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This chapter explores the pervasive and multidimensional nature of functional impairments in individuals living with serious mental illness (SMI), emphasizing deficits in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). It defines functional impairment as clinically significant disruption in expected behaviors across domains such as hygiene, nutrition, finances, and social engagement. Etiologically, impairments are linked to negative symptoms—particularly avolition—and neurocognitive deficits in executive functioning, memory, and attention. Epidemiological data reveal that 15%–29% of individuals with SMI require daily supervision, with impairments persisting despite pharmacological intervention. Behavioral strategies for assessment and intervention include multimodal evaluations, contextualized observations, and culturally sensitive tools like WHODAS 2.0 and MSIF. This chapter critiques outdated measures and advocates for individualized, behaviorally anchored assessments that capture the complexity, interdependence, and variability of functional capacities in SMI, underscoring the need for updated, psychometrically sound instruments tailored to this population.

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Problems with Functional Impairments in Daily Living Skills in Individuals Living with Serious Mental Illness

  • 章节

  • 发表日期：

    2026年

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  • Gerald F. McKeegan

摘要

This chapter explores the pervasive and multidimensional nature of functional impairments in individuals living with serious mental illness (SMI), emphasizing deficits in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). It defines functional impairment as clinically significant disruption in expected behaviors across domains such as hygiene, nutrition, finances, and social engagement. Etiologically, impairments are linked to negative symptoms—particularly avolition—and neurocognitive deficits in executive functioning, memory, and attention. Epidemiological data reveal that 15%–29% of individuals with SMI require daily supervision, with impairments persisting despite pharmacological intervention. Behavioral strategies for assessment and intervention include multimodal evaluations, contextualized observations, and culturally sensitive tools like WHODAS 2.0 and MSIF. This chapter critiques outdated measures and advocates for individualized, behaviorally anchored assessments that capture the complexity, interdependence, and variability of functional capacities in SMI, underscoring the need for updated, psychometrically sound instruments tailored to this population.