The consequence of these intersecting challenges is a vicious cycle in which those who are most impaired receive the least amount of support, thus deteriorating even more over time. People with SMI are often exposed to pervasive societal stigma about their conditions and therefore can be reluctant to openly seek services at a clinic if it risks them being labeled mentally ill. Barriers in the capacity to provide high-quality care on the provider’s side may be compounded by hesitancy around treatment seeking on the patient’s side. These public sector agencies are rarely able to meet the demand for services. Treatment of people with SMI typically takes place in publicly funded clinics and community mental health centers that are chronically underresourced, understaffed, and overextended. SMI is often accompanied by functional and psychosocial impairments, housing and employment challenges, and poverty. People with serious mental illnesses (SMIs), including schizophrenia-spectrum disorders, bipolar disorder, and severe and persistent depression, experience significant psychiatric symptoms such as hallucinations, delusions, and severe mood episodes.
Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3. Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Large effects were observed for the BDI-II ( d=0.58), RAS ( d=0.61), and RSES ( d=0.64) a moderate effect size was observed for the SDS ( d=0.44), and a small effect size was observed for the GAD-7 ( d=0.20). Participants rated CORE as highly usable and acceptable. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Overall, 315 individuals from 45 states participated in this study.
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