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Definition and prevalence of severe and persistent mental illness

Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Ospedale Policlinico, Verona, Italy

MORVEN LEESE, PhD and GRAHAM THORNICROFT, PhD

Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London

GIULIA BISOFFI, Dr Stat and MICHELE TANSELLA, MD

Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Ospedale Policlinico, Verona, Italy

Correspondence: Dr Mirella Ruggeri, Dipartimento di Medicina e Sanita' Pubblica, Sezione di Psichiatria, Università di Verona, 37134 Verona, Italy. Tel: +39-045-8074441; fax: +39-045-585871; e-mail: mruggeri{at}borgoroma.univr.it

Declaration of interest Funding provided by the University of Verona and the Bethlem and Maudsley NHS Trust.

Background There is little consistency in how severe mental illness (SMI) is defined in practice, and no operational definitions.

Aims To test two operationalised definitions, based on the National Institute of Mental Health (1987) definition: the first uses three criteria (diagnosis of psychosis; duration of service contact 2 years; GAF score 50), the second only the last two.

Method Annual prevalence rates of SMI in two European catchment areas for each criterion and the criteria combined were calculated.

Results The first definition produced rates of 2.55 and 1.34/1000 in London and Verona, respectively; the second permitted an additional 0.98/1000 non-psychotic disorders to be included in Verona.

Conclusions The three-dimensional definition selects a small group of patients with SMI who have psychotic disorders. The two-dimensional approach allows estimates of SMI prevalence rates which include all forms of mental disorder.

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