Problems With 'Serious Mental Illness' As A Policy Construct

Increasingly, mental health policies focus on "serious mental illness" (SMI). This trend is mostly unquestioned, but SMI policies have serious flaws that raise concerns about their effectiveness and desirability. One such flaw is the lack of consensus on how to define the population with SMI. This problem means that under various policies, groups identified as having SMI may be as much different as alike and may vary greatly in size. Another serious limitation is the lack of essential and accurate data on the SMI population. SMI policies are further complicated by unexamined conceptual issues-for example, why it is necessary to have policies in mental health services that discriminate on the basis of severity. Finally, the potential negative consequences of SMI policies, such as stigma effects, are rarely considered in their development. In this article I describe these problems and discuss the issues and challenges that they pose for effective mental health policies. I conclude that the desirability of many policies focused on serious mental illness are questionable, and I suggest types of questions that should be asked when such policies are considered.