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Q&AZ: What Is Serious Mental Illness?

Published: Tuesday, October 29, 2019 - 6:05am
Updated: Wednesday, June 10, 2020 - 11:40am
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Q&AZ is supported in part by Sierra Nevada Brewing Company

The term "mental illness" covers a wide range of health conditions affecting mood, thinking and behavior. A listener wanted to know: What is "serious mental illness?" How does such a label affect the patient? And who decides?

Serious mental illness (SMI) is not a diagnosis; it is a designation that qualifies a person for extra support services, often because the illness affects their ability to function.

Such services might include supported housing and employment, peer and family support, or an Assertive Community Treatment team that helps with daily living.

"The state has set up this designation system so that they can prioritize, let's face it, financial resources, so that the folks that really need those kinds of community supports get them," said Will Humble, executive director of the nonprofit Arizona Public Health Association.

Humble was director of the Arizona Department of Health Services when it oversaw the state's Medicaid program for people with mental illnesses.

To qualify for an SMI determination, a person's functional impairment must be caused by a qualifying mental illness. Examples include anxiety, bipolar disorders, depression, dissociative disorder, obsessive-compulsive disorder, post-traumatic stress disorder, personality disorder and psychotic disorders.

Designees generally have difficulty caring for themselves, maintaining relationships, or keeping up with work or school. They might also have a history of engaging in risky behavior, including disruptive conduct, substance use, or thoughts of harming themselves or others.

An application for an SMI determination can come from an individual, a provider, a family member or a Medicaid managed care organization.

The nonprofit Crisis Response Network then issues a decision based on state-specified criteria.

Members of Native American communities also have the option of applying through their own resources.

Humble recommends that people who need more information regarding serious mental illness contact a heath care provider or a local chapter of the national Alliance on mental Illness (NAMI). NAMI maintains a list of Arizona contacts on its website,

Arizona defines the rights of people with serious mental illness in Arizona Revised Statutes ยง 36-504 through 36-514, and in the Arizona Administrative Code, Title 9, Chapter 21, Section 201 through 211.

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