Severe and Persistent Mental Illness
1. What Is Severe (or Serious) and Persistent Mental Illness, or SPMI?
Severe and persistent mental illness, or SPMI, refers to a variety of mental health problems that result in severe disability. People have typically associated it with schizophrenia, but a more current understanding classifies the severely and persistently mentally ill individuals under various psychiatric diagnoses. Very interestingly, Dr. John Spollen reports in "Perspectives in Serious Mental Illness" that a proper understanding of what SPMI is cannot be gained through an understanding of a DSM diagnosis (n.p.). He adds that "there is a difference in culture when people speak of SPMI" (ibid.). Treating people with SPMI involves much more than simply managing medication. According to Dr. Spollen, "it should include multidisciplinary treatment rather than just a physician, that a biosocial rather than a purely medical approach is often used, and that functional outcomes, especially social and occupational, are often more important than symptomatic outcomes" (ibid.).
Given this broad understanding of SPMI, it is not surprising that there has been a considerable lack of conformity in defining exactly what SPMI is. According to Schinnar et al. in "An empirical literature review of definitions of severe and persistent mental illness", published in the American Journal of Psychiatry, "Seventeen definitions of the severely and persistently mentally ill have appeared in the literature over the past decade" (n.p.). The disparity in the criteria for judging who has SPMI was so great that in a study on a "representative sample of 222 patients receiving services in one of Philadelphia's inner-city neighborhoods, the analysis showed estimates of prevalence of serious mental illness ranging from 4% to 88% of the treated population, depending on the definition applied" (ibid).
One basic and helpful criterion for SPMI i...