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April 27, 2018

What is the PASRR Definition of Mental Illness?

According to 42 CFR 483.102(b), a disorder qualifies as a mental illness (MI) for PASRR purposes if it satisfies three major criteria:

1. It appears as a major mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, revised (DSM-III-R), published in 1987. This mental disorder is—

(A) 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
(B) 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 as defined in paragraph (b)(1)(i)(A) of this section.

1. It has resulted in functional impairments in major life activities in the last 3-6 months, including interpersonal functioning, concentration, and adaptation to change; and

2. The individual has a recent history of treatment, which means at least one of the following:

(A) Psychiatric treatment more intensive than outpatient care more than once in the past 2 years (e.g., partial hospitalization or inpatient hospitalization); or
(B) Within the last 2 years, due to the mental disorder, experienced 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.

The Code of Federal Regulations (CFR) provision, in effect since 1992, cited the DSM-III-R because it contained the most current compilation of mental disorders at the time the regulations were published, and because the authors of the original PASRR legislation (in the Omnibus Budget Reconciliation Act of 1987) wished to "identify" a set of people that would not change over time (so that the application of PASRR would itself not change arbitrarily).

DSM-5 now contains the most current compilation of mental disorders, meaning that the PASRR regulations mention disorders that DSM-5 now excludes (such as "organic brain disorder"). Because the regulations have not been updated, states have continued to use the DSM III-R as a reference point, meaning that states have "translated" between the DSM III-R and DSM-5, so that PASRR continues to apply to individuals with the same characteristics, even if the diagnostic categories (i.e., the names) changed.

For this reason, states that choose to use DSM-5 in their PASRR operational guidance will not risk being out of compliance. See FAQ Can states refer to the DSM-5 in their operations guidelines related to PASRR, or do they need to incorporate the CFR reference to the DSM III?

PTAC is available to assist states with questions about the definition of MI.

Download: AAMR_1983_MR_DFN

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