Specific Conditions. A person is considered
to have a serious mental illness if the person meets the following requirements
of diagnosis, level of impairment and duration of illness.
Diagnosis. The person has a major mental disorder diagnosable under
the DSM, current edition. This mental disorder is
a schizophrenic, mood,
paranoid, panic or other severe anxiety disorder; somatoform
disorder; personality disorder; other psychotic disorder; or
another mental disorder that may lead to a chronic disability; but
not a primary diagnosis
of dementia, including Alzheimer’s disease
or a related disorder, or a non-primary diagnosis of dementia unless the
primary diagnosis is a major mental disorder.
Level of impairment. Within the past 3 to 6 months the disorder has
resulted in functional limitations in major life activities that would be appropriate
for the person’s developmental stage. A person typically has at
least one of the following characteristics on a continuing or intermittent
basis:
interpersonal functioning. The person has serious difficulty interacting
appropriately and communicating effectively with other persons, has a possible
history of altercations, evictions, firing, fear of strangers, avoidance
of interpersonal relationships and social isolation; and/or
concentration, persistence, and pace.
The person has serious difficulty in sustaining focused attention for a
long enough period to permit the completion of tasks commonly found in
work settings or in work-like structured activities occurring in school
or home settings, manifests difficulties in concentration, inability to
complete simple tasks within an established time period, makes frequent
errors, or requires assistance in the completion of these tasks; and/or
adaptation to change. The person has
serious difficulty in adapting to typical changes in circumstances associated
with work, school, family, or social interaction; manifests agitation,
exacerbated signs and symptoms associated with the illness, or withdrawal
from the situation; or requires intervention by the mental health or judicial
system.
Recent treatment.
The treatment history indicates that the person has experienced at least one
of the following
psychiatric treatment more intensive than outpatient care
more than once in the past 2 years (e.g., partial hospitalization or inpatient
hospitalization); or
within the last 2 years and due to the mental disorder,
an episode of significant disruption to the normal living situation, for
which supportive services were required to maintain functioning at home,
or in a residential treatment environment, or which resulted in intervention
by housing or law enforcement officials.
Dementia. A person is considered to have
dementia if there is a primary diagnosis of dementia, as described in the
DSM, or a non-primary diagnosis of dementia unless the primary diagnosis
is a major mental disorder as defined in Section III.a.i, above. (Agitated
dementia with a suspicion of mental illness should be noted on the level
1 screen and sent to the department of mental health services for review).
Specialized Services. Specialized
services are those that are provided in addition to the routine care provided
by an NF, and that result in the continuous and aggressive implementation
of an individualized plan of care for mental illness. ; DHHS considers
specialized services to be appropriate in an NF when they
are developed and overseen by an interdisciplinary team that
includes a physician and mental health professionals; and
prescribe specific therapies
and activities supervised by trained mental health personnel; and
are directed
towards diagnosing and reducing the person’s behavioral symptoms, improving
the level of independent functioning, and achieving a functioning level that
permits reduction in the intensity of mental health services at the earliest
possible time.
The
prescribed therapies and activities in the individualized care plan may
include, but are not limited to the services of a psychiatrist, nurse practitioner,
psychologist or other qualified mental health professional, psychological testing
or evaluation, occupational therapy testing or evaluation, psychotherapy, medication
education, crisis planning and intervention services, day hospitalization or
acute care hospitalization and case management necessary to coordinate the
services described in the plan.
Services of Lesser Intensity than Specialized Services. The
NF must provide mental health services that are of a lesser intensity than specialized
services to all residents who need the lesser services.
Specialized Community NFs. DHHS supplements the services of several NFs throughout the state, to provide more intensive specialized services than would be provided at a community NF. Contact
the Preadmission Screening Services at the DHHS Regional Office to discuss this
option.
