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Serious Mental Illness (SMI)


Serious Mental Illness (SMI)

counselor talking with servicememberSerious Mental Illness or SMI is defined by the National Institute of Mental Health as a mental, behavioral or emotional disorder that results in serious functional impairment which substantially interferes with or limits one or more major life activities.  The majority of individuals meeting this criteria suffer from a psychotic/schizophrenia-spectrum disorder, a severe bipolar disorder, or a severe major depression (major depression with psychotic features or treatment resistant depression).  The presence of a SMI diagnosis impacts not only day-to-day functioning but it also increases the likelihood of several medical and social co-morbidities, elevates the risk of suicide, and shortens life expectancy.

Effects of Care Models to Improve General Medical Outcomes for Individuals With Serious Mental Illness

Effects of Care Models to Improve General Medical Outcomes for Individuals With Serious Mental Illness

Primary Care Engagement among Veterans with Experiences of Homelessness and Serious Mental Illness: An Evidence Map (May 2021)

Feasibility and Acceptability of the HOME Program for Veterans Recently Discharged from a Psychiatric Hospitalization. Matarazzo BB, Gerard GR, Jankovsky MC, Oslin DW, Brenner LA. Adm Policy Ment Health. 2021 Feb 1. doi: 10.1007/s10488-021-01109-7

Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey. Gabrielian S, Jones AL, Hoge AE, deRussy AJ, Kim YI, Montgomery AE, Blosnich JR, Gordon AJ, Gelberg L, Austin EL, Pollio D, Holmes SK, Varley AL, Kertesz SG. J Prim Care Community Health. 2021 Jan-Dec;12:2150132721993654. doi: 10.1177/2150132721993654

Do cognition and other person-level characteristics determine housing outcomes among homeless-experienced adults with serious mental illness? Gabrielian S, Hellemann G, Koosis ER, Green MF, Young AS. Psychiatr Rehabil J. 2020 Oct 12. doi: 10.1037/prj0000457

Psychiatric Multimorbidity in a Specialized Program for Severely Mentally Ill Veterans. Bhalla IP, Deegan D, Stefanovics EA, Rosenheck RA. Psychiatr Q. 2020 Aug 18. doi: 10.1007/s11126-020-09826-2

Prevalence and clinical correlates of intimate partner violence (IPV) in women with severe mental illness (SMI).
Nair S, A Satyanarayana V, Desai G. Asian J Psychiatr. 2020 Apr 28;52:102131. doi: 10.1016/j.ajp.2020.102131. [Epub ahead of print]

Suicidal ideation, behavior, and mortality in male and female US veterans with severe mental illness. Aslan M, Radhakrishnan K, Rajeevan N, Sueiro M, Goulet JL, Li Y, Depp C, Concato J, Harvey PD. J Affect Disord. 2020 Apr 15;267:144-152. doi: 10.1016/j.jad.2020.02.022. Epub 2020 Feb 7.

Influence of hardiness, avoidance coping, and combat exposure on depression in returning war veterans: A moderated-mediation study. Bartone PT, Homish GG. J Affect Disord. 2020 Mar 15;265:511-518. doi: 10.1016/j.jad.2020.01.127. Epub 2020 Jan 23.

High Quality of Care Persists with Shifting Depression Services From VA Specialty to Integrated Primary Care. Leung LB, Escarce JJ, Yoon J, Sugar CA, Wells KB, Young AS, Rubenstein LV.Med Care. 2019 Aug;57(8):654-658. doi: 10.1097/MLR.0000000000001141.

Effectiveness of Implementing a Collaborative Chronic Care Model for Clinician Teams on Patient Outcomes and Health Status in Mental Health (March 2019)

Motivational and cognitive correlates of community integration in homeless veterans entering a permanent supported housing program.Horan WP, Wynn JK, Gabrielian S, Glynn SM, Hellemann GS, Kern RS, Lee J, Marder SR, Sugar CA, Green MF.Am J Orthopsychiatry. 2019 Apr 25. doi: 10.1037/ort0000420. [Epub ahead of print]

Problem solving skills and deficits among homeless veterans with serious mental illness. Gabrielian S, Bromley E, Hamilton AB, Vu VT, Alexandrino A, Koosis E, Young AS. Am J Orthopsychiatry. 2019;89(2):287-295. doi: 10.1037/ort0000340. Epub 2018 Jul 16.

The effect of Housing First on adherence to methadone maintenance treatment. Parpouchi M, Moniruzzaman A, Rezansoff SN, Russolillo A, Somers JM. Int J Drug Policy. 2018 Jun;56:73-80. doi: 10.1016/j.drugpo.2018.03.012. Epub 2018 Mar 31.

One-year incidence and predictors of homelessness among 300,000 U.S. Veterans seen in specialty mental health care. Tsai J, Hoff RA, Harpaz-Rotem I. Psychol Serv. 2017 May;14(2):203-207. doi: 10.1037/ser0000083.

High inpatient utilization among Veterans Health Administration patients with substance-use disorders and co-occurring mental health conditions.Painter JM, Malte CA, Rubinsky AD, Campellone TR, Gilmore AK, Baer JS, Hawkins EJ. Am J Drug Alcohol Abuse. 2018;44(3):386-394. doi: 10.1080/00952990.2017.1381701. Epub 2017 Nov 2.

Internalized stigma of mental illness and depressive and psychotic symptoms in homeless veterans over 6 months. Boyd JE, Hayward H, Bassett ED, Hoff R. Psychiatry Res. 2016 Jun 30;240:253-259. doi:10.1016/j.psychres.2016.04.035. Epub 2016 Apr 29.

Psychopharmacologic Services for Homeless Veterans: Comparing Psychotropic Prescription Fills Among Homeless and Non-Homeless Veterans with Serious Mental Illness.Hermes E, Rosenheck R. Community Ment Health J. 2016 Feb;52(2):142-7. doi: 10.1007/s10597-015-9904-2. Epub 2015 Jul 23.

Factors affecting exits from homelessness among persons with serious mental illness and substance use disorders.Gabrielian S, Bromley E, Hellemann GS, Kern RS, Goldenson NI, Danley ME, Young AS.J Clin Psychiatry. 2015 Apr;76(4):e469-76. doi: 10.4088/JCP.14m09229.

Disparities in housing status among veterans with general medical, cognitive, and behavioral health conditions. Montgomery AE, Dichter ME, Thomasson AM, Roberts CB, Byrne T. Psychiatr Serv. 2015 Mar 1;66(3):317-20. doi: 10.1176/ Epub 2014 Dec 1.

Housing instability and mental distress among US veterans. Bossarte RM, Blosnich JR, Piegari RI, Hill LL, Kane V. Am J Public Health. 2013 Dec;103 Suppl 2:S213-6. doi: 10.2105/AJPH.2013.301277. Epub 2013 Oct 22.

Montgomery, A. E., Metraux, S., Culhane, D. P. (2013). Rethinking Homelessness Prevention among Persons with Serious Mental Illness. Social Issues and Policy Review, 7(1): 58-82. (doi: 10.1111/j.1751-2409.2012.01043.x)

O'Connor, K., Kline, A., Sawh, L., Rodrigues, S. Fisher, W., Kane, V., Kuhn, J., Ellison, M., Smelson, D. (2013). Unemployment and Co-Occurring Disorders among Homeless Veterans. Journal of Dual Diagnosis, 9(2): 134-138. (doi: 10.1080/15504263.2013.778804)

Rodrigues, S., Serper, M., Novak, S., Corrigan, P., Hobart, M., Ziedonis, D., Smelson, D. (2013). Self-Stigma, Self-Esteem, and Co-Occurring Disorders. Journal of Dual Diagnosis, 9(2): 129-133. (doi: 10.1080/15504263.2013.777988)

A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Smelson DA, Kline A, Kuhn J, Rodrigues S, O'Connor K, Fisher W, Sawh L, Kane V. Psychol Serv. 2013 May;10(2):161-7. doi: 10.1037/a0030948. Epub 2012 Dec 17.

Reinstitutionalization following psychiatric discharge among VA patients with serious mental illness: a national longitudinal study. Irmiter C, McCarthy JF, Barry KL, Soliman S, Blow FC. Psychiatr Q. 2007 Dec;78(4):279-86.

Veterans Affairs Health System and mental health treatment retention among patients with serious mental illness: evaluating accessibility and availability barriers. McCarthy JF, Blow FC, Valenstein M, Fischer EP, Owen RR, Barry KL, Hudson TJ, Ignacio RV.
Health Serv Res. 2007 Jun;42(3 Pt 1):1042-60.

Effects of Disaster on People with Severe Mental Illness (date unknown)

Military Service and Military Health Care Coverage are Associated with Reduced Racial Disparities in Time to Mental Health Treatment Initiation. Goldberg SB, Fortney JC, Chen JA, Young BA, Lehavot K, Simpson TL. Adm Policy Ment Health. 2020 Jan 27. doi: 10.1007/s10488-020-01017-2. [Epub ahead of print]

Problem solving skills and deficits among homeless veterans with serious mental illness. Gabrielian S, Bromley E, Hamilton AB, Vu VT, Alexandrino A, Koosis E, Young AS. Am J Orthopsychiatry. 2019;89(2):287-295. doi: 10.1037/ort0000340. Epub 2018 Jul 16.

Evidence-Based Psychtherapies for Depression, PTSD, and Other Mental Health Conditions

Evidence-Based Psychtherapies for Depression, PTSD, and Other Mental Health Conditions

Motivational Interviewing

Motivational Interviewing

National Guidelines for Behavioral Health Crisis Care: A Best Practice Toolkit – SAMHSA 2020

Image of SAMSHA's BestPracticeToolkit

2018: Services for Seriously Mentally Ill Veterans, Including Homeless Veterans: Public Law 115 - 251 - Department of Veterans Affairs Expiring Authorities Act of 2018

1987: HCMI-HCHV: Established by the Community-based psychiatric residential treatment for chronically mentally ill Veterans, PL 100-6

The Center is not responsible for the content or privacy policies of these Web sites and linking to these sites does not constitute endorsement by the Center of the sites' sponsors or the information, products, or services they provide.

Serious Mental Illness Advisor Website (SAMSHA): (SAMHSA): SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

Guidance for Individuals, Families, and Communities (SAMSHA)
National Alliance on Mental Health (NAMI): NAMI is the foundation for hundreds of NAMI State Organizations, NAMI Affiliates and volunteer leaders who work in local communities to raise awareness and provide essential and free education, advocacy and support group programs. provides one-stop access to U.S. government mental health and mental health problems information. aims to educate and guide:

  • The general public
  • Health and emergency preparedness professionals
  • Policy makers
  • Government and business leaders
  • School systems
  • Local communities

National Institute of Mental Health: The National Institute of Mental Health (NIMH) is the lead federal agency for research on mental disorders. NIMH is one of the 27 Institutes and Centers that make up the National Institutes of Health (NIH), the largest biomedical research agency in the world. NIH is part of the U.S. Department of Health and Human Services (HHS).

Mental Health First Aid is a course that teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.

Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: SAMHSA's National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.


Michal Wilson, MD

External Link Disclaimer: This page contains links that will take you outside of the Department of Veterans Affairs website. VA does not endorse and is not responsible for the content of the linked websites.

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