Living with Serious Mental Illness as an Adult
Living with serious mental illness (SMI) as an adult can present overwhelming challenges that affect nearly every aspect of daily life. In 2021 alone, over 14 million U.S. adults were living with some form of serious mental illness.
These illnesses, though prevalent, are often misunderstood, resulting in social stigma, misinformation, and limited access to care. Yet, despite these roadblocks, individuals with SMI can achieve recovery and lead fulfilling lives with proper treatment, support, and community understanding.
What is Considered a Serious Mental Illness?
Serious Mental Illness (SMI) is a smaller subset of mental illnesses that results in serious functional impairment. The most common Illnesses that are considered SMIs include major depressive disorder (MDD), schizophrenia, bipolar disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress (PTSD), and borderline personality disorder.
- Major Depressive Disorder (MDD) is a condition that causes a consistently low mood, disinterest in activities that used to be enjoyed, suicidal thoughts, and an all-consuming sense of apathy toward the world. People with MDD may not mentally be able to get out of bed, may lose sleep and appetite, and could attempt suicide.
- Schizophrenia is a condition that could result in hallucinations, delusions, and disordered thinking and behavior. People with schizophrenia can seemingly lose touch with reality, hear and see things that are not there and believe strongly in things that are not true. Because of these symptoms, many people with schizophrenia do not recognize that they need treatment.
- Bipolar Disorder There are three types of bipolar disorder, but all types involve unusual shifts in mood, energy, activity levels, and concentration. Bipolar I is recognized by severe manic episodes that last seven days or more or require hospital intervention. Usually, these also involve depressive episodes. Bipolar II has a pattern of depressive episodes and less severe manic episodes known as hypomanic episodes. Cyclothymic disorder, the third type of bipolar disorder, involves recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as manic or depressive episodes.
- Obsessive-Compulsive Disorder People with OCD experience all-consuming recurring thoughts and/or engage in repetitive behaviors. These obsessions and compulsions can be time-consuming and cause substantial distress, significantly interfering with daily life.
- Panic Disorder People with panic disorder experience repeated sudden and unexpected panic attacks. Panic attacks can involve shortness of breath, a racing heart, sweating, shaking, and overwhelming anxiety. People with this disorder often rearrange their lives to avoid any situation that may bring on an attack.
- Post Traumatic Stress Disorder is a condition triggered by a horrific or terrifying event. Symptoms of this disorder can include flashbacks, anxiety, avoidance of things related to the event, and uncontrollable, intrusive thoughts about the event.
- Borderline Personality Disorder impacts how individuals perceive themselves and others, making it challenging to build and maintain healthy relationships. Those with this disorder frequently experience intense, unstable relationships and harbor deep fears of abandonment. The overwhelming emotions associated with BPD often lead to impulsive actions that disrupt daily life.
Misconceptions About Living With Serious Mental Illness
From negative portrayals in the media to the social stigmatization of certain mental disorders, there are many misconceptions and false assumptions about people with SMI. These harmful beliefs lead to discrimination, causing individuals with SMI to feel marginalized and isolated in their struggle.
Treatability
One very common misconception is that people with SMI are untreatable and cannot live fulfilling lives. In actuality, there are many treatments, medications, and therapies available to treat SMI. Building and maintaining a full life requires plenty of work over a prolonged period of time, but it is possible. Studies show that up to 65% of people diagnosed with SMI achieve partial or full recovery over time.
Employment
Many believe that people with SMI cannot get hired or hold down a job. While rates of employment understandably decrease with the severity of mental illness, many individuals with SMI are just as productive as other employees. A U.S. study found that 54.5% of individuals with SMI were employed, compared with 75.9% of people without a mental illness and 68.8% of people with mild mental illness.
Violence
One of the most negative assumptions about people with SMI is that they are violent and prone to criminal activity. In reality, only 3%–5% of violent acts are committed by individuals with serious mental illness. In fact, those with severe mental illness are over ten times more likely to be victims of violent crime than the general population.
While people with SMI generally do not present a heightened risk of violence, certain disorders like schizophrenia and bipolar disorder have moderately higher rates of violence compared to the general population. The risk increases significantly in individuals with “triple morbidity,” such as those who have a severe mental disorder, a substance use disorder, and an antisocial personality disorder. However, it is both unethical and alienating to apply blanket assumptions of violence to all individuals with SMI.
Treatment for Serious Mental Illness
Since each person’s experience with SMI can vary significantly, it is important that SMI treatment is personalized and tailored to each individual’s unique needs. These treatments for SMI usually include a combination of medication, therapy/counseling, and supportive interventions.
Psychotherapy
Psychotherapy involves talking to a professional to help work through the challenges of SMI and manage its symptoms. This can involve a one-on-one setting or group therapy. Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that focuses on reframing negative thoughts to improve behaviors. CBT has been proven to be extremely effective for those with depression, anxiety, panic disorder, OCD, and PTSD.
CBT is not always effective for all types of SMI and can sometimes have a more negative effect on people with personality disorders. Dialectical Behavior Therapy (DBT) is a form of CBT designed to help people with extreme emotional reactions navigate their environment, particularly those who have borderline personality disorder. Instead of talking through problems, DBT focuses on changing behavior patterns. The goal of DBT is to help patients feel safe, accept themselves, and find ways to regulate their emotions.
Medication
Medication plays an important role in the treatment of serious mental illness. These medications influence the brain chemicals that regulate emotion and thought. Medication is most effective when used in combination with psychotherapy, and, in many cases, medication is needed to ease symptoms so that therapy can be more effective.
There are many different types of medication to help manage SMI, including antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers, each targeting different symptoms a person with SMI may experience. These medications are typically administered through a pill. However, some can come in the form of a patch, liquid, injection, or dissolvable tablet.
The goal when using medication is to manage symptoms at the lowest possible dose for the least amount of side effects. Some common side effects of antidepressants can include upset stomach, sexual dysfunction, and headache. Antipsychotics can have side effects of low energy, tremors, and weight gain.
Brain Stimulation Therapy
Brain stimulation therapy, also known as interventional psychiatry, is a form of treatment that is usually employed if a patient is not showing improvement with medication or psychotherapy. Transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), deep brain stimulation (DBS), and transcranial direct current stimulation (TDCS) all target brain circuit imbalances in patients using electricity to activate or inhibit parts of the brain. The electricity can be given directly through electrodes in the brain or indirectly through electrodes placed on the scalp. In most cases, the patient will be sedated with anesthesia before treatment.
CSC Programs
First-episode psychosis coordinated specialty care (CSC) programs are designed for people with schizophrenia in the early stages of their disease. These programs are evidence-based treatments that have been proven to reduce symptoms and improve the quality of life for people with SMI.
CSC programs focus on developing a highly personalized care plan for each patient, working towards recovery, school and work participation, family and relationships, and prescribing the appropriate medications to help them get back on track. In 2015, STEP clinical trials revealed that individuals receiving CSC services had fewer psychiatric hospitalizations and were more likely to be employed or in school than those in standard care for early schizophrenia.
Inpatient Hospital Treatment
Voluntary hospitalization allows patients with SMI to seek inpatient treatment on their own when their symptoms worsen beyond what can be managed with outpatient care. However, the hospital may decline admission if inpatient care is deemed medically unnecessary or if no appropriate beds are available. If a voluntarily admitted patient is considered a risk to themselves or others, or if it is determined they may leave before they are safely stabilized, they may be involuntarily admitted, even after initially seeking care voluntarily.
Involuntary treatment is a last resort, necessary only for some individuals with SMI when other options have been exhausted. To prevent people with SMI from deteriorating to the point of involuntary hospitalization, it is crucial that evidence-based treatment is available to them at every stage of their illness.
Continued Care
Once symptoms improve, continuing to take medicine and engaging in ongoing psychological and psychosocial treatments is critical. Individual therapy can help improve thought patterns, teach stress management, and identify early signs of relapse. Social skills training enhances communication and participation in daily activities, while family therapy supports loved ones in coping with the illness. Vocational rehabilitation and supported employment also play a key role in helping individuals with SMI prepare for, secure, and maintain jobs.
Access to Healthcare for SMI
Access to mental healthcare is crucial for people with SMI to receive the treatment they need for continued recovery. Unfortunately, more than half the adults in the U.S. with mental illness do not receive the treatment they need.
Education
The general lack of education and awareness about SMI can be a barrier to accessing care simply because people experiencing symptoms may not know that help exists for them. While physical injury or illness has clearly identifiable signs, symptoms of mental illness can remain hidden from others who don’t know what to look for. Some symptoms may even be dismissed as “worrying too much” or an “attitude problem.”
Stigma against SMI also discourages individuals from seeking help. Many avoid disclosing their struggles out of fear of being labeled with negative assumptions or misconceptions. Educating the public and combating this stigma can make people more comfortable in seeking the help they need.
Shortages
There is a severe shortage of mental health care professionals in the United States. Nearly 4 in 10 Americans live in areas lacking psychologists, counselors, and social workers, with 6 in 10 psychologists reporting no availability for new patients. This issue is especially pronounced in rural areas, where mental health professionals are scarce, let alone those with specialized expertise. In more populated regions, long waitlists are common, leaving patients to endure their symptoms while they wait for an opening.
The United States is also facing a shortage of available psychiatric beds for inpatient care. The number of psychiatric beds across private and public sectors has dropped significantly in the past 60 years. In too many cases, a psychiatric bed is not available when needed, and patients end up in emergency departments or discharged prematurely. When patients are discharged before their symptoms have fully stabilized, they could go on to harm themselves or others or engage in disruptive behavior that leads to arrest.
Finances
For many people with SMI, a lack of financial resources keeps them from accessing the care that they need. Luckily, The Affordable Care Act requires most individual and small employer health insurance plans to cover mental health as if it were any other physical illness.
However, even with insurance, the cost of care can be daunting. Many SMI patients require long-term and even life-long care, including medication, therapy, and treatment programs that can cause costly copays and deductibles to add up. For example, A patient with major depression can spend an average of $10,836 a year on treatment.
Medicaid is the largest payer for mental health services in the United States. Medicaid is a government program that provides healthcare coverage for those who qualify as low-income. Coverage from Medicaid includes inpatient treatment, psychiatric rehabilitation, assertive community treatment, and peer support services.
Homelessness
It is estimated that as many as one in three single adults experiencing homelessness have a serious mental illness. The exact number of people with SMI experiencing homelessness is hard to know, but in 2022, it was estimated at over 120,0000 individuals in the U.S.
With shortages of psychiatric beds and mental health professionals, people may not have access to the healthcare they need and are left untreated or undertreated. Without treatment, mental conditions can deteriorate, resulting in job loss, financial strain, and homelessness.
The link between mental illness and homelessness 39% of the time can be explained by financial strain. Currently, the United States is estimated to be about 7 million units short of affordable housing.
Living a Fulfilling Life With Serious Mental Illness
With the right treatment, care, and support, individuals with SMI can lead fulfilling lives, fostering healthy relationships, building careers, and finding their place within the community. Recovery doesn’t necessarily mean a complete cure; rather, it signifies reaching a state where a safe, dignified, and meaningful life is attainable.
Unfortunately, significant barriers to healthcare access still persist, preventing many from receiving the proven treatments that could help them thrive. Expanding accessibility to these treatments is crucial to ensuring that more people with SMI can achieve their full potential.