Health Disparities

Amongst People with

Serious Mental Illness (SMI)
Devonne Husband, Sydney Reed, and Rachel Naftulin
Definition
Serious mental illness (SMI) commonly refers to a diagnosis
of psychotic disorders, bipolar disorder, and either major
depression with psychotic symptoms or treatment-resistant
depression; SMI can also include anxiety disorders, eating
disorders, and personality disorders, if the degree of
functional impairment is severe. SMIs are long-term illnesses
involving substantial functional impairment over multiple
symptom domains. These impairments often lead to an
inability to maintain gainful employment, poor social support,
repeated psychiatric hospitalizations, homelessness,
incarceration, and coexisting substance use disorders.
(Agency for Healthcare Research and Quality, 2016, p. 1).
Demographic Statistics
Size of populations: There was an estimated 9,765,000
adults aged 18 or older in the US with SMI in 2015 (4.0% of
adults in the US) (Substance Abuse and Mental Services
Administration [SAMHSA], 2016, Table 8.5 A).
Insurance coverage: 37 percent of working-age adults with
severe mental illness were uninsured for at least part of the
year (Rowan, McAlpine, & Blewett, 2013, p. 1)
Age: Among adults aged 18 years old and older in 2015 with
SMI, 35% were men and 65% were women (SAMHSA, 2016,
Table 8.5 A).
 Demographic Statistics Cont.
In 2015, those with SMI were
characterized by employment
status as follows:
Full time= 37.3%
Part Time= 15.0%
Unemployed= 7.0%
Other= 40.7%
(SAMHSA, 2016, Table 8.5 A).
In 2015, those with SMI were
characterized by Hispanic origin and
Race as follows:
Not Hispanic or Latino: 88.6%
White= 73%
AA= 8.5%
AI/AN= 0.8%
Native Hawaiian or Other Pacific
Islander= 0.01%
Asian= 2.3%
Two or More Races= 3.7%
Hispanic or Latino: 11.4%
(SAMHSA, 2016, Table 8.5 A).
Health Disparities
Cardiovascular death among those with serious mental illness
is 2 to 3 times that of the general population. (Morden, Mistler,
Weeks, & Bartels, 2009, p. 188)
Adults with SMI in the US die 25 years earlier than those in
the general population (Viron & Stern, 2010, p. 458).
Rates of diabetes and hypertension care for people with SMI
were 1549 percentage points lower than the national
averages for the general population in Medicaid plans (Liu,
Brown, Morton, Potter, Patton, Patel, Lewis, Scholle, 2017, p.
304).
Nursing Intervention
Targeted Training and Illness Management (TTIM)
An education program delivered by trained nurses and other trained
peer educators to patients with serious mental illness and diabetes to
improve self-management of both diseases (Lawless, Kanuch, Martin,
Kaiser, Blixen, Fuentes-Casiano, Dawson, 2016, p. 25).
The education program consists of:
12 weekly group based sessions
Monthly follow-up contact (in person or via telephone) for 48 weeks to help
support person care plans on those participating to achieve their specified self-
management goal
Peer educators were adults with SMI and diabetes who exhibited self-
management and worked with the nurse educator to provide relevant support.
Nursing Intervention Cont.
During the program, the nurses provide guidance and address patient-
specific factors regarding self-efficacy, outcome expectations, health
knowledge, social support, cognitive skills, stigma, and substance abuse
(Lawson et al., 2016, p. 25-26). The nurses are facilitators and help break
down barriers.

Classes were highly participatory and effectively bolstered the

confidence of participants through mutual support and success in
the group.

Interdisciplinary team collaborates with clients to empower them to

become actively engaged in their care and believe in their ability
maintain health (Health Belief Model).
Results of Intervention
The study is still undergoing analysis of the results; however, the
researchers conclude that the study shows promising results in
getting adults with SMI and diabetes involved in managing their
conditions and receiving the knowledge needed to care for their
concurring diseases.

This intervention can assist those with SMI to manage an important

health disparity found in this vulnerable population, diabetes
mellitus.

Using education in the nursing role can empower patients to take

control of their diseases and it can translate to a healthier self care
in all aspects of their lives.
 References
Agency for Healthcare Research and Quality. (2016). Disparities within serious
mental illness (Publication No. 16-EHC027-EF). Retrieved from
https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/mental-illness-
disparities_technical-brief.pdf

Lawless, M. E., Kanuch, S. W., Martin, S., Kaise, D., Blixen, C., Fuentes-
Casiano, E., Dawson, N. V. (2016). A nursing approach to self-management
education for individuals with mental illness and diabetes. Diabetes Spectrum,
29(1), 24-31. doi: 10.2337/diaspect.29.1.24

Liu, J., Brown, J., Morton, S., Potter., D. E. B., Patton, L., Patel, M., Lewis, R., &
Scholle, S. H. (2017). Disparities in diabetes and hypertension care for
individuals with serious mental illness. The American Journal of Managed Care,
23(5), 304-308.
Morden, N. M., Mistler, L. A., Weeks, W. B., & Bartels, S. J. (2009). Health
care for patients with serious mental illness: Family medicines role. Journal
of the American Board of Family Medicine, 22, 187-195. doi:
10.3122/jabfm.2009.02.080059

Rowan, K., McAlpine, D., & Blewett, L. (2013). Access and cost barriers to
mental health care by insurance status. Health Affairs (Millwood), 32(10),
1723-1730. doi : 10.1377/hlthaff.2013.0133.

Substance Abuse and Mental Health Services Administration, Center for

Behavioral Health Statistics and Quality. (2016). Results from the 2015
national survey on drug use and health: Detailed tables. Retrieved from
https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-
2015/NSDUH-DetTabs-2015/NSDUH-DetTabs-2015.pdf
Viron, M. J. & Stern, T. A. (2010). The impact of serious mental illness on
health and healthcare. Psychosomatics, 51(6), 458-465. doi:
10.1016/S0033-3182(10)70737-4