What Is the Global Assessment of Functioning?

The Global Assessment of Functioning (GAF) is a rubric mental health providers use to discuss a patient's ability to cope with tasks of daily living. It includes a score between one and 100; this ranges from severe impairment that suggests a patient may be at severe risk of self-harm, to highly functioning patients who do not outwardly appear to have any symptoms. In an evaluation of a patient with suspected mental health problems, the Global Assessment of Functioning can provide a useful metric for assessment. The scale is more objective, which makes it useful for comparison in the future and discussions with other care providers.

Care providers examine how well patients function along three different axes. The first is social. In a Global Assessment of Functioning, practitioners want to know if patients interact regularly with friends and family. This assessment can include a discussion about which kinds of social activities the patient has engaged in recently, and what the patient does for fun. Varied social activities and diverse friendships can result in a higher score.

The second area of interest is occupational and school functioning, depending on the patient's age. If the patient goes to school or has a job, the care provider wants to know how well the patient functions in these environments. Patients who have trouble completing tasks, don't get along with people at school or work, or struggle with understanding directions get lower scores. Patients who are reliable and trusted by the people who work or learn with them get higher scores.

Psychological functioning is another concern on the Global Assessment of Functioning. This includes the level of self-care a patient can provide. Patients who cannot bathe, dress, and eat are a cause for concern. Likewise with patients who do not speak, are highly combative, or show signs of extreme emotional distress. In contrast, a relaxed, calm, friendly patient receives a higher score.

In a Global Assessment of Functioning, care providers discard issues created by environmental and situational factors, because these could unfairly influence the score. For example, a child with learning disabilities would be expected to struggle with school assignments. Poor grades wouldn't necessarily be a sign of declining function. Likewise, a homeless patient might not be able to bathe regularly, but this is not necessarily an indicator of poor self-care skills.

If a patient has an extremely low score, the care provider may recommend an immediate intervention to provide treatment. Moderate scores can indicate the need for therapy and other measures to help the patient, but do not suggest there is an immediate risk of danger to the patient or others. High scores show a patient is doing well in treatment or does not need mental health care.