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Immigrant and Refugee Health

Frequently Asked Questions (FAQ): Physical or Mental Disorders with Associated Harmful Behaviors and Substance-Related Disorders

CDC has updated the 2010 Technical Instructions for Physical or Mental Disorders with Associated Harmful Behaviors and Substance-Related Disorders. This is also known as Mental Health Technical Instructions (MH TIs). The diagnosis of mental disorders and substance-related disorders is made using the current American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. Therefore, the 2010 MH TIs have been modified to reflect the current fifth edition, DSM-5, which was released in the spring of 2013. The 2010 MH TIs were updated for both civil surgeons and panel physicians. All panel physicians and civil surgeons should be using the updated MH TIs no later than January 1, 2014.

What are the Technical Instructions for Physical or Mental Disorders with Associated Harmful Behaviors and Substance-Related Disorders?

HHS/CDC Part 34 regulations require that all immigrants and refugees coming to the United States be screened for physical and mental disorders with associated harmful behaviors and substance abuse and addiction. CDC’s Division of Global Migration and Quarantine (DGMQ) develops guidelines, called Technical Instructions, for physicians screening immigrants and refugees for physical and mental disorders with associated harmful behaviors and substance-related disorders. These Technical Instructions were updated for both panel physicians and civil surgeons.

What was updated in the 2010 Technical Instructions for Physical or Mental Disorders with Associated Harmful Behaviors and Substance-Related Disorders?

  • CDC updated the Technical Instructions in 2010 to provide clarification that the diagnosis of physical and mental disorders with associated harmful behavior and substance-related disorders is made based on existing medical standards, as determined by the current version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).
  • The diagnosis of remission is to be made in accordance with existing medical standards, as determined by the current version of the DSM.
  • Experimentation is no longer defined in the Technical Instructions. Instead, determinations of substance (drug) abuse and dependence are made based on existing medical standards, as determined by the current version of the DSM.

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