' , 

29422 Federal R~gister I Vol. 58, No. 96 I Thursday, May 20, 1993 I Notices 

In addition to the statutory 

requirements for schools, 'it is 

recommended that each participating 

school est&blisb a committee with 

representation from each of the primary 

health care disciplines for the purpose 

of; (1) informing students about the 

primary health caie specialties and the 

PO. program; (2) providing counseling 

assiStance to students; (3) providing 

input to the student &election process; 

and (4) providingprogram assessment 

and recommendations for improvement. 

Additional Information 

If additional programmatic • 

in formation is needed, please contact: 

Mr. Michael Heningbilrg. Director, 

Division of Student Assistance, Bureau 

of Health Professions, Health Resources 

and Services Administration, Parldawn 

Building, room 8-48, 5600 Fishers Lane, 

Rockville, Maryland 20857. Telephone: 

(301) 443-1173. . 

Dated: May 13, 1993. 

Robert G. Harm.Oll, 

Administrator. 

IFR Doc. 93-11912 Filed 5-19-93; 8:45 lUll) 

BILUHG COD[ 4110-11-f' 

National lnatltutu of Health 

National Institute of Mental Health; 

t.•eetlng 

The Division of Extramural Activities 

of the National Institute of Mental 

Health announces an ad hoc concept' 

review. This committee will be 

performing review of a Request for 

Applications entitled 

"Neuropsychological Test Performance 

in HIV I AIDS." 

This meeting will be held June 1, 

1993, from 2:30pm. to adjournment, in 

Room 15-95, Parklawn Building, 5600 

Fishers Lane, Rockville, Maryland 

20857, andwill be open to the public. 

Attendance by the public will be limited 

to spar.e available. !u:Jy person wishing 

to attend should notify the contact 

person by May 24,1993. 

Other information pertaining to the 

meeting may be obtained from the 

contact person indiC:ated. 

Committee name: Ad Hoc Concept Review 

Committee. 

Contac1: Jean G. Noronha, Ph.D., Room 9C15, Parllawn Building. Telephone: 301-496-

6470. 

Meeting dale: June t, 1993. 

Place: Room ts:-95,' Parkliwn Building, 

5600 Fishers Lane, Rockville, MD 20557. 

Open: June 1, 2:30p.m. to adjourr.ment. 

Individuals who plan lo·attend and need 

special assistance, auch as sign languago 

interpretation or other reasonable 

accommodatio:lS, shot:ld contact the contact 

person named abOve In advance of the 

meeting. 

(Catalog of Federal Domestic Assistance 

Program Numbers 93.126, Small Business 

Innovation Research: 93.176, ADAMHA 

Small Instrumentation Program Grants; 

93.242,,Mental Health Research Grants; 

93.281, Mental Research Scientist 

Development Award and Research Scientist 

Development Award for Clinicians: 93.282, 

Mental Health Research SerViCe Awards for 

Research Training; and 93.921, ADAMHA 

Sdence Education Partnership Award.) 

Dated: May 17, 1993. 

Susu IC. Feldman, 

Committee Management Officer, NJH. 

(FR Doc. 93-12048 Filed 5-19-93: 8:45am) 

Bll.LIHG CODt: ., o~G-41-M 

Substance Abuse and Mental Health 

Services Administration 

Center for Mental Health Services 

AcnoN: Final notice. 

SUMMARY: This notice establishes final 

definitions for: (1) Children with a 

. serious emotional disturbance. and (2) 

adults with a 5erious mental illness. It 

also describes the proposed process for 

developing standardized methods for 

identifying and e.stimati...,g the size of 

these two populations within each 

State. This action is being taken to 

comply with the requirements of Public 

Law 102..:321, the .ADAMHA 

Reorganization Act, which amends and 

supersedes Public Law 99-660. The 

definitions will affect State agencies (the 

recipients of Federal block grant funds 

for mental health services) and are 

necessary because the new law requires 

States to include incidence and 

prevalence estimates o-f the two 

populations as part of the State 

application for a (Ammunity Mental 

Health Services Block Grant award. The 

definitions are intended to encourage 

comprehensive planning for mental 

health services at the State level which 

will address the multiple needs of both 

of these populations, whether or not the 

state agency is the provider of the 

planned services. 

EFFEcnVE DATE: Immediately. It is the 

view of this Department that delaying 

the effective date for a period of thirty 

days is unnecessary and contrary to the 

public interest .• and therefore this rule is 

effective hr.inediately. This rule 

provides definitions for States and is 

necessary for State applications for 

Community Mental Health Services 

Block Grants. No party will be adversely 

affected by the immediate 

imple·mentation of these definitions, 

whereas a delayed effective dote will 

hinder comprehensive planning for 

mental health services. by States. In any 

event, the provisions cf 5 U.S.C. 553(d) 

do not apply since th~ rule relates to a 

grant program. 

FOR FURTliER INFORMAnON CONTACT: 

Irene S. Levine, Ph.D., Deputy Director, 

Center for Mental Health Services, (301) 

443-QOOl. 

Background 

Public Law 102-321, the ADAMHA 

Reorganization Act, was enacted on July 

10, 1992. This law, which amended the 

Public Health Service Act, created the 

Substance Abuse and Mental Health 

Services Administration (SAMHSA). 

Tbe Center for Mental Health Services 

(o.niS) was established within 

SAMHSA to coordinate. Federal efforts 

in the prevention and treatment of. 

mental illnesses and the promotion of 

mental health. Title U ofPublic Law 

102-321 establishes a BlOck Grant for 

Community Mental Health Services, 

administered by CMHS. which allows 

for allocation of funds to States for the 

provision of community mental health 

services to both children with a serious 

emotional disturbance and adults with a 

serious mental illness. Definitions of the 

terms "children with a serious -

emOtional disturbance" and "adults 

with a serious mental illness" and 

establishment of standardized methods 

for making estimates of the overall 

number (prevalence) and the number of . 

new cases (incidence) for these two 

populations arerequired as part of the 

implementation process for the new 

block grant. • 

Summary of Comments 

This document reflects a thorough 

review and analysis of comments 

rl!ceived in response ,to two earljer 

notices published in the Federal 

Register, one on August 21, 1992 (p. 

37979), the other on November 6, 1992 

(p. 53118). 

Nearly 1,200 letterS were received by 

the close of the public comment period, 

expressing either support or concern 

regarding the proposed definitions. 

Those expressing support generally 

praised the breadth of the proposed 

definitions; many of these lett~rs were 

poignant in that they cited instances 

where individuals were denied services 

because their disorders were not 

considered "serious" despite the fact 

that they were associated with 

) functional impairments that 

substantially interfered with or limited · 

th!l performance of qne or more major 

life activities. This segment of the 

respondents favored broad definitions 

and suggested that service priorities bP. . 

established by States (with input from 
.,. Federal Re~ister I \'ul. 58. r-.;o. 96 I Thursday. May 20. 1-993 I Notices 29423 

r.onceme-d citizens) within theSt' broad ~ govt:>n'iiiM!~ts to tai.lcr publidy-funded 

st~rvir.e s-.-stems to me~ local Jl9tlds B.i:ld 

priorities. However, all individue.ls 

who!'e _sen·kes are funded through · 

F~ernl Commuoitv t-isn!al Hi!alth 

S~n·ic~ '3lod:. Grant funds must fall 

wi!hin the criteria sAt forth in 'these 

definitiC~ns. Any ancillary UMt of the~ 

definitions for purposes. other than 

those ident~f.ed in'tha lagislation is, 

outside tho! purview and controi of 

CMHS. 

paramf'{ers. , . n.ose l!:qJressing concern gerrern!ly 

r.o!t>d that the use of Federal block grant 

ful'd~ 5hocld be limitt!d to individual~ 

·wi:!: the most severe and disabling 

disorders. such as ~cbizophrania and 

l'P:tjor mood disorders. These lettc~.s. 

which also contained compelling pe~or.al stories. n6tod the import&nce 

of rneasuring "stlriousness" by both 

disability and duration critt!ria, in 

addition to diagnosis. The letters 

describt>d eloquently the devastating 

effect ofL..,ese illnesses upon those with 

the disorders. as well as their families. 

and noted the paucity of public funds 

a\'&il:!ble for even this most needv and 

disabled group. A smaller set of letters 

for.u.sed on the inclusion or exclusion of 

!<pttcific disorders, such as substa.'lce use disc;ders. developmental disorders, 

a!trntion deficit disorder (ADD). aad Alzheim~r·s disease. 

Tht>Se final definitions s~k to strike 

a balance in addressing the diverStl 

concerns outlined in this summary and 

disrussed in greeter detail below. The 

dt.>finitions are intertded to be broad 

enough so that StatB;'l will oo abltt to 

de\·efop an accurate description of the 

popuiation in need of mental health 

sen·ices. Inclusion in the target 

populations is based on the presence of . 

functional impairment that substantially 

interferes 1'.-ith or limits the performance 

ofontl or more major life activities, in 

addition to a qualifving diagnosis. 

State mental heaftl1 agencies play an 

important leadership role in planning a statewide wsystem of care" thAt draws . 

upon Federal Community Mental Health 

Services Block Grant funds, as well as 

othci public and private reSources, to 

meet the needs of both chil~n and 

adults. Since it is obvious that resources 

for each of these populations are . inadtlquate in relation to need, States 

net-d to contim.:e to set priorities to 

6ssure that the most seriouslv 

emotionally disturbed childrSn and 

seriously mente!ly ill a4ults are given 

priority for services. In the ca..-.e of 

adults, this most-seriously mentaliy ill 

population is largely comprised of 

persons. With schizophrenia and\major 

mood disorders. Atteotian should also 

be given to·those indivi,dua!s with 

serious mental illnesses whose 

Durr:rt.ion Criteria 

Some comments Sl.lgg8Sted that 

duration criteria be added to each 

definition. ~inca duration criteria are 

already col'sidotred in making a specific 

"Diagnosticand Statistical Manual of 

Mttntal Disorders" (DSM-lli-R) 

diagnosis, adding additional criteria for 

durB1ion would either be redundant or 

in conflict with the duration criteria 

already associated with specific 

diagno~s. To provide additional 

clarification, specific language has b.;eJ'! 

inserted in both d~finitions noting that 

th,;se disorders have episodic;. recurrent. 

or persi.'ltent features. 

Severity Criteria 

Some comments urged ·that se\lerity 

critoria be added to each definition. As 

initialiv drafted, both defmitions 

required that to qualify as "serioul'," a 

diat.!nosable mental. emotional. or 

beh'Svioral disorder mus: also be 

ac::companied by functional impairment 

In the revised definition, the threshoid 

for functional impe.i.rtrli!nt has been 

more specifically described as 

"substantially interfering with or 

limiting" one cr more activitiE:ls. 

Furthermore, the .severity of functional 

impairment will be operationally 

defl.ned during the process of 

don;loping standardized methods fer 

estimation. 

Etiology of the Disarders 

disorders bave resulted in homelessness 

or inappropriate involvement in the 

criminal jUstice system. 

Inclusion in or exclusion from the 

definitions is not intended to confer or 

dtmy eligibility for any other ser.vice cr 

benefit at the Federal. State, or local 

levels. Additionally, the definitions are 

not intended to restrict the flexibility pr 

rgsponsibi!ity of State or local 

Some comments suggested that any 

definition of .. serious emotional 

disturbance" and .. serious mental 

illness" must include specific language 

explaining that these are brain diseAses 

v.;th a neurobiological basis. Similarly. 

suggestions were made to narrow the 

definitions so that they include only 

those diagnoses whose etiology has beiln 

proven to be neurobiological. 

Other comments acknOwledged that 

nithough there is w-owing scientific 

evidence suggesting that some disorders 

(e.~., schizophrenia and mood 

disorders) have a neurobiological 

component, it is sti'll not always 

possible to discern definitively which 

disorder! are exclusively biological in 

origin. which disorders are exdusi\'ety 

psychosocial in origin (with no 

biolul!lical component). and what the 

rolati\'e contrib:utiOilS of biolggkal and 

psyr.hQliOCial factors are in the etiology 

of these diSOTders. 

Sinca rapi.d advances are still tak~ 

plt~ce that can be expected to enhance 

our undet:standing Of the neurobiology 

of mental il.l:oes~. it would be 

prt!mature to limit these target 

populations to only \base diagnoses 

which have to date been documented as 

having neurobiological etiologies or to · d~:~termine the extent of neurob.i.ologic.al 

involvement in gi:v:et~ disordss.. 

Neelfor Culturol arrd Elhnic Serrsiti1it;· 

Concerns wem raised that th~ 

definitions: of a serious em.otional 

disturbance in·children and setious 

marital illnes..~ in adults need to b1:1 

sensitive to cultural and ethnic 

cor.r.eptions of illness.. Those exprt!ssing 

conc:ems should be assured that, in 

opttratioualizing the definitions.. C\lliS 

win ma~e every effort to incarporllte the 

<!autions expre-c;sed in DSM-lli-R (pp. 

xxvi-xxviil relating to the U5'! of 

diagnostic categories and the need to be 

sensitive to differences in language, 

valuHs, behavioral standards or norms. 

and idiomatic expressions of distress. 

Experiences Ol" beh&Viars that may be 

n<lfmative in one cultUre can be · -

interpreted as pathological in another. lt 

is also recognized that certain symptom 

clusters are unique to particular cultures 

and may be no less disabling than those 

Pppearing in DSM-111-R. These and all 

other cultural and ethnic GOne&rilS . 

relating to the definitions ohmm!al 

iliness should be setiously considered. 

Inclusion of Attention Deficit Disordl.!.r 

Concerns were raised from diffe~. 

points of view about whotber AOO 

should be included in the Child 

d!:lfinition or not. Some parents raised 

concerns about the n~ati'ie effects of . 

stigma if children with thiS disatdar 

were "labell~d" as having a serious 

emotional disturbance. Some treatment 

pro>iders and educators, an the other 

hand. raised concern about the 

difficulty in making a definitive 

diagnosis or ADD and the need to a."sure 

such children access to appropriate 

services. It was. decided. to include ADD 

in the definiti-on because a significant 

group of children with functional 

impairments associated with thls 

dismder might othMWise be excluded 

from services. 

Inclusion of Alzheimer's Disease 

Numerous cooc&ms were raised about 

the inclusion versus-exclusion of 

individuals with Alzheimer's diseas11in 

the definition. The groo.p of ltetters 
... 

,.. 

29424 Federal Register I Vol. 58, No. 96 I Thursday. May 20. 1993 I Notices 

supporting inclusion noted that 

individuals with Alzheimer's disease 

often "fall through the cracks of the 

treatment system," despite the needs of 

those afflicted. for mental health 

services to deal with the psychiatric 

. sequelae of this disabling disorder. 

Another group of comments noted that 

Alzheimer"s disease is excluded from 

the defin!tion for persons subject to Prtladmission Screening and Annual 

Resident Review (PSARR) W1der the 

Omnibus Budget and Reconciliation Act 

(OBRA) for 1987, as well as from the 

definition of adults with serious mental 

illness found in the nursing home 

provisions of OBRA for 1990. These 

letters suggested that inclusion of 

Alzheimer"s disease in the definition of 

adults with serious mental illness might 

inadvertently be used as a rationale for 

denying coverage under OBRA. Because 

of the strong clinical rationale for 

inclusion, the definition includes the 

diagnosis of Alzheimer's disease. li 

should be noted, however, that this 

inclusion is not intended to confer or 

deny coverage under OBR.A. to . 

individuals otherwise eligible for that 

coverage. 

Exclusion of Substance Use Disorders 

Many comments correctly pointed out 

that substance use plays a strong role in 

exacerbating mental, emotional. and 

behavioraldisorders and particularly 

increases the risk for serious emotional 

disturbance in children and adolescents. 

Also, sgme comments accurately noted 

that substance use disorders are 

inCluded as diagnosable mental 

disorders in DSM-III-R. 

Nevertheless, the decision to exclude 

. substance use disorders from these 

definitions is based primarily on the fact 

that the Federal Government (through. 

the Center for Substance Abuse 

Treatment) administers a separate 

. substance abuse treatment block grant 

intended to fund treatment and 

p·revention services to the States. 

Separate ne.eds assessment procedures 

are required by the Congress to govern 

award of these substance abuse funds. If 

substance use disorders were included 

in these definitions, needs assessment 

activities required by the two newly 

separated mental health and substance 

abuse block grant programs of the two 

Centers would significantly overlap. We 

also believe that Congress· did not 

intend that the limited funds now 

available to States under the 

Community Mental Health Services 

Block Grant be used to fund substance 

abuse services in the absence cif a 

dia~nosable mental disorder.' 

Fmally, it should be noted that given 

the frequent co-occurrence of mental 

and substance use disorders and tho 

n£"ed to provide better integrated cara 

for individuals within this population, 

this exclusion d'oes not apply to 

individuals who meet all other criteria 

set forth in thel'" definitions and have 

a co-occurring substance use disorder . 

This latter group is included in the 

target definitions and applicants for 

Cornmunitv Mental :Health Services 

Block Grant funds will be encouraged to 

ser..-e these individuals. . 

Exclusion of Developmental Disorders 

Comments were also received 

concerning the exclusion of 

developmental disorders (including 

mental retardation and pervasive 

developmen!al disorders). Although 

these disorders are included within 

DSM.-Ill-R, they have been excluded 

from this final notice unless they cooccur with another diagnosablll serious 

emotional disturbance or serious mental 

illness. While comments received cited 

the frequent involvement of mental 

health practitioners in treatment 

planning and service delivery for these 

individ.uals (particularly autistic 

childnm), separate Federal block grant 

funds and processes for needs 

assessments cover these population 

groups. 

Exclusion of "V" Codes 

Concerns were raised as to whether or 

not DSM:..Ill-R "V" Codes should be 

includud in the definitions. These have 

been excluded in the final definition 

because they represent conditions that 

mav be a focus of treatment but arc not 

attributed to a mental disorder. 

E.'l.clusion of "At Risk" Gr:oups 

Persons at risk for serious emotional 

disturbance or mental illness are not 

included in these definitions. Mental 

health needs are shaped by a multitude 

of forces, including biology, 

environment, and life events. It is 

recognized that serious emotional 

disturbance or mental illness occurs 

more predictably in the presence of 

certain risk factors. These factors 

include, but are not .limited to, 

homelessness; family history of mental 

illness; physical or sexual abuse or 

neglect;alcohol or other substance 

abuse; HIV infection; chronic and 

serious physical. or developmental 

disability or illness; heavy and/or 

persistent substance !JSe; and, in 

chHdren, multiple out-of"home 

placements. Nevertheless, in our 

deliberations, the importance of 

approaching the needs of children and 

adolescents within a developmental 

context was stressed. Prevention and 

early intervention services" should focus 

oil people experiencing any of these risk 

factors. It should be noted that paopltl 

with specific combinations of risk 

factors arc at much higher risk for 

st:riuus emotional disturbance or me:Jta! 

iII ness. 

Congrut'nce of the Child D€finition H"i;!. 

Other FC'dcral Definitions 

Concern was also expressed that the 

defin;tion of "serious emotional 

disturbance" in children should be 

congruent with the definitions of other 

Federal agencies and/or departments, 

particularly the U.S. Department of 

Education (DOE); which uses the 

identical term in the regulations 

implementing part B of the Individuals 

wilh Disabilities Education Act (IDE;\) 

This was fult to be important since the 

same children often seek various ty.pes . 

of services from different agencies. 

While it makes sense that definitions 

used by Federal child-serving agencies 

conform to one another, the fact that 

, identical terms may be used for difiere::·. 

purposes should be ke{Jt in mind .. The definition ~sed m this final 

notice is broader.Jhan the definition 

used in part B of IDEA. Thus, childre:-1 

who are considered seriously 

emotionally disturbed under this 

definition could be classified as having 

a different impairment under part B Of 

IDEA. For example, certain children 

withattention deficit disorder 

consiclertld "~eriously emotionally 

disturbed" under this definition, would 

b; considered "other health impaired"" 

undtlr part B of IDEA. 

In this regard, it should benoted that 

~ meeting the criteria for a "serious 

emotional disturbance" under this 

definition does not confer eligibility for 

special education serviCes funded 

through DOE under IDEA. Children 

acceptud for IDEA services under the 

cotegory of "Serious Emotional 

Disturbance" must meet specific IDE:\ 

criteria. Because of the incongruity 

betWtlf;ln these two Federal definitions, 

anv referrals from States, local. or 

private t!ducational agencies for IDEA 

services should not be made using the 

"serious emotional disturbance" 

designation developed under this 

statute. Referrals to these educational 

agencies may use DSM-m-R 

terminology. 

Standardized Methods for Estimation 

The definitions presented here will 

serve as the basis for developing 

standardized estimation methodologies 

bv each State to determine the 

prevalence and incidence of serious 

mental illness in adults and serious 

emotional disturbance in children and 

adolescents, Although the definitions 
1,. 

I 

Federal Register I Vol. 5!!, t-;-.,. 96 I Thiusdny. Ma.v 20. 1993 I N0ticcs 294Z5 

l nrl' being made a••ailab\e now, it is not 

anticipated that the estimntion 

ml!thodo\ogies will be developed and 

avaiiable for use bv States iu time for 

the fiscal veer (FYi 1994 Communih· 

Mentr,l Health Services Block Grarit. 

applications. Thus, while States arH 

encowaged to utilize these new · 

ddinitions in FY 1994 application!>, 

they will not be required to do so until 

thP estimation methodologies ho\'e bL~en 

developed and disseminated. 

The estimation methodologies for 

"adults \\ith a serious mental illness" 

and "children with a serious emotional 

disturban'ce" will be developed by two 

separate groups of technical exports 

who will operationalize the key 

concepts in each definition on the basis 

of available data sets. The c.ms will 

continue to consult with L">.e NatimHil 

J,nstitute of Mental Health ar.d ot!:~r 

relevant Federal agencies in J 

operationalizing these definitions . .A.s 

noted earlier, a kev activity of ecch 

group will be to ~velop o"pcration:.d 

measures for functional impairmenL 

The goal will be to develop overall' 

prevalence and incidence rates for 

socio-demographic subgroups that can 

be applied to respective population 

counts for a Stat_e in order to produce 

final State estimates. If relevant data sets 

are not a\·ailable to achieve this goal, 

then the technical-experts will 

recommend a.plan and timetable 

through which such data can be 

collected. 

Definitions 

Definition of Children With a Serious 

Emotional Disturbance 

Pursuant to section 1912(c) afthe 

Public Health Service Act. as amended 

by Public Law 102~21 "children with 

s serious emotional disturbance" are 

persons: 

• From birth up to age 18.•· · 

• Who currently or at any tiJ.nB duriug the 

past ycar,2 

• Have had a diagnosable m£>ntal, 

behavioral. or emotional disorder of 

sufficient dnnrtion tb meet diagnostic criteria 

specified within DSM-ffi-R,l . 

,

11he definition or serious emotional dlsturbance 

tD chlldnln is rastricted to ~ru ap to age 18. 

However, it i5I"IICOgllized thatSOIM States extend 

this agelllllip to·penon.s less th1.11 ase 22. To 

accommodah! this variability, States using Bll 

extended age range for c:hildreo'a S«Vic:es sho\tld 

provide IBpBlMe Ntimatn For periOIU below age 18 

and for per119JU. aged 1B to 22 within block grant 

applications. 2 The reference vear in IIBch or ths daflnilions 

refers to a c:onlimi'ous 12·month period because this 

ia a frequeutly used iDlerYal tD epidNJLiological 

re.sean:h and because it relate1. c:IQS8ly to commonly USIId planning cycles. 

'II Ia anticipated that the fourth edition of the 

Amari:an Psychiatric As~ociatlon Diagnostic and 

• Tha: resuhlld in functional imP"dinner.: 

which substan.tial!v inte;feres with or limits th~ child's role or functioning in family. 

sc:hool. or commun:ty acth·it;es• 

These disorders include anv mentuJdisorder (including those of biological 

etiology) listed inDSM-UI-R or tht:ir 

ICD-9.:..CM equi..-alent (and subsequent 

revisio~s), with tl.e exception of DSMIII-R '"V'" codt:s. substance use. and 

devalopmentai disorders. which aril 

excluded, unless thlly co-occur with 

another diagnosable serious emotional 

disturbo.n..:e. All of these disorders have 

episodic, rec:.rrent, or persistent 

fllilh.:res; however, they vary in termsof 

se1•erity and d:sabling effects. 

Functional impairment is defined as 

difficulties thc.t substantially interftlre 

with or limit a child or adolescent from 

achieving or n:aintaining one or more · 

developmentally-appropriate social, 

.behnvioral, cognitive, communk.ative, 

or adaptive skills. functional 

impairments of episodic, recurrent, and 

continuous duration are included unless 

they are te-mporary and expected 

responses to stressful events in the 

em·ironment. Children Who would ho.V? 

met functional impairmentcriteria 

during the referenced year without the 

benefit of treatment or other support 

services are included in· th.is definition. 

Dl'finition of Adults With a Serious 

Mental lllness 

Pursuant to section ~ 912(c) of the 

Public Health Service Act, as amended 

b\· Public Law 102-321 .. adults with a 

serious mental illness" are persons: 

• Age 18 and over,1 

• Who currently or at any time during the 

past year,z . ' 

• Have had a diagnosable mental, 

behavioral, or emotional disorder or sufficient duration to meet diagnostic criteria 

specified within DSM-IU-R,3 

• That bas resulted in functioDal 

Impairment which substantially interferes 

with or limits one or more major life 

activities.+ 

These disorders include any mental 

disorders (including those pf biological 

etiology) listedin DSM-III-R or their 

1~9-CM equivalent (and subsequent 

Statistical Manaal of Mental Disoruers. cir DSM-rv. 

will be publislutd md avaihtblela. Iaiii 11193 or earl J 

1994. The tenth revision of thel11.18rnatiooal 

.Clas.s!ficatlon of Di5eases (ICI);-10), develnped by 

the World H118lth Organizatinn, """ published in 

1992. but wUl probably DOt be officially adop!Bd iA 

the United Stews ur:tlllate tD the 1990's. TbBY 

revised aomenc:la!uru are Ukaly to a!facl both the 

language ohnental disordcri and the types of 

dlsorders CWTently lncludfld or exclud!!d from these 

dtlinitiom. M appropriate. the delinitioru will be 

updated by CMHS accot"dlngly. 4 FunctioMl impairment which ".uustantially" 

interferes "'ill be operationally defined as part of 

the process or dtrtflloping stand!lrdized mP.thods for 

estimation. · 

ru\·isiuns). with the exceptiop of DSM111-R "V" codes, substance use 

disorders. and developmental disordt!rs. 

whicb are excluded, unless they co· 

orcur with another diagno:;ahle serious 

mental iUness. All of these disorders 

have tlpisodic, rccurr!!nt. or persistent 

features; however, tbey vary in terms of 

St!\"t•rity and disabling effects. 

Functional impairment is defined as 

difficulties that substantially interfere 

with or limit role functioning in one or 

mow major life acti\·ities including · 

basir.A<!ilY !i_\:ing skills_(e.g., e:~.ting. 

bathing. chessing); instrumental living 

skills (tl.g .• maintaining a household, 

managing money, getting around the 

community, taking pre~ibed ~ 

rr:tldication); a.:1d functioning in social 

familv, and \'OcationaVeducatlonal 

conlt;xts. Adults who wguld havo met 

funclional impairment criteria during 

th~:: rt~ftlrenced year without the benefit 

of lrt!Dl..'llent or ather support services 

are considered to ha\'e serious mental 

illntlsses. 

!Jated: May 14. 1993. 

Joseph R. Leone, 

Acti11g Deputy Admin-istro:O£", Sub&taJJCt: 

Abuse and Mento! Health Se-rvfcn 

Administration. 

(FR Doc. 93-11959 Filed 5-19-93: 8:45am) 

BIL.UNG CODE 4112-20-M 

DEPARTMENT OF HOUSING AND 

URBAN DEVELOPMENT 

Office of Adml,.llstratlon 

[Docket No. N...;93-3G29l 

Subml~slon of Proposed lnkmnation 

Collection to OMB 

AGENCY: Office of Administratiou, HUD. 

ACTION: Notice. 

SUMMARY: The proposed information 

collec!ion requirement described below 

has been submitted to the Office of 

Management and Budget (OMB) for 

revit~w, as required by the Paperwork. 

RedUCtion Act. The Department is 

soliciting public comments on tha 

subject proposal. 

ADDRESSES: Interested persons are 

invited t'o submit comments regarding 

this propasat. Comments should refer to 

the. proposal by name and should be 

sent to: Angela Antone.lli, OI\4B Desk 

Officer, Office of Management and 

Bl!dget, New Executive Office Building. 

Washington. DC 20503. 

FOfl RIATHER INFORMATION CONTACT: Kay 

F. Weaver, Reports Management Officer. 

Department of Housing and Urban 

Development, 451 7~ Street. 

Southwest. Washington, DC 20410,