The Chronic Mentally Ill

Who are the chronic mentally ill; individuals who suffer from one of several diseases affecting the brain, the most essential part of human beings. The causes are still unknown, but are probably multiple. There is no cure, but, effective treatment does exist. People with serious mental illness are significantly functionally impaired by the illness for an indefinite period of time. At least 1% of the population has a serious mental illness. The problems of these persons and their families are compounded by centuries old stigma, the prejudice still persists.

Symptoms of chronic/serious mental illness:

Acute symptoms: Distorted perceptions; loss of contact with reality; delusions; hallucinations; disordered; disorganized and confused thinking; unstable and inappropriate emotions. ; Bizarre behavior; impaired judgment.

Residual or deficit symptoms, several of these usually present most of the time: vulnerability to certain kinds of stress; extreme dependency sometimes combined with hostility; difficulty with interpersonal relationships; deficient coping skills; poor transfer of learning; fear of new situations; restricted emotional response and lack of enjoyment; reduced speech and impaired abstract thinking; reduced ability to pay attention; slowness; apathy; lack of motivation; phobic avoidance of situations; sensitivity to stimulation.

 Common for anybody who learns that they have a serious, chronic, incurable illness:

General stress response with fear; grief; denial and impatience; anger; guilt and self-blame; depression; hopeless, helplessness; regression to earlier levels of functioning; preoccupation with self; immaturity.

This includes loss of normal role functioning and normal family, community functioning. Social breakdown syndrome can be a side effect of any treatment that removes the person from their usual social environment.

Coping and adaptation what is hoped for and is a possible outcome of treatment, rehabilitation, family support and self-help. Acceptance and hope; interest in the illness and its treatment active cooperation with treatment and rehabilitation; lifestyle modifications is what is attempted to achieve.

In general, patients need:

Indivilualiged treatment; Continuity of relationships with staff with a smooth transition between, and coordination among, programs and treatment components.

.Patient education and full understanding about the illness and its treatment; leading to informed consent; responsible patient role; safe and comfortable care and surroundings with adequate privacy and desired amount of contact with others; plans for crises; support and education of family and significant others.

 Compliance with care with appropriate medication by a psychiatrist and treatment team who understand the illness and its treatment; careful monitoring of beneficial effects and side effects. Elimination of unnecessary drugs; alcohol, caffeine, marijuana, etc.; symptom monitoring by patient and others.  Adequate rest and regular, planned, exercise; a balanced, nutritional diet.

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A therapeutic teamwork with a person which involves support; varying degree of support depending on need, respect, reality orientation is the goal of therapy.

Being actively, comfortably and purposeful busy; a relaxed atmosphere; a regular daily routine; including evenings, weekends and holidays; behavioral approach using natural consequences. Minimization of the handicap. If alcohol/drug use is a problem, attention to dependencies should be integrated with other treatment; psychosocial and occupational rehabilitation. Communication and problem solving skills for patient and significant others; construction of supportive social network; prevent or reverse social breakdown syndrome;  help with daily living; money management, transportation, housing, etc.

All of these issues need to be addressed in order for the person to live a more fulfilling, rewarding life.  Chronic sever mental illness can be managed with as little stress and debilitating effects as possible.  With the cooperation of the person, doctor and treatment team long term hospitalization can be avoided.