Serious Mental Illness (SMI) determination is based on the age of the ...

APPENDIX B

Serious Mental Illness (SMI) determination is based on the age of the individual, functional impairment, duration of the disorder and the diagnosis. Adults must meet all of the following four criteria:

1. Age: Must be an adult 18 years of age or older.

2. Diagnoses: Have one of the diagnoses as defined under the current American Psychiatric

Association Diagnostic and Statistical Manual of Mental Disorders. The diagnosis would need

to have been determined within the prior 12 months by an appropriately credentialed and

licensed professional.

Diagnoses codes and descriptions that are found in Appendix A and

Appendix B of this document are those providing a primary reason for

receiving public system behavioral health services.

3. Functional Impairment: The disturbance is excessive and causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. Duration: The disability must be expected to persist for six months or longer.

Person must meet SMI criteria and at least one of the following in A or B:

A . Symptom Severity and Other Risk Factors

Significant current danger to self or others or presence of active symptoms of a SMI. Three or more emergency room visits or at least one psychiatric hospitalization within

the last year. Individuals with substance use disorder that complicates SMI and results in

worsened intoxicated/withdrawal complications, bio medical conditions, emotional/behavior/cognitive conditions. Person is experiencing trauma symptoms related to sexual assault, domestic violence or other traumatic event.

B. Co-Occurring Disorders

Substance Use Disorder (SUD) diagnosis and any mental illness that affects functionality.

SMI or SUD and potentially life-threatening chronic medical condition (e.g., diabetes, HIV/AIDS, hepatitis).

SMI or SUD and Developmental Disability.

Approved by the Behavioral Health Collaborative ? August 2015

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Appendix A Serious Mental Illness (SMI) -Severe Emotional Disturbance (SED) Criteria

SMI-SED Category

Neurodevelopmental Disorders Neurodevelopmental Disorders

Neurodevelopmental Disorders

DSM-V ICD-9 299.00 307.22

307.23

DSM-V ICD-10 F84.0 F95.1

F95.2

Description

Autism Spectrum Disorder Motor Disorder ? Persistent (chronic) Motor or Vocal Tic Disorder Tourette's Disorder

Neurodevelopmental Disorders Neurodevelopmental Disorders

Neurodevelopmental Disorders

Neurodevelopmental Disorders

Neurodevelopmental Disorders

Neurodevelopmental Disorders

Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders

307.3 314.00 314.01 314.01 314.01 314.01 293.81 293.82 295.40 295.70 295.70

F98.4 F90.0 F90.1 F90.2 F90.8 F90.0 F06.2 F06.0 F20.81 F25.0 F25.1

Stereotypic Movement Disorder Attention ?Deficit/Hyperactivity Disorder: Predominantly inattentive presentation Attention ?Deficit/Hyperactivity Disorder: Predominantly hyperactive/impulsive presentation Attention ?Deficit/Hyperactivity Disorder: Combined presentation Attention ?Deficit/Hyperactivity Disorder: Other Specified Attention ?Deficit/Hyperactivity Disorder Attention ?Deficit/Hyperactivity Disorder: Unidentified Attention ?Deficit/Hyperactivity Disorder With delusions

With hallucinations

Schizophreniform Disorder

Bipolar type

Depressive type

Sources: SMI Criteria 8_19_2015 approved by the Collaborative document, SED Criteria 8_19_2015 approved by the Collaborative document, and Desk

Reference to the Diagnostic Criteria from DSM-5.

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Appendix A Serious Mental Illness (SMI) -Severe Emotional Disturbance (SED) Criteria

SMI-SED Category

Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Schizophrenia Spectrum and other Psychotic Disorders Bipolar and Related Disorders

Bipolar and Related Disorders

Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders Bipolar and Related Disorders

DSM-V ICD-9 295.90

297.1

298.8

293.89

298.9

301.22

293.83

293.83

296.40 296.41 296.42 296.43 296.44 296.45 296.46 296.50 296.51 296.52 296.53 296.54 296.55 296.56 296.89 296.80

DSM-V ICD-10 F20.9

F22

F28

F06.01

F29

F21

F06.33

F06.34

F31.9 F31.11 F31.12 F31.13 F31.2 F31.73 F31.74 F31.9 F31.31 F31.32 F31.4 F31.5 F31.75 F31.76 F31.81 F31.9

Description

Schizophrenia

Delusional Disorder

Other Specified Schizophrenia Spectrum and Other Psychotic Disorders Catatonia Associated with Another Mental Disorder or Unspecified Catatonia Unspecified Schizophrenia Spectrum and Other Psychotic Disorder Schizotypal (Personality) Disorder

Bipolar and Related Disorders due to another medical condition. Specify: With manic features or with manic hypomanic-like episode Bipolar and Related Disorders due to another medical condition? With mixed features Unspecified Mild Moderate Severe With psychotic features In partial remission In full remission Unspecified Mild Moderate Severe With psychotic features In partial remission In full remission Bipolar II Disorder Unspecified Bipolar and related disorder

Sources: SMI Criteria 8_19_2015 approved by the Collaborative document, SED Criteria 8_19_2015 approved by the Collaborative document, and Desk

Reference to the Diagnostic Criteria from DSM-5.

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Appendix A Serious Mental Illness (SMI) -Severe Emotional Disturbance (SED) Criteria

SMI-SED Category

Depressive Disorders Depressive Disorders

Depressive Disorders

Depressive Disorders

Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Depressive Disorders Anxiety Disorders Anxiety Disorders Anxiety Disorders Anxiety Disorders Anxiety Disorders Anxiety Disorders Anxiety Disorders Anxiety Disorders Obsessive-Compulsive Related Disorders

DSM-V ICD-9 296.99 293.83

293.83

293.83

296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.30 296.31 296.32 296.33 296.34 296.35 296.36 300.4 311 311 625.4 293.84 300.00 300.01 300.02 300.09 300.22 300.23 309.21 294.8

DSM-V ICD-10 F34.8 F06.31

F06.32

F06.34

F32.9 F32.0 F32.1 F32.2 F32.3 F32.4 F32.5 F33.9 F33.0 F33.1 F33.2 F33.3 F33.41 F33.42 F34.1 F32.8 F32.9 N94.3 F06.4 F41.9 F41.0 F41.1 F43.9 F40.00 F40.10 F93.0 F06.8

Description

Disruptive Mood Dysregulation Disorder Bipolar and Related Disorders Due to Another Medical Condition (80)?with depressive features Bipolar and Related Disorders Due to Another Medical Condition (80) -with major depressive-like episodes Bipolar and Related Disorders Due to Another Medical Condition (80) ? with mixed features Unspecified Mild Moderate Severe With psychotic features In partial remission In full remission Unspecified Mild Moderate Severe With psychotic features In partial remission In full remission Persistent Depressive Disorder Other Specified Depressive Disorder Unspecified Depressive Disorder Premenstrual Dysphoric Disorder Anxiety Disorder Due to Another Medical Condition Unspecified Anxiety Disorder Panic Disorder Generalized Anxiety Disorder Other Specified Anxiety Disorder Agoraphobia Social Anxiety Disorder (Social Phobia) Separation Anxiety Disorder Obsessive-Compulsive Disorder Due to Another Medical Condition

Sources: SMI Criteria 8_19_2015 approved by the Collaborative document, SED Criteria 8_19_2015 approved by the Collaborative document, and Desk

Reference to the Diagnostic Criteria from DSM-5.

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Appendix A Serious Mental Illness (SMI) -Severe Emotional Disturbance (SED) Criteria

SMI-SED Category

Obsessive-Compulsive Related Disorders

Obsessive-Compulsive Related Disorders Obsessive-Compulsive Related Disorders Obsessive-Compulsive Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Trauma-and Stressor Related Disorders Dissociative Disorders Dissociative Disorders Dissociative Disorders Dissociative Disorders Dissociative Disorders Dissociative Disorders Somatic Symptom and Related Disorders

Somatic Symptom and Related Disorders

DSM-V ICD-9 300.3

300.7 312.39 698.4 308.3 309.0 309.24 309.28 309.3 309.4 309.81 309.89 309.9 313.89 313.89 300.12 300.13 300.14 300.15 300.15 300.6 300.11

300.11

DSM-V ICD-10 F42

F45.22 F63.3 L98.1 F43.0 F43.21 F43.22 F43.23 F43.24 F43.25 F43.10 F43.8 F43.9 F94.1 F94.2 F44.0 F44.1 F44.81 F44.89 F44.9 F48.1 F44.4

F44.5

Description

Obsessive-Compulsive Disorder, Hoarding Disorder, Other Specified Obsessive-Compulsive Related Disorder, Unspecified Obsessive-Compulsive Related Disorder Body Dysmorphic Disorder Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder Acute Stress Disorder With depressed mood With anxiety With anxiety and depressed mood With disturbance of conduct With mixed disturbance of emotions and conduct Posttraumatic Stress Disorder Other Specified Trauma- and Stressor-Related Disorder Unspecified Trauma- and Stressor-Related Disorder Trauma- and Stressor-Related Disorder Disinhibited Social Engagement Disorder Dissociative Amnesia With dissociative fugue Dissociative Identity Disorder Other Specified Dissociative Disorder Unspecified Dissociative Disorder Depersonalization/Derealization Disorder Conversation Disorder (Functional Neurological Symptom Disorder. Specify: with weakness or paralysis; or with abnormal movement; or with swallowing symptoms Conversation Disorder (Functional Neurological Symptom)Disorder. Specify: with attacks of seizures; or with special sensory loss

Sources: SMI Criteria 8_19_2015 approved by the Collaborative document, SED Criteria 8_19_2015 approved by the Collaborative document, and Desk

Reference to the Diagnostic Criteria from DSM-5.

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