What Does The Term “Serious Mental Illness” Really Mean?

“We all have mental health” is a phrase we hear often and one that has gone a long way to lifting the stigma around mental illness.

Canadians seem to have fully embraced the concept that taking care of our mental health is as important as looking after our physical health. We might even be well down the road to understanding the “mind/body connection” that allows us to live to our fullest potential. And many of us are aware of the distinction between mental health and mental illness

But what do we mean when we use the term “serious mental illness”? 

Serious mental illness, commonly denoted as SMI, is determined by several factors: diagnosis, age, functional impairment, and duration. Specifically, the American Psychological Association states that: “Serious mental illness is a mental, behavioral or emotional disorder (excluding developmental and substance use disorders) resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.” This standard is commonly used in Canada. Those meeting the criteria of serious mental illness are the clients that Eli’s Place will serve when we open our doors. 

Diagnosis and Age

To be identified as having SMI, one must be 18 years of age or older. Many mental illnesses meet the criteria for SMI including, but not exclusive to: illnesses on the schizophrenia spectrum, bipolar disorder, depression, persistent depressive disorder, anxiety disorder, obsessive compulsive disorder, and trauma related disorders. Often these diagnoses have what are known as “co-morbidities” or “concurrent diagnosis” such as a substance abuse disorder or a chronic medical condition such as diabetes. 160,000 young Ontarians face serious mental illness—that’s 1 in 24 young adults. 

Functional Impairment

Typically, after an initial crisis, a young adult can cycle in and out of short term critical psychiatric care prior to a diagnosis being made. Several emergency visits and/or short stays in hospital within a single year are often the norm at this stage. Short stays or even longer stays in a psychiatric unit might repeat over several years. Each time, once stabilized, individuals struggle to re-enter their lives. Jumping back into life prior to the crisis, whether that might be in a post secondary educational setting, the workplace, establishing independent living routines or living within their family setting, can be hugely challenging. While the crisis might be over, the work of learning to live with serious mental illness is not. Functional impairment might persist for extended periods of several months or even indefinitely, impacting personal, social, and occupational relationships. 

Recovery

Canada’s mental health strategy has fully embraced a “Recovery Model.” As noted in the Canadian Medical Association Journal: “The concept of mental health “recovery” is based on evidence that people with severe mental illnesses can live autonomous, contributing and satisfying lives in the community, even in the presence of persisting symptoms.” Recovery means learning to live with a chronic illness using skills that can be developed over time. At Eli’s Place, our recovery model will empower clients to embrace life’s challenges in a positive way. Psychosocial interventions such as life skills training (cooking, managing finances, decision-making), occupational skills training (job searching, self-advocacy, employment support), relationship skills training (conflict management, self-reliance, pro-social connections) can build resilience over time. Often there can be a reduction in the severity of symptoms and a flourishing in a sense of well being. 

Hopeful Futures

While a diagnosis of serious mental illness can bring fear, anger and even shame, the evidence shows that recovery is possible. Our young adults with serious mental illness deserve the time and space needed to develop the skills to live with their illness. To break the cycle of crisis intervention and struggle, young adults need the evidence-based therapeutic option that Eli’s Place seeks to provide. 

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Kate Kostandoff is a member of the Eli’s Place Board. A retired high school teacher, she lives with her family in Port Hope, Ontario. 

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