Serious mental illness

Many people living with SMI experience institutional recidivism, which is the process of being admitted and readmitted into a hospital. This cycle is due in part to a lack of support being available for people living with SMI after being released from hospital, frequent encounters between them and the police, as well as miscommunication between clinicians and police officers. Patients with schizophrenia have the lowest risk of being hospitalized, likely due to frequent encounters with case managers to manage the chronic and persistent symptoms of schizophrenia. People with SMI seek medical services for a variety of non-mental health conditions, including diabetes, coronary artery disease, congestive heart failure, urinary conditions, pneumonia, chronic obstructive pulmonary disease, thyroid disease, digestive conditions and cancer. This may be due to psychosomatic factors, as well as poor lifestyle habits associated with reduced mental health such as smoking, poor diet, and lack of exercise. People with SMI typically take antipsychotic medications to manage their condition, however, second-generation antipsychotics can cause poor glycemic control for patients with diabetes, furthering complications in this population. Second-generation antipsychotics, also known as atypical antipsychotics are medications used to effectively treat the positive (e.g. hallucinations and delusions) and negative (e.g. flat affect and lack of motivation) symptoms of schizophrenia. This means that people with both SMI and diabetes are more frequently readmitted to hospitals one month after their initial hospitalization. Notably, patients with SMI have increasing reports of falls and substance abuse, including alcoholism. == Homelessness ==

Adults with SMI are 25 to 50 percent more likely to experience homelessness compared to the general population. One predictor of homelessness is poor therapeutic alliance with case managers. During that time, 15,153 people with SMI were in transitional housing, which is temporary housing when people are transitioning from emergency shelters to permanent housing. 48,783 people with SMI were living in emergency shelters. These difficulties can add additional stress, which may be why people with SMI experience a high rate of suicidal ideation and suicide attempts. When surveyed, 8% of people with SMI who were homeless reported that they had made a suicide attempt in the past 30 days. In addition, researchers found that SMI patients remained homeless for longer and had fewer housing stability when receiving mental health services in the absence of receiving housing. Combining housing first with Assertive Community Treatment leads to improved quality of life one year after initially starting housing first compared to just receiving outpatient mental health services. Additionally, housing first reduced number of days hospitalized and number of emergency room visits for people with SMI. == Stigma ==

People with SMI often experience stigma due to frequently stigmatizing representations of people with SMI in the media that portrays them as violent, criminals, and accountable for their condition because of weak character. People with SMI experience two kinds of stigma; public stigma and self-stigma. Public stigma refers to negative beliefs/perceptions that the public has about SMI; such as people with SMI should be feared, are irresponsible, that they should be responsible for their life decisions, and that they are childlike, needing constant care. Self-stigma can be reduced by increasing empowerment in individuals with SMI through counseling and/or peer support and other self-disclosing of their own struggles with mental illness. Consumer services, such as drop-in centers, peer support, mentoring services, and educational programs can increase empowerment in individuals with SMI. ==References==