Supportive living research/ the deffinition of severe and persistent mental illness by state

Hi again,

So yesterday and today have been doing some hard core research on the supportive living model. In order to know as much as possible about it. The next step hopefully will be talking with an actual e e expert, board of director or director of a place. Not sure how receptive friedman staff would be to that. What I want is more general information on the history, how hard it was to get going if there are things that needed to foundationally be in place to make it work before the actual program got going. I.E existing policies or something ETC

Questions directed to my own personal things around getting in to SLFS Jonathan will be working on that level of things.

Anyway I was very happy yesterday to have finally hit the jackpot on the rules and regulations available for all to see online.

Here is the link

It’s very well documented with all you need to read and easy to understand.

Feel free to take a look at it and give thoughts especially if at all interested in this process. The process of learning more about this unique program and how to replicate it in other states.

So as you can see the most important thing for Jess and I right now is the requirements.

1) Be age 22 years or over with a disability (as determined by the Social Security Administration) or elderly (age 65 years or over); and

2) Be screened by the Department or other State agency screening entity and found to be in need of nursing facility level of care and that SLF placement is appropriate to meet the needs of the individual. A new screen is not needed for a resident who is transferring between SLFs or comes from a nursing facility with no break in service. It is the admitting SLF’s responsibility to ensure that a screening document is received from the transferring SLF or nursing facility. Private pay individuals may choose to be admitted into the SLF when the screening assessment does not justify nursing facility level of care; and

3) Be without a primary or secondary diagnosis of developmental disability or serious and persistent mental illness. The developmental disability or mental illness must be determined by a qualified Department of Human Services screening agent; and

4) Have name checked against the United States Department of Justice Dru Sjodin National Offender Public Website at, the Illinois Sex Offender Registration website at and the Illinois Department of Corrections registered sex offender database at Refer to Section 146.215 for facility requirements if a person whose name appears on either registry is admitted to an SLF.

The biggest issue for us is the serious and persistent mental illness definition. Obveously we met criteria for this in 2013 when we moved to Albany which treats severe and persistent mental illness.

This term covers a lot and on it’s own seems confusing.

I did do some research and found that it’s different for each state.

Here is a good definition but it’s for NY

And my thoughts written for friends

Though no standardized criteria exists for SPMI, experts agree that determining whether one falls in the category involves the assessment of diagnostic severity, disability, and duration of the problem. Disorders that severely and persistently interfere wtih functioning are schizophrenia, bipolar disorder, other severe forms of depression, panic disorder, and obsessive-compulsive disorder. Definitions of SPMI vary by state.

So here’s what new York has to say


Serious and Persistent Mental Illness

In order to be considered an adult with a serious and persistent mental illness, "1" below must be met, in addition to either "2", "3", or "4":

1. Designated Mental Illness

The individual is 18 years of age or older and currently meets the criteria for a DSM-IV psychiatric diagnosis other than alcohol or drug disorders, organic brain syndromes, developmental disabilities or social conditions. ICD-CM psychiatric categories and codes that do not have an equivalent in DSM-IV are also included mental illness diagnoses. (this must be before like two years ago because we’re on DSMV now. And I know that in IL they exclude personality disorders so in IL maybe only axis I?)


2. SSI or SSDI due to Mental Illness

The individual is currently enrolled in SSI/SSDI due to a designated mental illness. (Gateway did ask about this. Neither Kinzy or I are getting SSI for mental illness. I get it for blindness and she gets it for her physical health issues. So is this SSI thing part of number one? So both on number one have to be met? In that case we wouldn’t meet the criteria.)


3. Extended Impairment in Functioning due to Mental Illness

a. Documentation that the individual has experienced two of the following four functional limitations due to a designated mental illness over the past 12 months on a continuous or intermittent basis:

1. Marked difficulties in self care (personal hygiene, diet, clothing avoiding injuries, securing health care or complying with medical advice).

2. Marked restriction of activities of daily living (maintaining a residence, using transportation, day to day money management, accessing community services).

3. Marked difficulties in maintaining social functioning (establishing and maintaining social relationships, interpersonal interactions with primary partner, children or other family members, friends, neighbors, social skills, compliance with social norms, appropriate use of leisure time).

4. Frequent deficiencies of concentration, persistence or pace resulting in failure to complete tasks in a timely manner (ability to complete tasks commonly found in work settings or in structured activities that take place in home or school settings, individuals may exhibit limitations in these areas when they repeatedly are unable to complete simple tasks within an established time period, make frequent errors in tasks, or require assistance in the completion of tasks). (Well we’d have all those problems if not living at Albany. Which brings us to)


4. Reliance on Psychiatric Treatment, Rehabilitation and Supports

A documented history shows that the individual at some prior time met the threshold for 3 (above), but the symptoms and/or functioning problems are currently attenuated by medication or psychiatric rehabilitation and supports. Medication refers to psychotropic medications which may control certain primary manifestations of mental disorder; e.g. hallucinations, but may or may not affect functional limitations imposed by the mental disorder. Psychiatric rehabilitation and supports refer to highly structured and supportive settings (e.g. Congregate or Apartment Treatment Programs) which may greatly reduce the demands placed on the individual and thereby, minimize overt symptoms and signs of the underlying mental disorder. (So we deffinetely meet the number four criteria! So I’m totally confused. If you take out the SSI thing we don’t meet criteria. But if one is just the diagnosis and we meet four then we meet the criteria.)

In this case as I want to go to an SLF this is criteria I actually *don’t want to meet. However if I end up staying in an MH residential, which deffinetely has it’s pros, I do want to meet this criteria and from this it sounds like I do.

I think the bottom line is what these people directors nursing, intake ETC say about honestly what they can handle in the facility. Yes they say get your mental health services elsewhere. But how do they coordinate that with what care they provide? What can we disclose to them and be respectfully treated of our mental illness?

Personally I feel so uncomfortable saying my MI is not my primary diagnosis, or the thing above even said not secondary diagnosis which it deffinetely would be at least secondary.

So am confused need to find the definition specific to IL.

And the real verdict will be talking with these people with my and Jess’s individual cases and them giving hopefully honest and realistic answers.

So yeah it’s a huge amount to think about and I’m sure when Jonathan gets their perspective it will make so much more sense.

But I’m so happy to have found this official stuff that even describes things like how they reimburse Medicaid, taking sixty percent of the weighted average of nursing home care. Would love to know how they developed that system.

So yeah happy with my research. If anyone has thoughts on the severe and persistent mental illness stuff particularly for IL would love to hear.

Would have had my Mr. J meeting but he had to help with yet another bed bug crisis on another floor! And our backup time of Friday won’t work due to dentist which I don’t want to reschedule.

So we’ll see when we can meet next.


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