In order to be considered an adult with a serious mental illness, "1" below must be met, in addition to either "2", "3", or "4":
Designated Mental Illness
The individual is 18 years of age or older and currently meets the criteria for a psychiatric diagnosis according to the most current Diagnostic and Statistical Manual of Mental Disorders (DSM) other than alcohol or drug disorders, organic brain syndromes, developmental disabilities, or social conditions. ICD-CM psychiatric categories and codes that do not have an equivalent in DSM are also included mental illness diagnoses.
SSI or SSI due to Mental Illness
The individual is currently enrolled in SSI/SSDI due to a designated mental illness.
Impairment in Functioning due to Mental Illness
Documentation that the individual has experienced two of the following four functional limitations due to a designated mental illness over the past 12 months on a continuous or intermittent basis:
Marked difficulties in self-care (personal hygiene, diet, clothing avoiding injuries, securing health care, or complying with medical advice).
Marked restriction of activities of daily living (maintaining a residence, using transportation, day to day money management, accessing community services).
Marked difficulties in maintaining social functioning (establishing and maintaining social relationships, interpersonal interactions with primary partner, children or other family members, friends, neighbors, social skills, compliance with social norms, appropriate use of leisure time).
Frequent deficiencies of concentration, persistence or pace resulting in failure to complete tasks in a timely manner (ability to complete tasks commonly found in work settings or in structured activities that take place in home or school settings, individuals may exhibit limitations in these areas when they repeatedly are unable to complete simple tasks within an established time period, make frequent errors in tasks, or require assistance in the completion of tasks).
Reliance on Psychiatric Treatment, Rehabilitation and Supports
A documented history shows that the individual at some prior time met the threshold for 3 (above), but the symptoms and/or functioning problems are currently attenuated by medication or psychiatric rehabilitation and supports. Medication refers to psychotropic medications which may control certain primary manifestations of mental disorder, e.g. hallucinations, but may or may not affect functional limitations imposed by the mental disorder. Psychiatric rehabilitation and supports refer to highly structured and supportive settings (e.g. Congregate or Apartment Treatment Programs) which may greatly reduce the demands placed on the individual and thereby, minimize overt symptoms and signs of the underlying mental disorder.