The IAR guidance identifies eight domains that should be considered when determining the next steps in the referral and treatment process for a person seeking mental health support. There are 4 primary assessment domains and 4 contextual domains. Specific criteria are outlined in the guidance for assessing severity across each domain.
DOMAIN 1 Symptom severity and distress
Current symptoms and duration, level of distress, experience of mental illness, symptom trajectory.
DOMAIN 2 Risk of harm
Past or current suicidal ideation or attempts, past or current self-harm, symptoms posing a risk to self or others, risk arising from self-neglect.
DOMAIN 3 Impact on functioning
Ability to fulfill usual roles/responsibilities, impact on or disruption to areas of life, capacity for self-care.
DOMAIN 4 Impact of co-existing conditions
Substance use/misuse, physical health condition, intellectual disability/cognitive impairment.
DOMAIN 5 Treatment and recovery history
Previous treatment (including specialist or mental health inpatient treatment), current engagement in treatment, response to past or current treatment.
DOMAIN 6 Social and environmental stressors
Life circumstances such as significant transitions, trauma, harm from others, interpersonal or social difficulties, performance related pressure, difficulty having basic needs met, illness, legal issues.
DOMAIN 7 Family and other supports
Presence of informal supports and their potential to contribute to recovery.
DOMAIN 8 Engagement and motivation
The individual's understanding of the symptoms, condition, and its impact. The person's ability and capacity to manage the condition and motivation to access the necessary support.