Poster #87 - Analyzing Serious Mental Illness determinations across the United States (AnSerMI)

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Abstract

Background: Serious Mental Illness (SMI) is a psychiatric condition impacting 11 million U.S. adults that significantly impairs an individual’s ability to perform major life activities, characterized by intense, long-lasting symptoms and substantial functional impairment. SMI determination comprises of three criteria – diagnosis, duration, and severity of functional impairment. The landscape of SMI determinations is highly fragmented, lacks a single, universally accepted operational definition in research, practice, and policy. This fragmentation makes it challenging to compare studies or states, allocate resources, or provide consistent care.
Methods: We analyzed SMI determinations across 50 states collected from publicly available sources and coded for analyses. Diagnostic criteria were coded using DSM-V criteria, severity and duration were coded based on states’ thresholds. A comparative analysis was conducted to find patterns across state policies.
Results: Of 50 states, 3 states had missing data. Schizophrenia & psychotic disorders (DSM-V Category 1) were primary diagnostic criteria for SMI across 37 (78.7%) states. The second common diagnostic category comprised bipolar & related disorders (Category 2) occurring in (31)66% states. Depressive disorders (Category 3) were the third most common class of disorders and appeared in 27 (57.4%) states' diagnostic criteria. There were 21 (44.6%) states, including all three categories. Severity of functional impairment was coded and classified into three thresholds – highly severe, moderately severe, and mildly severe. Data was available for 33(70%) states of which 10(30%) used highly severe, 11(33%) used moderately severe, and 12(36%) used mildly severe thresholds. For duration, data was available for 21 states of which 7(33%) states specified a criteria of 12 months, 6(28%) specified 2 years, 2(10%) specified 3 years, 1(5%) specified 6 months, and 2(10%) states did not specify any duration requirements.
Discussion: States employ varying and subjective criteria for measuring functional impairment, creating challenges in cross-state comparisons and resource allocation decisions. States with highly severe thresholds require intensive treatment infrastructure, those with milder severity thresholds need preventive and community-based services whereas moderate severity states need balanced acute and community care systems. The data reveal a complex landscape where regional healthcare philosophy, resource availability, and demographic factors influence how SMI is defined across the US. 
Conclusions: SMI determination factors may not be strictly regional but could be influenced by state-specific conditions or policies. Our comprehensive analysis of state-level definitions revealed both consensus and notable variations across three core parameters: severity thresholds, diagnostic criteria, and duration. These findings illuminate the current landscape of SMI definitions and highlight areas where standardization may improve care coordination and access.

Author

• Meghana S. Ray, Heed Lab, LLC
  Presenting Author