Anosognosia and SMI: Why it’s not as simple as “Not Wanting Help”

May is Mental Health Awareness month, and Mental Wellness will be the theme of GBCC's 2024 Health & Wellness Expo.
​In the blog below, Expo Co-Chair and Help in the Home Co-Founder Rayetta Michael shares her insights on anosognosia and severe mental illness.

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Guest Blog by: Rayetta Michael, Help in the Home

From the outside looking in, it’s easy to misinterpret the struggles and seeming unwillingness of someone with severe mental illness (SMI) to seek or accept help. In this month’s blog, we’re discussing a condition called “anosognosia” which prevents individuals with SMI from understanding their own diagnosis. 
Help in the Home has walked alongside family members in these situations through our Family Consultation services and our founders have advocated for Assisted Outpatient Treatment bills (AOT), to help those with SMI and anosognosia be able to access treatment. 
 
WHAT EXACTLY IS ANOSOGNOSIA?
Anosognosia is a “lack of insight” which removes the ability for an individual to comprehend and understand their own diagnosis. It is commonplace for people with schizophrenia and/or bipolar disorder to be incapable of acknowledging their own SMI diagnosis because of the SMI itself.  
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According to the Treatment Advocacy Center, approximately half of those with schizophrenia and 40% of those with bipolar disorder have symptoms of anosognosia. This condition inhibits some from consciously realizing they have been diagnosed with a mental illness and it is the main reason why many people diagnosed with schizophrenia and bipolar disorder refuse medications and other treatments. It is common to see this occur with Alzheimer’s disease and even stroke victims.
The good news is that when individuals with SMI start taking medication, insight into their illness can improve. The challenge is helping them access treatment.  That is where our passion to advocate for AOT laws comes into play.

CONSEQUENCES OF CURRENT LAWS
Assisted Outpatient Treatment (AOT), which is a civil court order for outpatient treatment, was created to help individuals with SMI and anosognosia access treatment.  All but three states have laws like this in place to protect those with SMI, but unfortunately Maryland is not one of those states. Many of the laws that protect human rights can also prevent those with SMI from accessing treatment. When dealing with anosognosia, there’s an inability for the person to see the need for help and therefore, be able to make rational decisions to ensure their health and safety.

AOT protects the rights of a human being whose brain has been hijacked by their mental illness. When someone with anosognosia doesn’t have laws protecting them, then the mental illness is in charge. This can make providing services extremely difficult, and often impossible. While we do not provide involuntary services at Help in the Home, we do provide support to family members through our Family Consultation services. Family members find comfort and strength through working with our Family Specialists to confirm they’re doing all they can do and that they aren’t in it alone.
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INTERNAL ADVOCACY POLICY
Even before our doors opened in 2008, Help in the Home had been relentlessly and tirelessly advocating for the passing of AOT bills in Maryland. For the last 18 years, this very controversial bill has often been seen as a violation of human rights by the opposition. Many who oppose this bill fail to grasp the impact that anosognosia has on individuals with SMI and how it impacts their ability to make informed decisions for themselves.
In addition to providing oral and written testimony in support of AOT for the past 15 years, this year Help in the Home established an internal advocacy policy for our team.  We require our employees to participate in some form of mental health policy advocacy at least once per year.

Qualifying activities include:

• Provide testimony to support mental health bills which improve quality of life and access to care
• Writing letters to local legislators in support of specific policies
• Attending mental health advocacy events to speak with local legislators

This policy encourages accountability for everyone on our team to support our clients and their families in every way possible. Additionally, we have increased our communication efforts to ensure that opportunities for advocacy are shared across our network which includes staff, clients, families, alumni, and professionals. Together, we can leverage our collective voices, knowledge, and experiences to make our state, country, and ultimately the world, a better place for people with SMI and their families. 
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Want to learn more about how you can help?  Dig into these resources:

• Dr. David Pickar’s Film, “The Realities of Serious Mental Illness” 
• NAMI Anosognosia Blog 
• Treatment Advocacy Center’s Video on Anosognosia 
• Book Recommendation: I’m Not Sick, I Don’t Need Help! by Xavier Amador, Ph.D. ​

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The views expressed in this blog post are solely those of the author and do not necessarily reflect the opinions or positions of the Greater Bethesda Chamber of Commerce. The Chamber is a non-partisan organization dedicated to fostering economic growth and community development in the Bethesda area. Any opinions, analysis, or recommendations presented in this post are those of the author alone and do not represent an endorsement or official stance by the Chamber. We encourage readers to consider multiple perspectives and consult with relevant experts before forming their own opinions on the topics discussed.