How to help women with serious mental illness lead healthier, more rewarding lives

There are many ways psychologists can get involved in improving care for women with SMI, said Stacy. A good start is getting educated on the topic: She and the other SMI guidelines authors encourage psychologists to read the SMI guidelines as well as related guidelines (see APA guidelines helpful in treating women with SMI). These documents and the recovery approach in general are aligned with the social justice aspects of APA’s strategic plan, Stacy added.

For individual treatment, several successful evidence-based interventions are compatible with a recovery-based approach, many of which psychologists are familiar with in other applications, Carr said. An example is cognitive behavioral therapy for psychosis, or CBTp, which helps people with schizophrenia and related disorders examine and challenge their experiences of psychosis and develop coping strategies to manage their symptoms. Studies show the treatment helps improve depression, self-esteem, and psychological well-being and leads to fewer hospitalizations. It has also been found to prevent first-episode psychosis in those at elevated risk of developing it (Agbor, C., et al., Cureus, Vol. 14, No. 9, 2022).

Another successful treatment for some forms of SMI is dialectical behavioral therapy, particularly for those who have borderline personality disorder, substance use disorder, or exhibit suicidal behavior (Peprah, K., & Argaez, C., Dialectical Behavioral Therapy for Adults with Mental Illness: A Review of Clinical Effectiveness and Guidelines, Canadian Agency for Drugs and Technologies in Health, 2017). And if a patient has a history of trauma, evidence-based treatments for trauma can also be highly effective, Carr noted.

It is also important to help women with SMI create plans in case things get out of control, such as behavior health advance directives, Hunt added. Like health advance directives, these directives (also called psychiatric or mental health advance directives) allow people to express their preferences on where and with whom they want to receive care and what treatments they are willing to receive, she explained.

Establishing these plans can give patients a sense of security and autonomy and psychologists a road map to help them feel more confident about providing these more egalitarian forms of treatment, Hunt added. That’s because the plans allow patients and providers to discuss in detail, ahead of time, any repercussions that may come about in relation to a patient’s expressed decisions.

“Talking about these things, not being afraid to talk about them, can help providers feel less worried about advocating for patients’ treatment wishes in times of crisis,” she said. (See Resources for more.)

Environmental interventions that address systemic barriers are at least as important as individual treatments, the SMI guidelines also point out. Programs such as supported employment and supported housing can help women with SMI gain greater stability in their lives, which in turn can aid their mental health (Killaspy, H., et al., World Psychiatry, Vol. 21, No. 1, 2022). And in general, the guidelines note that “psychologists are recommended to take on diverse roles rather than staying fastidious to traditional roles.” For example, they are encouraged, when possible, to act as case managers who get involved in women’s activities of daily living and to work on interdisciplinary teams, which can help to ensure that women with SMI get the help, care, and resources they need to thrive.

On a larger scale, psychologists can become involved in advocacy efforts for this population, as well as in efforts to change the thinking and practices in systems that may negatively affect women with SMI. Stacy, for example, trains Yale postdocs as part of an interdisciplinary curriculum on SMI; consults with mental health organizations on how to incorporate these models into their systems and performance; and gives talks nationally and abroad on gender differences in mental health, biases within the mental health system, and sociocultural factors that precipitate and perpetuate SMI.

Learning more about women with SMI is important for the field at large, Stacy added. All psychologists will encounter women with SMI at various points in their career, and given their expertise in human behavior, the mind, and sociocultural influences, it makes sense for clinicians, researchers, and administrators to take a deeper dive.

On a personal level, there is great satisfaction in helping women who face significant challenges to gain better health and greater autonomy, Carr added.

“The reason people do this work is because they’re passionate about it,” she said. “They believe in the value of cultural responsiveness and the reality that people with SMI are marginalized. The work may be harder than other kinds of work, but it’s also rewarding. And if we’re not there, we’re not the voice for the change that needs to occur.”