2008 DMH Eligibility Decision by Hearing Officer Harmon-2

Keyword: Attention deficit hyperactivity disorder, Post traumatic stress disorder 

Counsel present for Appellant:

Counsel present for DMH: Appellant present:

Holding: ineligible

The issue on appeal was whether the decision by the Department of Mental Health that the Appellant is not eligible for DMH services based on clinical criteria set out in 104 CMR 29.04(3) (a) has a reasonable basis. 

Appellant is twenty one years of age and has a history notable for malnutrition, delayed speech, and emotional neglect. He was removed from his father and mother at the age of 4 due to their substance and domestic abuse issues. In particular, he witnessed his father’s domestic abuse towards his mother. From age four through eleven, he was put through multiple foster homes before being admitted to a hospital for auditory hallucinations, lying, and aggression. Upon discharge, he was placed in a Massachusetts residential program where he stayed until 2007, at the age of 20. He was then placed in therapeutic foster care.

The appellant has been receiving special education services since kindergarten. He applied for Adult Continuing Care Services (ACCS) in 2005 and was denied by a DMH Determination Specialist. He appealed this decision only to be denied again. In 2007 he reapplied for ACCS and the Psy. D. submitted that the presenting psychiatric problem was Bipolar Disorder and the Axis II diagnosis was borderline intellectual function. The findings of fact report no detailed psychiatric assessments. The only two psychiatric clinic evaluations report the client as having ADHD and PDHD but no explanation or support for the PTSD is offered. In fact, no support for these behaviors is described in either of the applications to Adult Continuing Care Services.

The hearing officer found that based on the findings of fact, the Applicant failed to prove by a preponderance of the evidence that he met the criteria for DMH continuing care services. The reasoning was that “merely naming a diagnosis is not sufficient” because the support, the proof, has to be found in the record and that was what was lacking. Even thought PTSD does qualify, there was no actual support in the record and, thus, the appellant was ineligible.