Schizophrenia is traditionally classified as a serious mental illness (SMI), emphasizing chronicity and disability. However, growing evidence supports that it also shows features of a neurodevelopmental syndrome, highlighting disruptions in early brain development and a diverse spectrum of trajectories. This paper proposes expanding the conceptualization of schizophrenia as both an SMI and a neurodevelopmental syndrome. We review biological, clinical, and epidemiological evidence supporting a neurodevelopmental model of schizophrenia. We then propose a three-pronged strategy to operationalize this reframing: (i) reclassification in the ICD-11 and DSM-5 as a neurodevelopmental syndrome; (ii) renaming to reflect established and evolving scientific evidence; and (iii) reshaping societal narratives so schizophrenia is understood as a developmental condition that remains modifiable. A neurodevelopmental framing may advance access, quality, and equity in schizophrenia care. Reframing schizophrenia as a neurodevelopmental syndrome reflects modern science and, based on precedent from other countries, could catalyze systemic changes to improve care, access, and equity.

Adults with serious mental illness (SMI) have elevated morbidity and mortality, largely attributable to increased cigarette smoking. Effective smoking cessation interventions remain a critical need for this population. This study tested the Parks and Recreation Quit Smoking Program (PARQuit), a multi-component treatment program for adults with SMI. The aims were to compare the effectiveness of the PARQuit physical activity and PARQuit sedentary groups on smoking cessation, smoking reduction, and psychiatric symptom reduction. Ninety-nine participants with SMI were randomized to a physical activity intervention or a sedentary control group, each receiving pharmacotherapy (nicotine replacement therapy (NRT) or bupropion SR) and cessation counseling for 12 weeks in the United States of America, from 2019 through 2025. The PARQuit physical activity group engaged in game-based group exercise (50 minutes, 3 times/week), whereas the PARQuit sedentary group participated in sedentary group activities. Outcomes included smoking cessation (measured at baseline, 6, and 12 weeks) and psychiatric symptoms assessed via the Brief Psychiatric Rating Scale. At baseline, participants smoked a mean of 76 cigarettes per week, declining to 35 cigarettes at 12 weeks. Both groups showed a significant linear decline in cigarette consumption over time (mean change: -3.7 cigarettes/week; 95% CI: -5.2, -2.4), with no significant between-group difference. Smoking abstinence increased significantly (McNemar χ2=5.33, p<.05). Psychiatric symptoms decreased continually, with scores dropping by 0.29 units per week (95% CI: -0.50, -0.09) in both groups. Although there were no significant differences between study groups, both study groups showed a significant reduction in cigarettes smoked each week and in psychiatric symptoms. Group-based counseling and pharmacotherapy likely contributed to these improvements. Future research should assess longer-term outcomes in sustaining smoking cessation. Clinical Trials Registration Number: NCT03950427.

Differential disparities in coronary revascularization across serious mental illness subtypes: A Nationwide analysis of 6.2 million myocardial infarction hospitalizations.

Financial independence, an important developmental milestone of emerging adulthood (ages 18-29), is critical to independent functioning in life. Examining whether financial independence in emerging adults with serious mental illness (SMI) is associated with self-stigma may inform ways to support achieving this milestone. Financial independence was investigated as a mediator between self-stigma and two of its harmful outcomes, lower self-esteem, and an increased "why try" effect. The "why try" effect was defined as a sense of futility about achieving life goals due to self-stigma. Self-stigma was expected to be associated with less financial independence, and less financial independence was expected to be related to reduced self-esteem and an increased "why try" effect. Emerging adult community mental health center clients who had an SMI (n = 239) were recruited to complete an electronic survey. Path analysis was used to analyze data. Consistent with previous research, self-stigma was associated with decreased self-esteem and an increased "why try" effect. Financial independence was associated with higher self-esteem and, unexpectedly, with an increased "why try" effect. Contrary to past findings among adults, self-stigma was associated with increased financial independence. Two indirect associations through financial independence were observed between (a) self-stigma and self-esteem and (b) self-stigma and the "why try" effect. Findings indicate that emerging adults with SMI may simultaneously experience self-stigma, financial independence, and the "why try" effect. Implications for psychiatric rehabilitation include increasing assistance with managing self-stigma among emerging adults with SMI pursuing financial independence. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

People with Borderline Personality Disorder (PBPD) have been historically excluded from Assertive Community Treatment (ACT) teams. The 'gold standard' ACT service model in community psychiatry aims to serve people with serious mental illness (SMI), typically diagnosed with psychotic and mood disorders. For various clinical, administrative, and model innovation reasons, PBPD are notably present on ACT teams, presenting unique clinical challenges; yet clinician perspectives and experiences are little known.Qualitative study using semi-structured interviews and thematic analysis on experiences and perspectives of clinicians from a well-established ACT team in an academic setting that transitioned to a Flexible ACT team in Toronto, Canada.Clinicians reported working with PBPD presents unique training, skills, clinical, team, system, and personal level challenges Five main themes included: (1) Lack of specific training among clinicians in serving people with BPD; (2) Diverse views of suitability of ACT for PBPD; (3) Specific challenges for clinicians working with PBPD on ACT; (4) Positive aspects of using ACT to serve PBPD; (5) Potential adaptive changes to ACT teams working with PBPD. Conclusion: Having PBPD on ACT teams is a little acknowledged and less known area of ACT and has significant impact on ACT services. Further attention to training and skill building, service adaptation, and research that improve care and therapeutic relationships with PBPD on ACT are warranted. Having PBPD on ACT teams is a little acknowledged and less known area of ACT and has significant impact on ACT services. Further attention to training and skill building, service adaptation, and research that improve care and therapeutic relationships with PBPD on ACT are warranted.

Most genome-wide association studies (GWAS) of serious mental illness (SMI) have been conducted for categorical diagnoses in samples of primarily European ancestry. The portability of findings to non-Europeans, and to SMI-related symptoms/dimensional traits remains uncertain. In a sample of 8,666 SMI cases and controls from the Paisa region of Colombia we show that a primarily European schizophrenia GWAS polygenic risk score (PRS) predicted all SMI diagnoses in this sample, as well as symptoms (assessed in cases only) and traits assessed agnostic to SMI diagnosis: a one SD unit (SDU) increase in this PRS was associated to decreased risk in cases of suicidal thoughts (OR=0.89, 95% confidence interval 0.84-0.94), depressed mood (OR=0.90, 95% confidence interval 0.85-0.95), and increased risk of delusions (OR=1.12, 95% confidence interval 1.06-1.18) and to decreased cognition (in cases and controls) across five distinct domains (average decrease in cognition of 0.065 SDU, p<7e-05). We show that a published European GWAS of cognition predicted levels of executive function (average decrease in cognition of 0.06 SDU per unit increase in PRS, p<2e-04), but not diagnosis or symptoms. Specific loci identified in the SMI GWAS also showed association to multiple diagnoses, symptoms, and cognitive traits in Paisa. The most noteworthy result was for a locus on chromosome 7p22.3, associated in multiple SMI GWAS, that showed association in Paisa to increased risk of bipolar disorder, and to reduced complex cognition and social cognition. Our findings demonstrate wide portability from European GWAS to an admixed American sample, with associations to multiple transdiagnostic phenotypes.

Recreational therapists work in behavioral health settings, including forensic and correctional settings, providing treatment to individuals with serious mental illness (SMI). Limited literature exists regarding the role of recreational therapy (RT) in these settings. Using hermeneutic phenomenology, semi-structured interviews (n=10) explored the lived experiences of recreational therapists working with adults with SMI in forensic and correctional settings. Qualitative findings yielded three main themes: 1) RT roles and responsibilities, 2) Facilitators for recreational therapists in these settings, and 3) Constraints for recreational therapists in these settings. Across the three main themes, 11 subthemes were identified. Study findings were compared to the American Therapeutic Recreation Association Standards of Practice (2019) and the National Council for Therapeutic Recreation Certification Professional Knowledge Areas and Job Domains (2021) to determine (a) whether practitioners working in forensic and correctional settings were meeting professional competencies; and (b) if there were any competencies specific to RT and forensic and correctional settings that needed to be better represented in professional RT documents. Study findings, limitations, and implications for RT practice, education, and research are shared.

Understanding the factors that influence the adoption and implementation of evidence-based practices (EBPs) is crucial for expanding access to high-quality treatments for serious mental illness (SMI). This study evaluated how provider characteristics and perceptions influence adoption and implementation outcomes of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) in community mental health centers (CMHCs). CMHC providers (N = 124) were trained to deliver TSC to CMHC patients diagnosed with SMI (N = 395). Providers completed measures on demographic and professional characteristics. Additionally, assessments conducted after providers completed TSC training and delivered TSC to a patient measured provider perceptions of TSC (i.e., treatment fit, willingness and confidence) and adoption and implementation outcomes (i.e., referrals, sessions delivered, and treatment completion). Providers reported highly positive perceptions of TSC. Providers' education was associated with number of referrals and treatment completion. Additionally, provider perceptions of the TSC's appropriateness and feasibility at post-training predicted later perception of treatment fit. Overall, findings suggest providers perceive TSC to be well-suited for CMHCs, where provider characteristics are diverse, which bodes well for sustainment and scalability in community settings. Clinical Trial Registration: This study was preregistered on clinicaltrials.gov (identifier: NCT04154631) on November 6, 2019. https://clinicaltrials.gov/study/NCT04154631 .

Tobacco use is prevalent among military veterans. Veterans with serious mental illness (SMI) smoke cigarettes at higher rates than their counterparts, which causes major health disparities. Additional efforts are needed to support smoking cessation in this population. This study was informed by the theory of planned behavior and used a rapid qualitative matrix approach to explore how attitudes, perceived behavioral control, and social norms influenced smoking among veterans with SMI to inform tailored treatment. In a sample of 20 veterans, smoking initiation was often linked to military culture and early exposure to smoking. Peer pressure and social belonging either facilitated or inhibited quit attempts. Veterans wanted to quit, but continued smoking due to addiction and to cope with mental health challenges. Smoking cessation discussions for veterans with SMI should be integrated into routine mental health care and explore social norms around smoking, coping strategies, and the psychological benefits of quitting.

A new executive order from the White House could jump‐start additional research and new approvals of psychedelic drugs for the treatment of serious mental illness (SMI). Among its provisions, the April 18 order directs federal agencies to expedite reviews of products that have successfully completed Phase 3 trials, so that they can be more rapidly rescheduled from their current Schedule I (no recognized medical use) status.

Access to mental health care is critical for the effective management of serious mental illness (SMI), but consumers with low socioeconomic status (SES) have lower rates of service usage and worse retention in care. Digital technologies are often lauded as a way to bridge access gaps; however, little is known about how technology-mediated care may influence care access among low-SES consumers and how consumers use technology in care access. This study aimed to examine the applicability of Levesque et al's access framework to technology-mediated care for SMI and analyze how low-SES consumers use technology to facilitate care access. Furthermore, the study assesses whether and how technologies are involved in care access at multiple points within the process of accessing care. This study used 2 qualitative methods: ethnographic observations at a mental health treatment court and interviews with low-SES consumers with SMI using community mental health care (n=14) and key informant interviews with health and service providers working with this population (n=14). Observations occurred from July 2022 through September 2023, and interviews occurred between January 2022 and May 2024. Data analysis involved both inductive and deductive coding approaches. Data from both the interviews and observations were analyzed in NVivo and further triangulated through analytic memos. Levesque et al's framework required several extensions to accommodate technology-mediated care related to SMI for low-SES consumers: (1) a cyclical rather than linear trajectory; (2) simultaneous care acquisition from multiple health and service providers; (3) staying in care long-term; (4) identification of both one-time and ongoing health needs; and (5) an emergency pathway for entering care. Consumers often faced challenges related to the varied digital requirements of each provider and a dearth of integrative, patient-facing tools like portals. Within this context, some consumers use mobile apps, communication, and telehealth technologies across various care access stages. Consumers used technology by figuring out how to navigate technology-mediated care, especially by leaning on others, such as case managers, for support. These others provided consumers with temporary technologies, showed them how to use technologies, and accompanied them through the process of using technology for accessing care. This study highlights that accessing care is iterative and ongoing, involving multiple forms of co-occurring service provision. A theoretical contribution of this work is its extension of Levesque et al's care access framework to better reflect technology-mediated care for SMI among low-SES consumers. This work also underscores ongoing challenges for accessing technology-mediated care and the importance of human support in addressing access difficulties. Clinical implications include incorporating digital readiness assessments and providing comprehensive guidance on how consumers can effectively use technologies for care. Future work should investigate how technology-mediated care can make care access easier rather than harder.

ABSTRACT Background: Kratom’s rise in popularity during multiple overlapping drug use crises is potentially driving poor mental health outcomes and straining health systems. Objective: To investigate temporal changes in the compounding effect of kratom on serious mental illness (SMI) when co-used with other drugs. Methods: We used the National Survey of Drug Use and Health (2021–2023; N = 139,524; male n = 61,926; female n = 77,598) to identify SMI, a range of drug use disorders (SUD), and kratom use. Our focal predictor was whether an individual had 1) no SUD and no kratom use, 2) an SUD without kratom, 3) kratom use without an SUD, or 4) both an SUD and kratom use. We used multiple logistic regression to model whether SMI is associated with SUD/kratom status, year, and their interactions. Results: Roughly 6% of adults met the criteria for SMI. We found that the increase in SMI over 3 years was fastest and markedly different among those with both OUD and kratom use, such that the predicted SMI prevalence went from 20% in 2021 to 50% by 2023 (interaction p = .01), whereas SMI remained relatively stable for other drug combinations, including those with OUD without kratom use, kratom without OUD, and neither OUD nor kratom. Conclusion: Over a short period of 3 years, SMI more than doubled among those with concurrent kratom use and OUD. At a time of strained US treatment systems, high overdose rates, and a mental health crisis, we stress the multiplicative association between kratom, opioid use disorder, and SMI.

Individuals with serious mental illness (SMI) face profound and largely preventable physical health inequities shaped by social and structural conditions, representing a major public health concern related to avoidable health inequalities. Because many receive everyday support in community mental health (CMH) systems, these services represent a crucial arena for understanding how such inequities are encountered and made sense of in practice. The study examines how physical health is understood within German CMH practice. Five group discussions with 30 CMH workers were analysed using an interpretive qualitative approach. The analysis identified five professional logics through which physical health becomes part of CMH support: trusting relationships that both enable and limit action; psychological stability as a core mandate; physical health positioned between recognition and delegation; fragile motivation combined with an ethics of restraint; and health promotion situated between aspiration and structural constraint. The findings show that helping relationships, everyday environments, and organisational structures create specific conditions for health-related support. Strengthening these interconnected levels may enable CMH to integrate physical health more systematically, offering insights relevant to international CMH contexts facing similar relational and structural challenges.

In an analysis of 173 multiplex families from the Portuguese Island Collection (PIC) this study characterizes the shared genetic architecture of serious mental illnesses (SMI) including schizophrenia (SZ) , bipolar disorder (BP) , major depression (MDD) , and autism (ASD) . Within this cohort, co-segregation of psychotic and mood disorders occurred in 28% of families, while 7% demonstrated co-segregation of intellectual disability or ASD with SZ and mood disorder phenotypes. Whole-genome sequencing (WGS) was performed on a three-generation PIC family to identify rare, large-effect variants. This led to the identification of an extremely rare predicted loss of function (LoF) mutation in the Chromodomain Helicase DNA Binding Protein 2 (CHD2) gene. These results demonstrate that high-density multiplex families in founder populations are a powerful resource for mapping rare, large-effect variants that cross clinical diagnostic boundaries, as the identified CHD2 mutation suggests that the disruption of a single neurodevelopmental gene may lead to diverse SMI phenotypes. By combining population and family-based methodologies, this approach leverages shared genetic backgrounds and environments to provide a unique opportunity for cellular studies to explore the biological mechanisms underlying SMI, offering significant potential to inform future functional research and identify novel therapeutic targets.

Tobacco treatment has been a Veterans Health Administration (VHA) priority since 2008, which has increased access to treatment. However, additional system-level efforts are needed to reduce the disparities in smoking rates and tobacco treatment access that have persisted between veterans with and without serious mental illness (SMI). The local Institutional Review Board deemed this project exempt because of minimal risk to human subjects. We interviewed 20 VHA providers (psychiatrists, nurse practitioners, pharmacists, physicians, social workers, nurses, psychologists, peer specialists, and occupational therapists) from a local VHA health care system's outpatient SMI clinics and analyzed qualitative data using a rapid analysis inductive-deductive approach to determine how system-level barriers, such as administrative factors and social norms, influenced tobacco treatment delivery. Providers often tried to stay current on VHA tobacco treatment resources, but said that too much or too little information would stymie efforts. For example, high volumes of information sent via email and available on the intranet made it challenging to find smoking-related resources, while restricted information about changes to medication availability complicated prescribing. Providers described these barriers as interfering with their delivery of smoking treatment. Some also viewed tobacco discussions as antithetical to their mission of providing veteran-centered care, which dissuaded them from initiating such discussions. In addition, providers working in rural settings questioned the accessibility of certain VHA smoking cessation resources, like in-person groups or the VA Quit Line, for veterans with SMI. Finally, nonprescribers shared that the ease of coordinating care with prescribers facilitated tobacco treatment delivery. Mental health providers in a VHA health care system had difficulty accessing VHA tobacco treatment resources. Adjustments to medical record and electronic communication infrastructure, as well as more consistent communication between facility-level tobacco champions and frontline providers could make tobacco treatment resources more accessible to providers, though care is needed to ensure this information does not exacerbate information overload. Training and education that helps providers feel comfortable integrating tobacco treatment into routine mental health care is also critical to ensuring equitable access to tobacco treatment for veterans with SMI in rural areas.

Tobacco Treatment Competencies: A Brief Review of Advanced Practice Psychiatric Nursing Education.

African Americans (AAs) who have serious mental illness (SMI) and are overweight face elevated risk for emotional eating, yet the psychosocial predictors of this behavior remain understudied. We analyzed data from 212 AAs with SMI who were overweight (average BMI = 37.9) using hierarchical regression. Model 1 included mental and physical health; Model 2 added recovery; and Model 3 incorporated weight self-efficacy. Models 1 and 3 significantly predicted emotional eating, each yielding significant increases in explained variance. To capture heterogeneity in eating behaviors, we conducted a latent profile analysis using significant predictors, identifying two distinct groups: Reactive Eating and Mindful Eating. The Reactive group reported greater susceptibility to eating in response to negative emotions and lower weight self-efficacy, but better physical health than the Mindful group. Sociodemographic differences were also observed. Findings underline the importance of developing interventions tailored to emotion-related eating among AAs with a diagnosis of SMI who are overweight.

Resilience is a critical indicator of the personal recovery process for people with serious mental illness (SMI). However, little is known about resilience subtypes among this population. Grounded in Kumpfer's resilience model (KRM), the study aims to identify latent types of resilience among people with SMI using latent profile analysis (LPA). A cross-sectional survey design was used. A total of 297 individuals with self-reported SMI completed an online survey, including demographic variables and measures that resemble core components of the KRM. The LPA identified three resilience profiles: Maladaptive, Homeostatic and Resilient. One-way analyses of variance (ANOVA) revealed distinct patterns of the three resilience profiles on all factors in the KRM and the outcome variable-adaptation to psychiatric disability. ANOVA and Chi-square tests indicated several demographic variables predict profile membership, including age, marital status, highest educational attainment, employment status, average weekly work hours and primary SMI diagnosis. However, sex, race-ethnicity, annual income and years since SMI diagnosis do not predict profile membership. The study contributes to the understanding of resilience subtypes and associated protective and risk factors for resilience among people with SMI, suggesting early, tailored strength-based interventions to promote resilience and personal recovery.

Individuals with serious mental illness (SMI) are overrepresented in the criminal justice system. They frequently cycle between jail and emergency departments and experience poor health outcomes. Some jails offer mental health services, but the criminal justice environment is not conducive to optimal treatment and recovery. Individuals with SMI may require targeted interventions, but few studies have examined characteristics of individuals in jail with and without an SMI or compared their post-release trajectories. We conducted a retrospective cross-sectional study using health services and jail system data from the City and County of San Francisco from July 1, 2011 to June 30, 2021. We included 1568 adults with at least one jail incarceration from July 1, 2017 to June 30, 2018, stratified by the presence or absence of an SMI diagnosis, and compared health services use, jail system interactions, and associated factors. Compared to individuals without SMI, those with SMI had higher rates of substance use disorder (82.5% vs. 53.3%) and homelessness (82.2% vs. 61.0%). The longest single jail incarceration averaged 11.3days longer for individuals with SMI (p < 0.05, 95% CI: 1.38, 21.26). Post-release, individuals with SMI had higher rates of health services use and reincarceration. We found that individuals with SMI in jail have higher rates of homelessness, health services use, and jail reincarceration. This underlines the responsibility placed on jails to address the complex needs of individuals with SMI. Investment should focus on reentry and diversion programs, as well as expanding jail and community-based mental health care for individuals with SMI.

Objectives: The desire to belong is a fundamental aspect of human nature that drives behavior and decision-making. Belonging is not only a need but also a powerful source of motivation. This review aims to contribute to the knowledge regarding recovery from serious mental illness (SMI) and the sense of belonging, by describing how studies understand and incorporate the concept of sense of belonging in mental health practices related to recovery. This topic is important for practitioners, policymakers, people with lived experience, their supporters, and the population in general, as understanding and addressing a sense of belonging should be taken into consideration when effectively supporting and promoting the wellbeing of people with SMI. Research Design and Methods: This integrative review screened peer-reviewed articles from the past 10 years that addressed the sense of belonging involving adult populations experiencing mental suffering. Results: The final sample included 23 empirical studies. These studies revealed the sense of belonging as an experiential, personal, and relational experience involving the following themes: “I can be myself”, “I am a part of the pie”, "I am wanted”, “It’s a mutual thing”, and “There’s trust”. Conclusions: This review emphasizes the important role that a sense of belonging plays in the recovery process, highlighting that inclusion alone is insufficient without a sense of meaningful, reciprocal connections that foster trust. The findings call for further research across disciplines and communities, aiming to genuinely support and embrace people living with SMI.