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Early Serious Mental Illness

SAMHSA defines Early Serious Mental Illness (ESMI) as a condition that affects an individual, regardless of their age, and that is a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within the DSM 5 (APA, 2013). For a significant portion of the time since the onset of the disturbance, the individual has not achieved or is at risk for not achieving the expected level of interpersonal, academic or occupational functioning.

This definition is not intended to include conditions that are attributable to the psychologic effects of a substance, substance use disorder, are attributable to an intellectual developmental disorder or another medical condition. The term ESMI is intended for the initial period of onset of the symptoms.

OhioMHAS, in collaboration with SAMHSA, has included the following diagnostic criteria when prioritizing funding for individuals with ESMI:

First Episode Psychosis Diagnostic Criteria (within two years of initial onset):

Brief Psychotic Disorder, Schizophreniform Disorder, Bipolar Disorder with Psychotic Features, Major Depression with Psychotic Features, Schizoaffective Disorder, Delusional Disorder and Schizophrenia.

Early Serious Mental Illness Diagnostic Criteria (onset generally early 20’s):

Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia), Bipolar 1 Disorder, Bipolar II Disorder and Cyclothymic Disorder.


National organizations offer a number of tools to assist providers in readiness for providing services to individuals with first episode psychosis, including webinars and issue briefs.


Ohio's FEP Program

Using SAMHSA federal Block Grant funds, the Ohio Department of Mental Health and Addiction Services funds agencies throughout the state to develop or expand programs for individuals experiencing their first episode of psychosis. The FEP programs target individuals ages 15-35 who are within two years of their initial symptoms of psychosis. These providers offer the Coordinated Specialty Care (CSC) Model which is primarily designed for adolescents and young adults. CSC consists of assertive case management, individual or group psychotherapy, supported employment and education services, family education and support, and possibly low doses of anti-psychotic medications. These services are also closely coordinated with primary health care.

Project ECHO