When a person is seriously mentally ill, health care providers will take note of something referred to as “ADL’s.”  This stands for “Activities of Daily Living.”  People with serious mental illness often have trouble accomplishing these activities of daily living, most of which the non-mentally ill take for granted.

Activities of Daily Living include: bathing, brushing teeth, other aspects of personal hygiene like washing and combing hair, changing regularly into clean clothes, and eating sensible meals on a consistent schedule. ADL’s can also include medication compliance and a regular sleep schedule. Most of us carry out our own activities of daily living without fanfare, automatically, and we can self-regulate all our basic needs and functions.

But for a person with serious mental illness (SMI), these activities of daily living could easily make up the entire “to-do list” for their day. Accomplishing these ADL’s can be seen as a milestone or at least a good marker for stability or progress.  ADL’s may change over time, with more added.  Initially, such as in a hospital setting, some of these ADL’s will be used as criteria for determining if a person is “gravely ill” and in need of a higher level of care.  When my own son finally moved into a therapeutic program, he was hardly doing any of his ADL’s without prompting. Within weeks he was on a schedule and the staff even required that he make his own bed daily and do his own laundry weekly. He was able to add these activities to his routine within a short period of reminding and encouragement.

Some of these ADL’s will determine if a person can live on their own or in a group Board and Care. Some of these ADL’s will help determine if the person is on the right medication or the right dosage. Even Conservatorship or eligibility for disability benefits will take into account the person’s ability to adhere to their ADL’s.

There is a wide range in functionality for people with mental illness and some folks need reminding, prompting, and rewards for doing their ADL’s.  Everyone does better in life if they have a routine of healthy habits, like daily exercise.  But for mental illness, the ADL’s can make a huge difference in the quality of their life, with extended implications.  For example, it’s not just important to bathe regularly for our own self-esteem.  Others don’t want to spend time with is if we smell bad, so helping a person with SMI do their ADL’s can also mean the difference between socializing or not, or even having a job or not.

When a person has a Thought Disorder and/or a Mood Disorder, doing the ADL’s may simply not occur to the person, engrossed in their own internal world or plagued with paralyzing anxiety. We have all had isolated bad days or a bad week, where we didn’t care how we looked or if we got anything accomplished. Severe depression or episodic depression can make it hard for some to even get out of bed. Our ADL’s will be pushed to the wayside until we feel better.  With severe mental illness, a person could feel lethargic, unmotivated, tired or depressed on a regular basis.  Since we cannot know what is really going on inside another person without them willing to express their thoughts and emotions, sometimes the ADL’s are the only way to gage what is going on with a person and used as a diagnostic tool, setting a baseline for recovery and eventual higher-functioning and more demanding goals.

Author: Kartar Diamond is a Mental Illness Advocate and author of Noah’s Schizophrenia: A Mother’s Search for Truth