Although serious mental illness (SMI), such as schizophrenia and bipolar disorder, impacts more than 14 million people in the U.S., general psychologists have historically received limited training in this area. That began to change in 2013 with the creation of the Specialty Council for SMI Psychology and was further boosted in 2019 when the American Psychological Association recognized SMI psychology as its own specialty.
Lauren Gonzales, PhD, a licensed clinical psychologist at NewYork-Presbyterian and Columbia and the New York State Office of Mental Health, served on the Training and Evaluation Committee of the Specialty Council for SMI Psychology and recently co-authored a summary of their recent guidelines and competencies. Below, she discusses the importance of building expertise in SMI and how these recent guidelines can help.
How do you define a serious mental illness?
What exactly constitutes an SMI is up for debate. I led a systemic review, published in 2022, that showed there is significant variability in how we define SMI, and called for better definitions of this concept in research. It is not an official psychiatric diagnosis, but rather an umbrella term that captures psychiatric illnesses that involve significant interference with daily functioning and quality of life. Often — but not always — people think of the SMI umbrella as including schizophrenia and related disorders, bipolar disorder, major depression, and PTSD. But if we are using a definition that accounts for functioning and quality of life, other diagnoses could also fit, such as eating disorders and borderline personality disorder.
People with SMI have been found to experience significant social, physical, and mental health disparities which can cause significant barriers to recovery and quality of life.
What prompted the creation of these training guidelines?
The SMI population is up against unique barriers to treatment, and these conditions often result in significant functional impairment, which requires for interventions from highly trained specialists in this area. Unfortunately, treating SMI is not part of standard psychological curriculum; therefore, a workforce that is adequately trained to help these individuals is critically needed. This includes knowledge not only of specific evidence-based treatment, but also skills such as cultural humility, a knowledge and awareness of the unique sociocultural structures at play, and a knowledge of the systems of care.
What are some of those treatment barriers?
People with SMI have been found to experience significant social, physical, and mental health disparities which can cause significant barriers to recovery and quality of life. Compared to the general population, they have disproportionately low rates of employment, poor physical health indicators and outcomes, a disproportionately high rate of poverty and housing instability, and are about 10 times more likely to be victims of violent crime. Research has also found that individuals from already marginalized communities of color are more likely to receive SMI diagnoses than their white counterparts. The perceived stigma of mental illness is another huge barrier.
The guidelines have a focus on recovery-oriented treatment. Can you explain what that is?
The recovery model began as a grassroots model that somewhat parallels recovery-oriented models of addiction, such as Alcoholics Anonymous. Recovery involves what the client would like to achieve for themselves and how they would like their life to look. Recovery is a process, and it does not equate to the absence of symptoms. We think about symptoms and mental health as occurring on a spectrum at any given time, not as a singular outcome. Recovery-oriented treatments are person-centered, which means that treatment is collaborative and tailored to the individual client and what is important to them.
Why are you passionate about this standardized training approach?
When I was a trainee, I was lucky because I found a mentor who was also passionate about working with the SMI population. He helped guide me so that I could seek out appropriate training experiences. However, without a standardized system of SMI training, not every mental health professional looking to enter this field will be so fortunate. Just as evidence-based treatment practices can help decrease disparities in treatment access and benefit, standardized and evidence-based training practices can also promote equitable access to quality training opportunities.
How would you like to see these guidelines used?
My hope is that these guidelines will be used by training programs in SMI psychology; I personally use these guidelines with my own trainees who have an interest in it. We are a small but growing field, and mentorship has historically been one-on-one with students who may not be in SMI-focused training programs, and therefore don’t have a pre-existing structure in place to guide their SMI training. My hope is that with these guidelines, SMI-focused training programs will continue to expand to meet the increasing demand. From there, we can grow the workforce, which in turn has the potential to expand access to quality treatments for more people.
