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Definitions to guide U.S. estimates, treatment of mentally ill


WASHINGTON -- The federal government has officially defined "serious mental illness" in preparation for the first national estimate of the number of people suffering from a condition that keeps them from leading a normal life.

Dr. Frank Sullivan, acting director of the new Federal Center for Mental Health Services, said that the definitions, which became official Thursday, provide a national uniform standard with which all the states can work.

The states will use the definitions to decide who is eligible for treatment in state and local clinics, which receive federal funds, and where patients are treated at no cost or at reduced rates.

The definitions could also determine who would be covered for treatment of mental illness under a new health-care system that is expected to grow out of the plan being formed by the Clinton administration.

Some mental health groups oppose the new definitions, saying that they are so broad they would include many people who are not seriously ill, resulting in their being treated while those who need help are shut out.

The seriously ill already find it difficult to obtain treatment at the clinics, the organizations say, because they are discouraged by long waiting periods that result from the shortage of staff members and financing.

Dr. Sullivan disagreed.

The definitions, which help settle a decades-long debate over mentalillness, say that to be seriously mentally ill, an adult must have or have had in the past year a diagnosable mental, behavioral or emotional disorder that interferes with one or more major activities in life, such as dressing, eating or working.

The definition for children says the disorder must interfere with activities like family relationships or school or community functions.

Laurie Flynn, a lobbyist for the National Alliance for the Mentally Ill, a group representing the families of those with serious mental illnesses, said of the definitions:

"We are outraged. This appears to make almost any condition a serious mental illness. Common sense tells you this isn't true."

She said she understood theoretically that using broad definitions first, to get a count of the number of those who need services, made political sense.

"But historically, every time that strategy has been adopted, our people -- the most severely ill schizophrenics and depressed people -- seem to be the first ones left out."

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