What Is a Serious and Persistent Mental Illness (SPMI) in Older Persons?
by Melodee Harris
The Social Security Administration is revising the rules for SPMI that were published in the Federal Register in 2010. The rules are used to evaluate claims for mental disorders. This is a brief overview of rules for SPMI effective January 17, 2017.
SPMI is a documented mental illness over the past 2 years that:
- Requires ongoing treatment that diminishes symptoms and
- Treatment that results in marginal adjustment or decreased capacity to adapt to the home environment.
Some examples of SPMI: neurocognitive disorders, schizophrenia, depressive bipolar disorder, anxiety, and obsessive compulsive disorder.
SPMI was used in the Revised Medical Criteria for Evaluating Mental Disorders: Proposed Rule published in 2010 in the Federal Register. SPMI provided an alternative to old terminology in an effort to decrease stigma. Although SPMI can be found in government documents, each state may have its own interpretation.
SPMI replaced these terms:
- Serious and persistent mental disorder.
- Seriously and persistently mental illness.
- Chronic mental impairment.
- Chronic mentally ill.
Changes for SPMI in the new Revised Medical Criteria for Evaluating Mental Disorders Final Rule (2016) from the previous 2010 document include a longer time interval for documented mental illness and some updates to provide consistency with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
View the Revised Medical Criteria for Evaluating Mental Disorders Final Rule.
- Harris, M. (in press). Serious and persistent mental illnesses in older persons. GPNI Series.
- Insel, T. (2013). Director’s blog: Getting serious about mental illness. National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/about/director/2013/getting-serious-about-mental-illnesses.shtml
- Melillo, K. (2011). Introduction and overview of aging in older adulthood. In K. Devereaux Melillo & S. Crocker Houde (Eds.), Geropsychiatric and mental health nursing (2nd ed.), pp. 3-30. Sudbury, MA: Jones & Bartlett Learning.
- Revised medical criteria for evaluating mental disorders: Proposed rule. (2010). Federal Register, 75(160), 71632-71635. Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2010-08-19/pdf/2010-20247.pdf
Melodee Harris, PhD, APRN, GNP-B
Chair, Geropsychiatric Nursing Special Interest Group