often anti-anxiety and/or anti-depressants are prescribed, there is nothing specifically for dissociative disorders). I don’t think anyone would argue DID, for example, isn’t serious.

    • Great point about conditions that do and don’t respond to meds. Personality disorders in general can be considered very serious but typically aren’t thought to be as treatable with psychopharmaceuticals, at least as I understand it.

  8. Wow – I spoke too soon. The Blue Cross Blue Shield page lists DID as ‘non-serious.’

    That’s baffling.


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