Target Population Definition

Eligible Population Definition

TARGET POPULATION: Serious Mental Illness (SMI) for DMHDD funded MH services

AGE: Must be 18 years of age or older

Individuals with serious mental illness are adults whose emotional or behavioral functioning is so impaired as to interfere with their capacity to remain in the community without supportive treatment. The mental impairment is severe and persistent and may result in a limitation of their capacities for primary activities of daily living, interpersonal relationships, homemaking, self-care, employment or recreation. The mental impairment may limit their ability to seek or receive local, state or federal assistance such as housing, medical and dental care, rehabilitation services, income assistance and food stamps, or protective services.

Must meet I+(II or III):

  1. Diagnostic Criteria:
    The client must have one of the following diagnoses that meets DSM-IV criteria and which is the focus of the treatment being provided:

    • Schizophrenia (295.xx)
    • Schizophreniform Disorder (295.4)
    • Schizo-affective Disorder (295.7)
    • Delusional Disorder (297.1)
    • Shared Psychotic Disorder (297.3)
    • Brief Psychotic Disorder (298.8)
    • Psychotic Disorder NOS (298.9)
    • Bipolar Disorders (296.0x, 296.4x, 296.5x, 296.6x, 296.7, 296.80, 296.89, 296.90)
    • Cyclothymic Disorder (301.13)
    • Major Depression (296.2x, 296.3x)
    • Obsessive-Compulsive Disorder (300.30)
    • Anorexia Nervosa (307.1)
    • Bulimia Nervosa (307.51)
  2. Treatment History
    (Treatment history covers the client's lifetime treatment and is restricted to treatment for the DSM IV diagnosis specified in Section I.)
    To qualify under this section, the client must meet at least ONE of the criteria below:

    1.  Continuous treatment of 6 months or more, including treatment during adolescence, in
      one, or a combination of, the following modalities: inpatient treatment, day treatment or partial hospitalization.
    2.  Six months continuous residence in residential programming (e.g., long-term care facility or assisted, supported or supervised residential programs)
    3. Two or more admissions of any duration to inpatient treatment, day treatment, partial hospitalization or residential programming within a 12-month period.
    4. A history of using the following outpatient services over a 1 year period, either continuously or intermittently: psychotropic medication management, case management, outreach and engagement services.
    5. Previous treatment in an outpatient modality, and a history of at least one mental health psychiatric hospitalization.
  3. Functional Criteria
    (Functional criteria has been purposely narrowed to descriptors of the most serious levels of functional impairment and are not intended to reflect the full range of possible impairment.)
    To qualify under this section, the client must meet at least TWO of the criteria, A1 through A7, or B1 as a result of the DSM-IV diagnosis specified in Section I.
    The client:

      1. Has a serious impairment in social, occupational or school functioning.
      2. Is unemployed or working only part-time due to mental illness and not for reasons of physical disability or some other role responsibility (e.g., student or primary caregiver for dependent family member); is employed in a sheltered setting or supportive work situation, or has markedly limited work skills.
      3. Requires help to seek public financial assistance for out-of-hospital maintenance (e.g., Medicaid, SSI, SSDI, other indicators).
      4. Does not seek appropriate supportive community services, e.g. recreational, educational or vocational support services, without assistance.
      5. Lacks supportive social systems in the community (e.g., no intimate or confiding relationship with anyone in their personal life, no close friends or group affiliations, is highly transient or has inability to co-exist within family setting).
      6. Requires assistance in basic life and survival skills (must be reminded to take medication, must have transportation to mental health clinic and other supportive services, needs assistance in self-care, household management, food preparation or money management, etc., is homeless or at risk of becoming homeless).
      7. Exhibits inappropriate or dangerous social behavior which results in demand for intervention by the mental health and/or judicial/legal system.
    1. The client does not currently meet the functional criteria listed above, however, the client:
      1. Is currently receiving treatment, has a history within the past 5 years of functional impairment meeting TWO of the functional criteria listed above which persisted for at least 1 months, and there is documentation supporting the professional judgement that regression in functional impairment would occur without continuing treatment.