Global Burden of Mental Disorders: Quality of Care and Unmet Needs for Treatment of Chronic Mental Illness

1. Who Is Chronically Ill?

Individuals who, through no fault of their own or their families, suffer from one of several diseases affecting the brain, the most complex of human organs. The causes remain unknown, but are probably multiple. There is no cure, but we do have effective treatment. In addition to having a brain disease, people with chronic mental illness (serious mental illness) are (by definition) significantly functionally impaired by the illness for an indefinite period of time (diagnosis, disability, duration). At least 1% of the population are chronic mentally ill. The problems of victims and their families are compounded by stigma, one of the cruellest and most prevalent forms of bigotry that exists.

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  Symptoms of Chronic Mental Illness: Acute, “positive” symptoms (at least one of these usually present, at least during an exacerbation of illness):

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    Distorted perceptions; loss of contact with reality;

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      Delusions.

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      Hallucinations.

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    Disordered, disorganized and confused thinking.

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    Unstable and inappropriate emotions.

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    Bizarre behavior; impaired judgment.

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  Residual (“negative”) or deficit symptoms (several of these usually present most of the time):

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    Vulnerability to certain kinds of stress.

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    Extreme dependency (sometimes combined with hostility).

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    Difficulty with interpersonal relationships.

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    Deficient coping skills.

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    Poor transfer of learning; fear of new situations.

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    Restricted emotional response and lack of enjoyment.

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    Reduced speech and impaired abstract thinking.

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    Reduced ability to pay attention; slowness.

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    Apathy; lack of motivation; phobic avoidance of situations.

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    Sensitivity to over- (and under-) stimulation (Goldman, 1998).

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  “Normal” Reactions to Chronic Illness: These reactions are common in anyone who realizes they have a serious, chronic (incurable) illness, and may progress through stages (like the mourning process). Some of these characteristics are often present and can be mis-diagnosed as positive or negative symptoms.

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    General stress response (“fight, flight, fright”).

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    Grief; denial and impatience (lack of acceptance).

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    Anger and striking out.

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    Guilt and self-blame.

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    Depression; hopeless, helpless feelings; demoralization.

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    Regression to earlier levels of functioning.

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    Preoccupation with “self” (apparent disinterest in others).

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    Interruption of normal development (immaturity).

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  Social Breakdown Syndrome: This includes loss of normal role functioning and varying degrees of extrusion (or exclusion) from normal family/community functioning. Characteristics are similar to the negative symptoms of chronic mental illness and also resemble institutionalization syndrome. Social breakdown syndrome can be a side effect of any treatment that removes the client/patient from his/her usual social environment (or excuses him from usual role expectations) (e.g., prolonged hospitalization or too much “overprotection” on the part of clinical staff and/or family members) (Goldman, 1998).