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Severe mental disability
MHS uses the definition of severe mental disability described by Administrative Rule 5122-24-01 (B)(68) of the Ohio Department of Mental Health (ODMH, 2004) Certification Standards for Community Mental Health Agencies. In this rule, a "person with severe mental disability" means an adult who meets at least two of the three criteria of diagnosis, duration, and disability.
For diagnosis, ODMH publishes a list of qualifying disorders, defined in the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV; American Psychiatric Association, 1994).
For duration, the mental disorder must have resulted in one or more hospitalizations of specified duration, or major functional impairment lasting more than two years, resulting in use of outpatient mental health services.
For disability, there must be disruption in two or more major life activities, such as employment, self-care, perception, and social relations.
Many homeless persons who participate in MHS services have a schizophrenic disorder. This disorder is characterized by episodes of delusions, hallucinations, and other disturbances of perception, thought, mood, motivation, and interpersonal relationships. Studies of urban populations in the United States have found a lifetime prevalence of schizophrenia of about one percent. Other homeless persons with a severe mental disability served by MHS have a severe mood disorder, such as bipolar disorder, major depression, or schizoaffective disorder, characterized by repeated episodes of severe depression or irritability.
Personality disorders may also result in a severe mental disability. These disorders are enduring, inflexible, and maladaptive ways of perceiving, thinking about, and interacting with the world. They may be present without any other mental disorder, or they may co-exist with one or more other disorders. Antisocial, borderline, histrionic, and narcissistic personality disorders are among the most common, and the most disabling.
References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Ohio Department of Mental Health. (2004). Certification standards for community mental health agencies. Administrative rules 5122-23 to 5122-29. Columbus, OH: Author.
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