Federal Definitions of SMI and SED
The definitions of serious mental illness and serious emotional
disability published by the Center for Mental Health Services (CMHS) in
the Federal Register are as follows.
Serious Mental Illness (SMI)
"…, adults with a serious mental illness are persons 18 years and older
who, at any time during a given year, had a diagnosable mental,
behavioral, or emotional disorder that met the criteria of DSM-III-R1
and … that has resulted in functional impairment which substantially
interferes with or limits one or more major life activities.…"
The definition states that "adults who would have met functional
impairment criteria during the referenced year without the benefit of
treatment or other support services are considered to have serious
mental illnesses….DSM-III-R ‘V’ codes, substance use disorders, and
developmental disorders are excluded from this definition…."
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Estimation Methodology for Adults With Serious Mental Illness (SMI)
AGENCY: Center for Mental Health Services, Substance Abuse and
Mental Health Services Administration, HHS.
Federal Register: June 24, 1999 (Volume 64, Number 121). Pages
33890-33897
Online via GPO Access [wais.access.gpo.gov][DOCID: fr24jn99-67]
Serious Emotional Disability (SED)
The CMHS definition is that children with “serious emotional
disturbance” are persons:
1. From birth up to age 18
2. Who currently or at any time during the past year have
had a diagnosable mental, behavioral, or emotional
disorder of sufficient duration to meet diagnostic criteria
specified within DSM- III-R
Note –that since these definitions have not been updated in the federal register since 1994, an earlier
version of the Diagnostic and Statistical Manual is used as the reference (DSM-III-R). It is presumed that
the current version of the DSM applies (i.e., DSM-IV from 1994 – present).
1
3. That resulted in functional impairment, which substantially
interferes with or limits the child's role or functioning in
family, school, or community activities (p.29425).
The definition goes on to indicate that “these disorders include any
mental disorder (including those of biological etiology) listed in DSMIII-R or their ICD-9-CM equivalent (and subsequent revisions) with the
exception of DSM-III-R `V' codes, substance use, and developmental
disorders, which are excluded, unless they co-occur with another
diagnosable serious emotional disturbance….” (p. 29425).
“Functional impairment is defined as difficulties that substantially
interfere with or limit a child or adolescent from achieving or
maintaining one or more developmentally-appropriate social,
behavioral, cognitive, communicative, or adaptive skills. Functional
impairments of episodic, recurrent, and continuous duration are
included unless they are temporary and expected responses to
stressful events in their environment. Children who would have met
functional impairment criteria during the referenced year without the
benefit of treatment or other support services are included in this
definition….” (p. 29425).
Federal Register: Volume 58, Number 96. Pages 29422-29425.