DEFINITION OF SERIOUS MENTAL ILLNESS (SMI)

 

ADULTS (18 AND OLDER)

 

SMI History

 

In the early 1980s, DMHSAS began to place more emphasis on the treatment of individuals who suffer from a major mental illness.  To begin to monitor the movement of these individuals through the system and to identify services provided to this population, the Department developed criteria to define this target population as individuals with a "chronic mental illness."  This definition focused on diagnosis, functioning and duration of illness.  The duration of the illness had to be at least two years to meet the target population definition.

 

Beginning in 1991, the definition was changed somewhat; less emphasis was placed on diagnosis and more emphasis placed on functional impairment.  Many of the components of the Federal definition were incorporated into the definition.  As a result, the definition was broadened to include more individuals and the title was changed to "severe and persistent mental illness."

 

In 1995, with the advent of managed care, the Department again revised the target population definition.  The title was changed to "serious mental illness."  There was little change in diagnostic criteria.  Less emphasis was placed on duration of illness, and the functional impairment criteria were revised.  In addition, a functional assessment tool was developed to make the identification of this target population more objective.

 

"Serious Mental Illness" (Adult With a Serious Mental Illness) means an individual 18 years of age or older who meets the following criteria:

 

A.         Currently or at any time during the past year have had a diagnosable mental, behavioral or emotional disorder of sufficient duration to meet criteria specified within DSM-IV with the exception of "V" codes, substance use disorders, and developmental disorders, unless they co-occur with another diagnosable serious mental illness;

and

B.        Has at least (a) moderate impairment in at least four, (b) severe impairment in two or (c) extreme impairment in one of the following areas:

1.         Feeling, Mood, and Affect:  Uncontrolled emotion is clearly disruptive in its effects on other aspects of a person's life.  Marked change in mood.  Depression and/or anxiety incapacitates person.  Emotional responses are inappropriate to the situation.

2.         Thinking:  Severe impairment in concentration, persistence, and pace.  Frequent or consistent interference with daily life due to impaired thinking.  Presence of delusions and/or hallucinations.   Frequent substitution of fantasy for reality.

3.         Family:  Disruption of family relationships.  Family does not function as a unit and experiences frequent turbulence. Relationships that exist are psychologically devastating.

4.         Interpersonal:  Severe inability to establish or maintain a personal social support system.  Lacks close friends or group affiliations.  Socially isolated.

5.         Role Performance:  Frequent disruption of role performance and individual is unable to meet usual expectations.  Unable to obtain or maintain employment and/or conduct daily living chores such as care of immediate living environment.

6.         Socio-legal:  Inability to maintain conduct within the limits prescribed by law, rules, and strong mores.  Disregard for safety of others. Destructive to property. Involvement with law enforcement.

7.         Self Care/Basic Needs:  Disruption in the ability to provide for his/her own needs such as food, clothing, shelter, and transportation.  Assistance required in obtaining housing, food and/or clothing.  Unable to maintain hygiene, diet, clothing, and prepare food.

or

C.        Has a duration of illness of at least one year and (a) at least moderate impairment in two, or (b) severe impairment in one of the following areas:

1.         Feeling, Mood, and Affect:  Uncontrolled emotion is clearly disruptive in its effects on other aspects of a person's life. Marked change in mood.  Depression and/or anxiety incapacitates person. Emotional responses are inappropriate to the situation.

2.         Thinking:  Severe impairment in concentration, persistence and pace.  Frequent or consistent interference with daily life due to impaired thinking.  Presence of delusions and/or hallucinations. Frequent substitution of fantasy for reality.

3.         Family:  Disruption of family relationships.  Family does not function as a unit and experiences frequent turbulence. Relationships that exist are psychologically devastating.

4.         Interpersonal:  Severe inability to establish or maintain a personal social support system.  Lacks close friends or group affiliations.  Socially isolated.

5.         Role Performance:  Frequent disruption of role performance and individual is unable to meet usual expectations.  Unable to obtain or maintain employment and/or conduct daily living chores such as, care of immediate living environment.

6.         Socio-legal:  Inability to maintain conduct within the limits prescribed by law, rules, and strong mores.  Disregard for safety of others.  Destructive to property. Involvement with law enforcement.

7.         Self Care/Basic Needs:  Disruption in the ability to provide for his/her own needs such as food, clothing, shelter and transportation.  Assistance required in obtaining housing, food and/or clothing.  Unable to maintain hygiene, diet, clothing, and prepare food.

 

NOTE:            Individuals with a primary diagnosis of substance abuse or developmental disorder are excluded from this definition.

 

Individuals may show less impairment if they are on medications or receiving other treatment services that reduce the symptoms of the illness, but moderate to severe impairment in functioning would result with discontinuation of the medications.