On this page, we explain a little more about a few of the forms of SMI. These are complex conditions and the below will not represent the experiences of everyone.
This article discusses SMI, including symptoms, diagnosis and impacts, which some readers may find distressing. Contact details for organisations which can offer support can be found at the bottom of this page.
What is SMI?
SMI refers to psychotic conditions which severely impair a person’s ability to carry out daily tasks, such as self-care, and impact employment and/or relationships. Psychosis is a term used to describe when a person interprets or perceives reality in a different way to those around them.
There is no single cause of SMI. Research suggests a combination of factors increase risk of developing these conditions, including genetics, differences in brain chemistry, stressful life experiences and environmental conditions. We need more research to continue to better understand the complex causes, including genetic, biological, and environmental factors.
We also need more research to find new treatments for these conditions. Current medications for these conditions often have significant side effects, and treatment resistance. Research is also needed to improve diagnosis as some people may be misdiagnosed.
We hope research at the MHP could lead to more effective and personalised therapies with fewer side effects, ultimately improving the quality of life for those affected.
We all have highs and lows, but for a small minority of people, their highs are much higher, and their lows are much lower than average. People with bipolar experience periods of extreme elation, sometimes called manic or hypomanic episodes, and periods of intense sadness and hopelessness, usually called depressive episodes.
These episodes vary widely in their severity and frequency and can often be overwhelming and distressing for both the person affected and their loved ones. Many people with the right support can manage their bipolar.
Bipolar disorder is, however, more complex than experiencing ‘highs’ and ‘lows’. People may experience changes in their thinking skills (cognition) and behaviour and these symptoms may persist between each episode.
1-2% of the population will be diagnosed with bipolar disorder, many as young adults. Some treatments are available to manage the condition, including medications such as lithium or other mood stabilisers. Talking therapies such as Cognitive Behaviour Therapy (CBT) are also helpful for many people.
Major Depression is characterised by persistent low mood, a loss of interest in activities, fatigue, trouble concentrating, changes in sleep or appetite, and feelings of worthlessness.
People with major depression often have no hope for their future and may experience challenges which make it harder to manage daily life, like work, school, or relationships. Major depression is frequently associated with anxiety, and it increases the risk of developing other health issues, such as chronic pain, including Fibromyalgia. It also increases the risk of suicide and of physical illnesses such as cardiovascular disease.
Around 15-20% of adults experience major depression at least once in their lifetime. Treatment for major depression may include talking therapies, such as cognitive-behavioural therapy (CBT) or interpersonal therapy, and medications such as antidepressants.
New research for major depression is emerging, such as work showing the efficacy of ketamine. This could lead to earlier diagnosis, personalised therapies, and improved prevention of severe outcomes like chronic disability and suicide.
Schizophrenia typically involves distortions in thinking (delusions), and perception (hallucinations). Delusions take the form of false persistent beliefs and hallucination often take the form of hearing voices when there is nobody around to explain them. Schizophrenia can affect language, communication, and cause difficulties in memory and attention. People may also experience reduced emotional expression, reduced motivation and social withdrawal. These symptoms are known as the negative symptoms of schizophrenia and can be very challenging to treat. The most effective medications in these cases often have severe physical side effects, reducing quality of life.
Schizophrenia affects 1 in 100 people in the UK in their lifetime, yet the condition is widely misunderstood and stigmatised. There are many effective treatments which may help people to manage the condition long-term, the largest group of which are called antipsychotic medications. Research shows supportive treatments like social skills training, family therapy, and access to community-based support services are also helpful for many people with this condition.
Borderline Personality Disorder (BPD), also referred to as Emotionally Unstable Personality Disorder (EUPD) and Complex Post Traumatic Stress Disorder (CPTSD), is a diagnosis given to some people who experience complex emotions.
“Complex emotions" is another term you may hear. This means experiences and feelings that are often confusing and difficult to manage. These may include challenges in relationships, fears of abandonment, difficulties regulating emotions, experiencing intense emotions or detachment (dissociation), and managing impulses like self-harm or suicidal thoughts.
It's your choice which term, if any, you use. People have very different views.
No two people with BPD have exactly the same symptoms. Some individuals never receive a diagnosis, while others do but find it doesn’t lead to effective treatment. For many, the diagnosis can be stigmatising and detrimental to their health and well-being.
The diagnosis of BPD is a label that is often problematic. It is associated with stigma, prejudice, and misunderstandings by health professionals. BPD is most common among people who have experienced trauma, particularly early in life, which can impact brain development and stress responses. Some suggest that CPTSD might therefore be a more helpful diagnosis, as it highlights the role of trauma.
Tragically, around 10% of people diagnosed with BPD die by suicide, making it a life-threatening condition. Despite advances, we still know too little about how to help people with BPD. While psychological treatments are available, they can be hard to access. Additionally, despite the fact that over 90% of people with BPD are prescribed psychiatric medications, there is no clear scientific evidence that these medications are effective.
This information is adapted from the glossary put together by our Complex Emotions Hub, in collaboration with people with lived experience.
SMI can also include a range of other disorders, including eating disorders and personality disorders. These conditions often co-occur, and people may experience symptoms with a severe impact on their day-to-day life and need specialist treatment by a psychiatrist.
It’s not uncommon for individuals with one of these conditions to experience symptoms or diagnoses of another. For instance, around 20% of people with schizophrenia also experience significant depressive episodes. People with bipolar disorder may also experience delusions and hallucination.
We know individuals may experience significant symptoms of SMI without meeting full diagnostic criteria or before receiving a formal diagnosis. It is often unclear if or when these symptoms need to be treated and many researchers are looking for ways to prevent first and future episodes of illness. Each individual treatment for SMI may not work for everyone who received it and treatments may cause side effects that people find difficult to tolerate. Sometimes it takes a process of trial-and-error to find the best treatment for an individual.
Some of our Hubs have produced their own glossaries:
Or you can read more on these websites:
We are a platform dedicated to SMI research, and so we don’t offer treatments or support directly. If you are struggling with mental health, please consider getting in touch with your GP or a psychiatrist.
Mind
InfoLine: 0300 123 3393
The Mind InfoLine can help you find specialist services in your area
Samaritans
Phone number: 116 123
Shout
Or text SHOUT to 85258
Hub of hope
Mental health support database
A directory of UK helplines can be found on the Find a Helpline directory list
This article was written with the support of a mental health professional and reviewed by people with lived experience of SMI.