Mental Illness in Leicester and Evington Part IV Severe Mental Disorder

A severe mental illness (SMI) is generally understood to mean a mental health condition that is serious in symptoms and impact, long-lasting or recurrent, causes substantial impairment in daily functioning, relationships, work, judgment, or self-care and often requires specialist psychiatric treatment and support.

Different countries and organisations use slightly different definitions. In the UK, bodies such as the National Health Service and mental health services commonly use the term for illnesses involving psychosis, major mood disorders, or severe functional impairment.

Common conditions classed as severe mental illnesses include schizophrenia, bipolar disorder, major depressive disorder and schizoaffective disorder.

Schizophrenia is probably the most well-known of these severe illnesses as many of the people who have committed homicides in recent times, such as Valdo Calocane, have been diagnosed with the disorder. It is a chronic psychotic disorder affecting thinking, perception, emotions, and behaviour. Typical features can include hallucinations (hearing voices, seeing things), delusions (fixed false beliefs), disorganised thinking or speech, social withdrawal, reduced emotional expression and cognitive difficulties. People may experience episodes of acute psychosis and periods of relative stability.

Bipolar disorder is another severe mental illness. It is condition involving major shifts in mood, energy, activity, and judgment. Episodes may include mania, elevated or irritable mood, reduced need for sleep, grandiosity, risky behaviour and racing thoughts. Those with bipolar disorder may fluctuate between periods of manic highs and depression, low mood, hopelessness, fatigue and suicidal thoughts. Some people also experience psychosis during severe episodes.

Major depressive disorder which is more severe than ordinary sadness or grief is yet another SMI. Severe forms may involve persistent despair, Inability to function, loss of pleasure, extreme slowing or agitation, psychotic symptoms, self-neglect and suicidal thinking. When psychosis occurs, it is sometimes called psychotic depression.

Schizoaffective disorder is an illness where schizophrenia and bipolar disorder combine and includes symptoms of schizophrenia (psychosis) and significant mood symptoms (depression or mania). It sits between psychotic and mood disorders diagnostically.

The key characteristic of severe mental illness is psychosis, i.e. a loss of contact with reality, manifesting in hallucinations, delusions and severe thought disturbance. Psychosis though is one of the clearest markers of many SMIs.

SMIs often result in functional impairment as the illness substantially affects employment and employability, education, relationships, independent living, decision-making and self-care. The duration is often long-term, recurrent and episodic with relapses. Some people recover fully; others require lifelong support.

Those suffering from a SMI often have increased risk and vulnerability, with suicide, self-neglect, homelessness, unemployment, physical ill-health, social isolation and vulnerability to exploitation as key features of their illness. However, most people with SMI are not violent, and stigma around mental illness is a major issue.

Treatment often combines medication (antipsychotics, antidepressants, mood stabilisers), psychological therapies, community mental health support, crisis services, supported housing or rehabilitation and social care support.

Common medications prescribed for SMI include Olanzapine, Lithium and Sertraline.

In England and Wales, under the Mental Health Act 1983, people with severe mental disorders may sometimes be detained in hospital (“sectioned”), and or treated, compulsorily (against their wishes) under legal safeguards.

Sources:

• https://www.nhs.uk/mental-health/conditions/
• https://www.nhs.uk/mental-health/conditions/schizophrenia/overview/
• https://www.nhs.uk/mental-health/conditions/bipolar-disorder/
• https://www.legislation.gov.uk/ukpga/1983/20/contents
• https://www.who.int/standards/classifications/classification-of-diseases
• https://www.nice.org.uk/guidance/cg178
• https://www.nice.org.uk/guidance/cg185
• https://www.nice.org.uk/guidance/ng222