Reliability of the Term "Serious Mental Illness": A Systematic Review.

OBJECTIVE: The term "serious mental illness" (SMI) is widely used across research, practice, and policy settings. However, there is no consistent operational definition, and its reliability has not been systematically evaluated. The purpose of this review was to provide a comprehensive qualitative content analysis of "SMI" empirical research, including study and sample characteristics and SMI operational definitions. These data can provide important considerations for how stakeholders conceptualize SMI. METHODS: Systematic review of PsycInfo, PsycArticles, and PubMed databases from January 1, 2015, to December 31, 2019, identified 788 original empirical studies that characterized the sample as having "SMI." RESULTS: Descriptive content analysis indicated that most studies (85%) provided no operational definition for SMI. Only 15% defined the term, and an additional 26% provided examples of SMI that included only psychiatric diagnostic categories (e.g., SMI, such as schizophrenia). Of the 327 studies that provided any description of SMI, variability was noted regarding whether criteria included any mental health diagnosis (N=31) or only specified diagnoses (N=289), functional impairment (N=73), or any specified duration of symptoms (N=39). Across all studies that characterized samples as having SMI, substantial variability was noted regarding included diagnostic classifications. CONCLUSIONS: Referencing "SMI" is second nature for many stakeholders. Findings suggest that evidence-based practice and policy efforts should weigh the level of research support indicating that the construct and the term "SMI" lacks generalizability. Researchers and stakeholders are encouraged to develop precise and agreed-upon diagnostic language in their efforts to support and advocate for people with mental illnesses.

The influence of defendant race and mental disorder type on mock juror decision-making in insanity trials.

This study examined the joint influence of defendant race (Black/White) and mental disorder type (schizophrenia/depression) on mock juror decisions in a Not Guilty by Reason of Insanity (NGRI) case. We reasoned that unwillingness to vote for insanity would be more pronounced for a Black defendant with schizophrenia, given overlapping dangerousness and criminality stereotypes associated with those groups. Online community participants (N = 216) read a fictional second-degree murder case in which we varied mental disorder type and defendant race, then provided a verdict (guilty/NGRI) and answered questions regarding the trial. In line with hypotheses, participants were significantly more likely to vote guilty for a Black defendant with schizophrenia as compared to depression, but there were no significant differences for the White defendant. Results of this study suggest that bias in insanity trials can be exacerbated for a racialized defendant.