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UNDERSTANDING THE FIVE-AXIS SYSTEM AND MENTAL HEALTH EVALUATIONS

 

 

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In family court case, a party's mental health is relevant to a host of issues - child custody, parenting time, spousal support and the ability to earn income to pay child support. You can, subject to your lawyer's advice and after thoroughly weighing the pros and cons, assert your right to keep your healthcare records confidential. This includes mental healthcare. However, the family court may still order you to submit to an evaluation - even with your confidentiality for your own records intact.

If your judge has ordered mental health / psychiatric evaluations for your case, you should understand the nuts and bolts of the evaluations so that you are in a better position to support, or refute, them--

Most psychiatric evaluations follow a format suggested by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The diagnosis is given on five dimensions, or "axes."

Axes I and II are for reporting any emotional, mental, or personality disorders or other conditions that are a focus of clinical attention. These are the heart of any assessment. Many psychiatric evaluations deal only with Axes I and II.

Axis III is for reporting other general medical conditions that are potentially relevant to the understanding or management of the Axes I and II problems. For example, depression may be caused by a thyroid problem.

Axis IV is for reporting stressful circumstances that m ay affect the diagnosis, treatment, or prognosis for mental disorders reported under Axis I and II. Examples of such circumstances are death of a family member, financial problems, job problems, sexual or physical abuse, and inadequate health care. These stressful circumstances are sometimes categorized on a scale that ranges from mild through moderate, severe, and extreme to catastrophic.

Axis V is for reporting clinical judgment of the individual's overall level of psychological, social, and occupational functioning. How well the subject functions is summarized by a single number on a scale from 1 to 100. This can be useful to an adjudicator as a measure of how subject's mental condition may impact on work performance and ability to maintain the security of classified information.

For an explanation of what these numbers mean, see the Global Assessment of Functioning (GAF) Scale, below.

Global Assessment of Functioning (GAF) Scale

Psychological, social, and occupational functioning is measured on a hypothetical continuum of mental health - illness. Impairment in functioning due to physical (or environmental) limitations is not included. Intermediate numbers such as 45, 68, or 72 may be used as appropriate.

100 - 91: Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.

90 - 81: Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members)

80 - 71: If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social occupational or school functioning (e.g., temporarily falling behind in schoolwork).

70 - 61: Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

60 - 51: Moderate symptoms (e.g., flat affect and unnecessarily detailed or repetitive speech, occasional panic attacks) OR moderate difficulty in social, occupational or school functioning (e.g., few friends, conflicts with peers or co-workers).

50 - 41: Serious symptoms ( e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

40 - 31: Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant ) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

30 - 21: Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g. stays in bed all day; no job, home, or friends).

20 - 11: Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

10 - 1: Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

0: Inadequate information.

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