132 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER 6. Barriers to Treatment (5) A. The client described difficulties with gaining access to medica l facilities or health care providers. B. Health care providers have discriminated against the client due to his/her severe and persistent mental illness symptoms. C. The client has failed to make his/her medical needs known due to the effects of his/her severe and persistent mental illness symptoms. D. As the client has gained better access to medical facilities and health care providers, his/her overall level of functioning has increased. 7. Failure to Access Medical Treatment (6) A. The client has f ailed to access appropriate medical treatment due to his/her severe and persistent mental illness symptoms. B. The client's health status has suffered due to his/her failure to access appropriate medical treatment. C. As the client's severe and persisten t mental illness symptoms have been stabilized, his/her medical treatment has been more easily accessed. D. The client's medical status has improved due to his/her accessing appropriate medical treatment. 8. Poor Health Habits (7) A. The client displaye d poor oral hygiene. B. The client bathes infrequently and has significant body odor on a consistent basis. C. The client lives in unsanitary living conditions. D. The client displayed poor health habits due to his/her pattern of severe and persistent m ental illness symptoms. E. As the client has stabilized his/her severe and persistent mental illness symptoms, he/she has displayed better health habits. 9. Financial Limitations (8) A. The client has failed to access or follow through with medical trea tment due to financial limitations. B. The client has obtained financial resources to assist with his/her medical treatment. C. The client's medical problems have improved due to economically available medical treatment. 10. Chemical Dependence Complica tions (9) A. The client has developed medical complications because of his/her chronic chemical dependence history. B. The client has accepted that he/she has deteriorated medically because of his/her chemical dependence pattern and has terminated substa nce abuse. C. The client is in denial about the negative medical effects of his/her substance abuse and continues his/her self-destructive pattern. D. The client's medical condition has improved subsequent to termination of substance abuse. 