This
pdf from 2000 listed following definitions of SMI .
87
Paul Lelliott, April 1997
EXISTING DEFINITIONS OF SMI
Proposals
C1. Goldman et al. (1981) proposed the following criteria:
- Diagnosis : According to DSM-III criteria, either:
l organic brain syndrome
l schizophrenia
l paranoid and other psychoses
l major affective disorders.
- Disability : Erosion of, or prevention of the development of, functional
capacities in relation to three or more primary aspects of daily
life:
l personal hygiene and self-care
l self-direction
l interpersonal relationships
l social transactions
l learning
l recreation
l economic self-sufficiency.
- Duration : Most have required > three months hospitalisation in one year
or > one year in preceding five years. Although some have
required short-term hospitalisation (< three months) or have
only received out-patient care.
C2. McLean and Liebowitz (1989) considered at least one of the following must be
present:
- two or more years of contact with services
- depot prescribed
- ICD-9 classification 295 or 297
- three or more in-patient admissions in the last two years
- three or more day-patient episodes in the last two years
- DSM-III-R highest level of adaptive functioning in the past year = level 5 or
less.
C3. The Department of Health (1995) proposed the following criteria be
considered:
- Safety History of significant violence, self-harm or self-neglect or
at risk of exploitation due to mental illness.
- In/formal help Need for intensive support in the community either from
informal carers or from formal services such as more than
one contact with specialist services per week, involvement
of two or more agencies or subject to Section 117 of the
Mental Health Act, Supervised Discharge or a Restriction
Order.
- Diagnosis Presence of severe mental disorder including psychotic
illness, severe neurotic illness, personality disorder,
dementia, development disorder.
- Disability Significant impairment of functioning in role performance
in one or more of occupation, family responsibility or
accommodation; particularly where this has led to social
isolation and/or difficulties with the activities of daily
living. Indicators of this may include being in receipt of
Disability Living Allowance, being homeless or requiring
supported, sheltered accommodation.
- Duration Length of illness of greater than one year or likelihood of
illness persisting; three or more admissions, or aggregate
total of one year stay, in past five years.
C4. The Audit Commission (1994) defined three categories of people with mental
illness in contact with secondary care services:
- Psychotic diagnosis, organic illness or injury and previous compulsory
admission or aggregate one year stay in hospital in past five years or three
or more admissions in past five years.
- Psychotic diagnosis, organic illness or injury or any previous admissions in
past five years.
- No record of hospital admissions and no recorded psychotic diagnosis,
organic illness or injury.
Summary
C5. In summary, all definitions which have been developed from the service
provider perspective have included:
- certain diagnostic categories which would include ICD-10 categories FO,
F2, F30, F31, F32 and F33
- some measure of duration of illness either a specified time since onset of
illness or a specified period of hospitalisation
- some measure of intensity of contact with services usually specified as a
certain time in hospital or a certain number of admissions over a given
period.
C6. In addition, most definitions have included:
- statement about extent of disability as perceived by the user in terms of
impairment of functioning in role performance.
C7. One definition has included:
- statement about risk posed, to others or self
- applicability of statutory powers to compel the patient to receive treatment.
C9. In the absence of any widely accepted definition of severe mental illness, the
Working Group proposed the following which it is recognised only takes into
account the service provider perspective:
There must be a mental disorder as designated by a mental health professional
(psychiatrist, mental health nurse, clinical psychologist, occupational therapist
or mental health social worker) AND one or more of the following must apply:
- There must have been a score of 4 on at least one, or a score of 3 on at least
two, of the HoNOS items 1-10 (excluding item 5 “ physical illness or disability
problems”) during the previous six months.
- Any admission in the past year under a treatment Section of the Mental
Health Act.
- A total of six months in hospital, mental health residential care or day
hospital or three admissions to hospital or day hospital over the past five
years.
- Six months of continuous community care involving more than one worker
or the need for such care if unavailable or refused.
Perhaps someone has knowledge of more up to date definitions?
