Defining Serious Mental Illness


Troy Trygstad, PharmD, MBA, PhD, and Carla Cobb, PharmD, BCCPP, share the criteria for the classification as well as the prevalence of serious mental illness.

Troy Trygstad, PharmD, MBA, PhD: Hello, and thank you for joining this Pharmacy Times® Peer Exchange® panel discussion. One in 25 adults in the United States lives with serious mental illness that substantially interferes with, or limits, 1 or more major life activities. Among individuals with a serious mental illness, access to therapy and treatment and adherence to therapy can be very challenging. This Peer Exchange® will focus on the long-acting injectable medications to treat serious mental illness and how the pharmacist is perfectly positioned to administer these drugs to increase adherence and, most importantly, quality of life in these patients.

I’m Dr. Troy Trygstad, and I am the vice president of pharmacy programs and partners at Community Care of North Carolina in North Carolina. I’m also the editor-in-chief of Pharmacy Times®. Participating today on our distinguished panel are: Dr. Adrienne Cervone, owner of Beaver Health Mart Pharmacy in Beaver, Pennsylvania; Dr. Carla Cobb, founder and consultant at Capita Consulting in Billings, Montana; and Dr. Tripp Logan, vice president of L & S and Medical Arts pharmacies in Charleston, Missouri. He’s also a partner with MedHere Today in Nashville, Tennessee. Thank you all so much for joining us.

Carla, I want to start with you. As a pharmacist who has been in practice on nights and weekends in a community pharmacy for upwards of 15 or more years now, I can’t say that I am well versed in differentiating different types of mental disorders. Could you start us off with a broad description of the difference between any mental illness and serious mental illness, or SMI?

Carla Cobb, PharmD, BCPP: Yes. So, mental illnesses are very common, as you mentioned, in the general population. When we talk about serious mental illness, we’re focused on those that are very debilitating, that tend to affect ability to function and affect daily life. Those are the distinguishing features.

Troy Trygstad, PharmD, MBA, PhD: So, if I have any mental illness, then it tends to be less debilitating, functioning, etc, etc. But if I have a severe mental illness, I might not be able to go through life in a capacity like somebody without severe mental illness. So, it impacts my job, so on and so forth. How many different diagnoses would be considered under the umbrella of serious mental illness? Is it a pretty broad range of diagnoses?

Carla Cobb, PharmD, BCPP: Yes. So, typically, serious mental illness includes diagnoses of schizophrenia, severe bipolar disorder, and severe depression. Also in there may be schizoaffective disorder. And so, there are illnesses where some people are highly functioning, and are able to continue with their lives as normal. But people with severe mental illnesses tend to, as you mentioned, have significant impact to their daily life, to their ability to have relationships, their ability to hold a job, go to school, those kinds of things that many of us take for granted. And many people with mental illnesses are able to hold jobs and go to school and get married and have kids and live sort of normal lives. But people with serious mental illness tend not to be as able to do those things.

Troy Trygstad, PharmD, MBA, PhD: Sure. And what would be the prevalence? Is this something where I might run across somebody in the course of my life once every month or might I come across somebody and maybe not even know it, more than once a month?

Carla Cobb, PharmD, BCPP: So, these illnesses are very common, and many people don’t realize that. But in general, we think that, depending on where you look, 4% to 5% of the population suffers from one of these serious mental illnesses. So, these are people who you probably encounter ,and know on a daily basis perhaps, and not realize it.

Troy Trygstad, PharmD, MBA, PhD: Right. The 1-in-25 number. If I come across 500 people in the course of a month, it’s a pretty good bet that I’ve interacted with somebody with a serious mental illness. And perhaps one of the goals of all of us as healthcare providers is to go about life and not know that there’s a lot of folks with a serious mental illness. But they’re well treated, and we don’t know that they have it.

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