Domain 1 - Symptom Severity and Distress (Primary Domain)

Overview

An initial assessment should examine severity of symptoms, distress and previous history of mental illness. Severity of current symptoms and associated levels of distress are important factors in assigning a level of care and making a referral decision. Assessing changes in symptom severity and distress also forms an important part of outcome monitoring.

Assessment of an individual on this domain should consider:

  • current symptoms and duration,
  • level of distress attributable to mental health issues,
  • experience of mental illness, and
  • are symptoms improving/worsening, is distress improving/worsening, are new symptoms emerging?

Scoring

0 = No problem in this domain – no descriptors apply

1 = Mild or sub diagnostic

  1. Currently experiencing some, but not all, of the symptoms associated with an anxiety disorder (e.g., symptoms like excessive worry, difficulty concentrating) or depressive disorder (e.g., symptoms like sadness, irritability, exhaustion, disrupted sleep, anger) that have typically been present for less than 6 months (but this may vary). Current symptoms at a level that would likely result in a diagnosis or associated with a mild level of distress.
  2. Other mental health condition that is associated with mild distress.
  3. Currently experiencing symptoms (described above) at sub diagnostic level but risk of escalating.

2 = Moderate

  1. Currently experiencing symptoms indicative of an anxiety disorder (e.g., excessive worry, panic, racing mind, difficulty concentrating) or depressive disorder (e.g., excessive sadness, irritability, exhaustion, disrupted sleep, loss of interest and pleasure) that have typically been present for more than 6 months (but this may vary) but symptoms may be of more recent origin. Symptoms are at a level that would likely meet diagnostic criteria, and/or are associated with a moderate to high level of distress.
  2. Other mental health condition that is associated with moderate to high levels of distress.
  3. History of a diagnosed mental health condition that has not responded to treatment, with continuing symptoms and moderate to high levels of distress.

3 = Severe

  1. A history of significant and ongoing symptoms indicative of a severe mental illness (e.g., hallucinations, paranoia, disordered thinking, extreme mood variation, delusions, extreme avoidant behaviour) but the symptoms are mostly well managed or are re-appearing and at risk of escalation without ongoing assistance.
  2. Other mental health condition that is associated with very high levels of distress.
  3. Recent onset of symptoms indicative of a severe mental illness and the person is experiencing high to very high levels of distress.
  4. Has been admitted to hospital for a mental health condition in previous 12 months.

4 = Very severe

  1. A history of significant and persistent symptoms that are indicative of a severe mental illness (e.g., hallucinations, paranoia, disordered thinking, extreme mood variation, delusions, severe avoidant behaviour) and symptoms are mostly poorly managed.
  2. Recent onset of symptoms that are indicative of a severe mental illness (e.g., hallucinations, paranoia, disordered thinking, extreme mood variation, delusions, or severe avoidant behaviours) presenting in the context of significant complexity requiring multiple agency involvement.
  3. Other long-term mental health condition presenting in the context of significant complexity that requires multiple agency involvement.