Domain 3 - Functioning (Primary Domain)


An initial assessment should consider functional impairment caused by or exacerbated by the mental health condition. While other types of disabilities may play a role in determining what types of support services may be required, they should generally not be considered in determining mental health intervention intensity within a stepped care continuum.

Assessment of an individual on this domain should consider:

  • a person’s ability to fulfil usual roles/ responsibilities,
  • impact on or disruption to areas of life (e.g., employment, parenting, education, or other social roles), and
  • impact on the person’s basic activities of daily living (e.g., self-care, mobility, toileting, feeding, and personal hygiene).


0 = No problems in this domain – no descriptors apply

1 = Mild impact

  1. Diminished ability to function in one or more of their usual roles, including work, social, parenting/care of dependents, education but without significant or adverse consequences.
  2. The person experiences brief and transient disruptions in functioning.

2 = Moderate impact

  1. Functioning is impaired in more than one of their usual roles including work, social, parenting and family, education, to the extent that they are unable to meet the requirements of those roles on average 1 to 2 days per month.
  2. The person experiences occasional difficulties with basic activities of daily living but without threat to health.

3 = Severe impact

  1. Significant difficulties with functioning, resulting in disruption to many areas of the person’s life (e.g., work, education, interpersonal relationships, or self-care) but the person can function independently with adequate treatment and community support.
  2. The person experiences difficulties with basic self-care (e.g., hygiene, eating, or appearance) on a frequent, consistent basis without threat to health.

4 = Very severe to extreme impact

  1. Profound difficulties with functioning, resulting in major disruption to virtually all areas of the person’s life (e.g., unable to work or participate in education, withdrawal from interpersonal relationships).
  2. Mental health condition contributes to severe and persistent self-neglect that poses a threat to health.