314 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER D. It was acknowledged that family and societal issues regarding sexual orientation may cause increased stress. E. The effects of increased stress on the client's symptoms were reviewed. F. The client's worth was affirmed regardless of his/her sexual identity. 46. Refer to a Support Group for Sexual Orientation/Mental Illness Concerns ( 46) A. The client was referred to a suppo rt group for those who are struggling with sexual orientation issues and severe and persistent mental illness concerns. B. The client has attended the support group for individuals with sexual orientation issues and severe and persistent mental illness, a nd the benefits of this support group were reviewed. C. The client reported that he/she has not experienced any positive benefit from the use of a support group, but he/she was encouraged to continue to attend. D. The client has not used the support grou p for individuals with sexual orientation issues and severe and persistent mental illness and was redirected to do so. 