Grave Disability Evaluation – Client Interview Questions

Here's a practical questionnaire-style tool you can use when assessing whether a client may meet grave disability criteria under the context of SMI (schizophrenia, schizoaffective disorder, bipolar disorder, etc.).

These questions are grouped by relevant domains and are meant to be asked directly to the client (with follow-up or collateral if needed).

Grave Disability Evaluation – Client Interview Questions

1. Orientation and Insight

  • What day is it today? What year?

  • Where are you right now?

  • Can you tell me your full name and date of birth?

  • Do you believe you need help right now? Why or why not?

  • Do you think your medications help you? Are you currently taking them?

2. Basic Needs: Food and Water

  • When was the last time you ate?

  • Do you have access to food on a regular basis?

  • How do you usually get your meals?

  • Are you able to prepare food safely?

  • Have you gone without eating or drinking recently? Why?

3. Basic Needs: Shelter

  • Where did you sleep last night?

  • Do you have a place where you feel safe sleeping?

  • Do you have any concerns about your current living situation?

  • What would you do if you couldn’t stay where you are tonight?

4. Basic Needs: Hygiene and Medical

  • When was the last time you showered or changed clothes?

  • Are you taking care of your hygiene needs?

  • Do you have any medical conditions you’re treating right now?

  • Do you have access to your medications?

  • Are you attending medical or psychiatric appointments?

5. Safety – Self-Neglect or Risk of Harm

  • Have you had any trouble keeping yourself safe recently?

  • Are you doing anything that could be dangerous to yourself or others?

  • Have you walked into traffic, stopped taking essential meds, or refused care?

  • Do you feel like someone is trying to harm you?

  • Are you hearing or seeing things that others don’t?

6. Decision-Making / Functioning

  • Are you able to make decisions about your day-to-day needs?

  • Have you paid rent or managed money recently?

  • Can you keep appointments or follow basic instructions?

  • Are you able to care for yourself without someone checking in?

7. Support System

  • Do you have family or friends you can contact if you need help?

  • Is anyone helping you right now (case manager, social worker, friend)?

  • Do you feel alone or like you have no one to rely on?

8. Risk Amplifiers

  • Have you stopped taking your medication recently? Why?

  • Have you used drugs or alcohol in the past few days?

  • Has anyone told you that you seem different or need help?

9. Perceptual Distortions / Delusions

  • Are you hearing voices right now?

  • What are the voices saying to you?

  • Do you believe someone is out to get you?

  • Are there things happening around you that others don’t see?

10. Plan / Follow-through

  • What’s your plan for today?

  • What do you plan to do tomorrow?

  • If I weren’t here right now, what would you be doing?

Scoring/Usage Notes (For Clinician Use Only)

  • Look for inability to meet basic needs, severe disorganization, psychosis impacting judgment, and lack of insight.

  • Document specific behaviors that illustrate grave disability — e.g., “Client has not eaten in 3 days, believes food is poisoned,” “Client is wandering streets at night with no plan for shelter.”

  • Use this questionnaire as one component of a full clinical picture when consulting with a crisis team or DCR.

Visual Signs of Escalation, Disorganization, or Grave Disability

1. Signs of Physical Aggression or Threatening Behavior

  • Fists clenched or balled up at sides

  • Jaw clenched or grinding teeth

  • Posturing (chest puffed, shoulders back, pacing toward you)

  • Eyebrows furrowed or eyes locked in an intense stare

  • Rapid pacing or advancing toward others

  • Verbally threatening or loudly vocalizing (e.g., yelling, screaming)

  • Making direct or indirect threats (e.g., “You better watch out”)

  • Breathing heavily or erratically

  • Raised voice, shouting, or speaking in pressured, disorganized speech

  • Slamming objects or hitting walls

  • Abrupt or exaggerated movements (sudden standing, lunging, kicking)

2. Signs of Extreme Agitation or Psychomotor Activity

  • Restlessness or inability to sit still

  • Trembling or shaking hands

  • Rocking back and forth

  • Flailing limbs or erratic gestures

  • Repeatedly taking off clothing or moving with no clear purpose

  • Excessive sweating (with no environmental cause)

  • Redness or flushing of the face

  • Rapid eye movements or scanning environment suspiciously

3. Signs of Disorganization or Psychosis

  • Mumbling to self or responding to internal stimuli

  • Talking to people who aren’t there

  • Holding unusual body positions or postures

  • Attempting to eat, drink, or ingest inedible items

  • Carrying large amounts of unrelated items (hoarding)

  • Clothing inappropriate for weather (e.g., coat in summer, no shoes in winter)

  • Inability to follow simple directions or answer basic questions

  • Poor hygiene (strong body odor, dirty clothes, visible filth or feces)

4. Signs of Fear, Paranoia, or Flight Risk

  • Constantly looking over shoulder or hypervigilance

  • Avoiding eye contact or shrinking away from others

  • Attempting to leave without reason or sudden darting movements

  • Whispering or hiding in corners

  • Covering ears or eyes as if overwhelmed by stimuli

  • Refusing help but unable to verbalize why

5. Suicidal or Gravely Disabled Indicators

  • Lying on the ground or refusing to move

  • Not eating or drinking (or reporting no food/water for days)

  • Wandering aimlessly with no destination

  • Refusing all medications despite serious symptoms

  • Appearing lost, confused, or dissociated in public spaces

  • Leaving a hospital, shelter, or care setting without a plan or resources

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