For some, serious mental health struggles can be be lifelong.

The National Institute on Mental Health says that serious mental illness (known as SMI) is “a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.”

In 2019, there were an estimated 13.1 million adults age 18 or older in the U.S. with SMIs, also known as “serious and persistent” mental illness. Examples can include schizophrenia or bipolar disorder.

According to the National Alliance on Mental Illness-Minnesota (NAMIMN), the four most common mental illness diagnoses for adults are anxiety disorders, major depression, bipolar disorder, and schizophrenia. For children and adolescents, the most common are anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), depression, bipolar disorder, Asperger’s syndrome, and eating disorders. Degrees and expressions of these mental illnesses take a variety of forms.

According to Sue Aberholden (M.P.H. ’80), executive director of NAMI-MN (namimn.org), the biggest challenges individuals with SMIs face are finding stable housing and employment, along with appropriate support services.

“Our mental health system isn’t broken—it was never fully built,” she says, noting a better system would include more efforts to provide early identification and intervention for mental health issues; having enough beds and intensive services to address acute mental health crises; and having better insurance support for long-term treatment. She also notes that existing inpatient beds in Minnesota for individuals suffering from mental health crises are often full to capacity on any given day.

As for supporting individuals with SMIs within the wider community, Abderholden says having multiple options are key.

“For some people, [living in] a corporate foster care setting with a Medicare waiver is going to work,” she says. “For other people, [it’s] several small apartments that are in the same building, while still providing support. For still others, as long as they have housing and someone to come in and check in on them, as with a community support team, they’re fine. But it is really hard.”

One program that exists in Minnesota to help individuals with severe mental illness live more independently is Tasks Unlimited, one of the largest such groups in the metro area.

Founded in 1970, Tasks follows an alternative approach to hospitalization, popularized by social psychologist George W. Fairweather. Known as the Fairweather model, under this approach individuals with severe mental illness live together in small groups, providing support to each other, while also receiving job training or working. (See Bruce Ario’s first-person essay here about his experiences with Tasks.)

Tasks helps its clients find employment through contracts it maintains for janitorial, office, or remodeling work. Ashley Trepp (M.S.W. ’04) is the director of mental health services of the not-for-profit and oversees staff who provide intensive residential treatment services, case management, adult mental health rehabilitative services, and the peer-supported Fairweather Lodge and jobs program. The group also offers a homeless outreach effort and a day shelter to reach individuals not supported through other efforts, and also works with individuals leaving Anoka Metro Regional Treatment Center, Minnesota’s largest state-operated psychiatric hospital, through a program called “Whatever It Takes.”

“The vast majority of our [work] serves folks with a diagnosed mental illness,” says Trepp, noting that schizophrenia and bipolar disorder are common. Tasks assists people who have “enough functional barriers [with daily life] where they are in need of services,” she adds.

The group serves nearly 300 clients, with 21 lodges around the Twin Cities metro area. It also has 14 job contracts, both federal and county, in Minneapolis and St. Paul. A number of specialized lodges through Tasks also support seniors or women or individuals convicted of felonies that stemmed from their mental illness.