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Definition of severe mental illness (adapted from the National Services Framework for Mental health – Modern Standards and Service Models DH 1999)

Severe mental illness is defined as “a mental disorder as agreed within the secondary care Community Mental Health Team assessment process”

And either

There must have been a score of 4 (very severe problem) on at least one, or a score of 3 (moderately severe problem) on at least two of the HoNOS items 1-10 (excluding item 5 “physical illness or disability problems”) during the last six months.

Or

There must have been a significant level of service usage over the past five years as shown by:

• a total of six months in a psychiatric ward or day hospital or
• three admissions to hospital or day hospital or
• six months of psychiatric community care involving more than one worker or the perceived need for such care if unavailable or refused

This means that people who are accepted by specialist mental health services for assessment, help, support and treatment will have a mental disorder as designated within the secondary care Community Mental health Team assessment process.

• People with a severe and/ or enduring mental illness who are referred to specialist mental health services are therefore likely to present with any of the following:-
• The mental disorder will be associated with high or significant risk to the individual themselves or to other people;
• The nature of the mental disorder requires specialist treatment or care from a specialist mental health professional
• The impact of the disorder makes the individual vulnerable and unable to protect themselves from significant harm or exploitation;
• The mental disorder has a disabling impact on people’s social and physical functioning in the community
• The mental disorder will cause very significant stress to individuals and/ or their carers (including dependent children
• The long term nature of the mental disorder requires that specialist support from secondary mental health services be provided

• People may also present with a range of challenging behaviors and should therefore be referred for specialist mental health care if:
• They are likely to disengage from services but remain in need of support
• They have a personality disorder and a history of severe mental illnesses and pose significant risk, and are responsive to treatment and/ care and support which continues to reduce risk to the community;
• They have a learning disability and are subject to the provisions of the Mental Health Act
• They are subject to statutory aftercare under Section 117 of the Mental health Act (these cases will be maintained as a subset of the care co-ordination register) or Guardianship (Section 7) or a Supervised Discharge Order (Section 25)

• People with a severe and enduring illness which impacts very significantly on their daily lives and those of their carers will primarily be people with:
• Major psychosis such as schizophrenia
• Bipolar affective disorder
• Severe depression with psychotic features
• Severe obsessive compulsive disorder
• Severe depressive states
• Severe phobic or anxiety states
• Moderate depressive states which have not yet responded to appropriate treatment within primary care.

This list is not exhaustive and can also include people with other problems who require specialist assessment and/ or intervention e.g. eating disorders.

People are not eligible for services if:

• They abuse substances and do not have a severe mental disorder
• They are offenders and are under arrest and do not have a severe mental disorder
• They suffer from a mild or moderate mental illness. The primary health care team will normally deal with mild or moderate mental health problems with liaison and support available from secondary care.