Severe and Persistent Mental Illness

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Severe and Persistent Mental Illness

Mental disorders are the leading cause of disability in the U.S. and Canada for people ages 15 to 44, according to the National Institute of Mental Health. Fortunately, only about six percent - or 1 in 17 - suffer from a severe and persistent mental illness.


Severe and persistent mental illness, or SPMI, is the term mental health professionals use to describe mental illnesses with complex symptoms that require ongoing treatment and management, most often varying types and dosages of medication and therapy.

A Cyclical Illness

Severe mental illness typically does not level off and remain at a steady state. Rather, symptoms come and go in relation to stress. As a result, people with SPMI may be able to function independently for periods of time but may need intensive support with housing, school, work, social functioning, and other everyday life concerns when they experience a stressful event.

A Misunderstood Illness

There are many misconceptions about severe mental illness. For example, many people think schizophrenia means "split personality" or they believe psychotic refers to someone who is very angry. Others think that these disorders are identical to mood disorders.

In reality, every severe and persistent mental illness is a biological phenomenon caused by physical changes in the brain, causing marked changes in a person's ability to make choices based on consequences, to socialize, to access community supports, to identify what is real, and to organize thoughts.

Common SPMI Illnesses

  • Schizophrenia
  • Schizoaffective disorder
  • Delusional disorder, psychosis not-otherwise-specified, and other psychotic disorders
  • Bipolar disorder, also known as manic-depression
  • Severe depression that resists treatment and impacts ability to function
  • Personality disorders that are severe enough to prevent functioning