Title: What to look out for in a person with SMI
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 2 - Ethiopia (Full)

What to look out for in a person with SMI

This is very similar to what you do when you meet someone you have not seen for a long time. You are curious and you want to find out what has changed in that person over the years. You notice the way they approach you, whether they look interested in you, how they are dressed and how they appear more generally (whether they have taken good care of themselves, whether they have lost or put on weight, etc.), whether they seem kind or careless and so on. Similarly, it is important to be natural and have some curiosity when you see someone whom you suspect to have a mental illness. The main difference is that you try to be more systematic in your approach when you see someone with a potential mental illness. The following guidelines will help you to do this.

Appearance

How does the person appear? Are they calm and dressed appropriately? Are they as clean and tidy as you would expect them to be? Do their actions seem restless and agitated or, the opposite, tired and seemingly slowed down? Do they look physically sick? Do they behave aggressively? Do they appear suspicious of you or others? Do they look at you openly or do they look down or away all of the time, avoiding eye contact? Do they seem to talk or laugh to themselves for no obvious reason?

Speech

Does the person speak at all? Can you make sense of what they say, and how easy is it to understand what they are saying? Do they speak too loudly or too quietly, or does the volume of their voice seem normal?

Emotion

Does the person appear or act in a way that is unusually or inappropriately over-cheerful (too happy), or do they seem very sad for no clear reason? Do they behave in a fearful or aggressive manner?

Thinking

Listen carefully to the content of what people say, because this provides a clue to how they are thinking. What does the person worry about? How much do they worry? Are these worries common to most people, or do they seem extreme or at odds with reality?

Perception

This refers to the person's ability to connect with the outside world through their sensory organs (eyes, ears, etc.). You should attend carefully to find out whether the patient's hearing, sight, smell, taste, touch and/or other sensations have been affected. When a person perceives things that are not really happening this is usually called a hallucination (look back at Box 10.2). Ask the person and/or their family if he or she sees or experiences things that might indicate they are having hallucinations.

Insight

This refers to whether the person is aware that they have a problem. For example, the man who fears his wife is being unfaithful may believe this is true, even when the evidence strongly contradicts him. In such circumstances he is likely to be unaware that what he thinks about his wife is a symptom of his mental illness: he lacks insight.

There are many more abnormalities a person with mental illness may have, but most people with SMI tend to have one or more of those listed above. You will learn more about what you should do when you suspect someone has a mental illness in Study Session 11. Mental illnesses are not without risk. We will now first discuss how you can manage the risks associated with mental illness.