(Provided by the CCER - Western Washington University)

Long Term Mental Illness

Also called Serious Mental Illness (SMI), Severe and Persistent Mental Illness (SPMI), Chronic Mental Illness (CMI), etc.

Research has linked mental illness to changes in brain chemistry and structure. Brain nerves use electrical impulses and chemical agents (neurotransmitters) to transfer information. This transfer mechanism is faulty in people with mental illness, there are too many neurotransmitters, or they aren't reabsorbed quickly enough, or the nerves are too sensitive to the chemicals. This biochemical basis is the reason that medication is an important part of treatment for most people with mental illness.

The effect of the chemical problems varies depending on the area of the brain and the specific neurotransmitters involved. Some people have difficulty filtering, processing, and acting on information and are said to have a thought disorder or schizophrenia. Others have difficulty with extreme mood swings and are said to have a mood (affective) disorder such as depression or bipolar disorder. The effects of these illnesses are often cyclical, with periods of stability. Still other individuals have both thought and mood symptoms, and are labeled schizoaffective.

Thought and mood disorders are most probably caused by a combination of genetic predisposition and various stressors, much like diabetes or hypertension. Most develop in the late teens or early adulthood, impacting vocational/educational development.

Personality disorders are also considered long term mental illnesses, though the role of brain chemistry is not as clear and medical (drug) treatment is generally not effective.

Rehabilitation for people with long term mental illness involves both maximizing recovery through medical treatment, counseling, skill training, and support; and compensating for residual deficiencies. Many people with mental illness continue to experience symptoms for years or even decades, and those symptoms may be only partially controlled by medication. However, in many cases people can be successfully employed through job matching and accommodation strategies that maximize the individual's strengths and skills and work around residual symptoms.

Long term outcomes depend on pre illness factors (education, employment history, family background, work. habits, self confidence, etc.) as well as on the illness itself.