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According to the National Institute for Mental Health Serious Mental Illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.

SMI includes major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress (PTSD) and borderline personality disorder. Studies have shown that individuals with SMI show higher rates of acute and chronic illnesses, receive lower-quality general medical care, demonstrate worse long-term outcomes, and have a shorter life expectancy than the general population (VA). More than 75% of individuals with SMI have more than one mental illness, or a mental illness and a substance use or misuse condition (Kessler, Chiu, Demler, & Walters, 2005)

  • In 2019, there were an estimated 13.1 million adults aged 18 or older in the United States with SMI. This number represented 5.2% of all U.S. adults.

  • The prevalence of SMI was higher among females (6.5%) than males (3.9%).

  • Young adults aged 18-25 years had the highest prevalence of SMI (8.6%) compared to adults aged 26-49 years (6.8%) and aged 50 and older (2.9%).

  • The prevalence of SMI was highest among the adults reporting two or more races (9.3%), followed by AI/AN adults (6.7%). The prevalence of SMI was lowest among NH/OPI adults (2.6%)


Anosognosia, also called "lack of insight," is a symptom of severe mental illness experienced by some that impairs a person’s ability to understand and perceive his or her illness. It is the single largest reason why people with schizophrenia or bipolar disorder refuse medications or do not seek treatment. Without awareness of the illness, refusing treatment appears rational, no matter how clear the need for treatment might be to others.


Approximately 50% of individuals with schizophrenia and 40% with bipolar disorder have symptoms of anosognosia. Long recognized in stroke, Alzheimer’s disease and other neurological conditions, studies of anosognosia in psychiatric disorders is producing a growing body of evidence of anatomical damage in the part of the brain involved with self-reflection. When taking medications, insight improves in some patients.

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