The Mental Health Screening Requirement

USCIS requires civil surgeons to conduct a mental health screening as part of every immigration medical exam. The civil surgeon reviews the applicant's mental health history, conducts a clinical interview, and documents findings on Form I-693 in the physical and mental examination section.

The civil surgeon is not a psychiatrist and does not conduct a comprehensive psychiatric evaluation. The screening is designed to identify conditions that may constitute grounds of inadmissibility — specifically, physical or mental disorders with associated harmful behavior.

The Critical Distinction: Harmful Behavior

Under INA § 212(a)(1)(A)(iii), a physical or mental disorder is a ground of inadmissibility only when it is accompanied by behavior that has posed or is likely to pose a threat to the property, safety, or welfare of the applicant or others.

This means that a mental health diagnosis alone — depression, anxiety, PTSD, bipolar disorder, schizophrenia — is not a ground of inadmissibility. The inadmissibility finding requires both a diagnosis and associated harmful behavior.

Civil surgeons document this distinction carefully on Form I-693. If the civil surgeon identifies a mental health condition but determines there is no associated harmful behavior, the condition is noted but does not result in a Class A finding.

What the Civil Surgeon Evaluates

During the mental health screening, the civil surgeon will:

• Review the applicant's self-reported mental health history, including any diagnoses, hospitalizations, or treatment
• Ask about any history of violent behavior, self-harm, or behavior that posed a risk to others
• Assess the applicant's current mental status through clinical observation during the interview
• Review any psychiatric medications the applicant is currently taking
• Consider whether any reported behavior meets the threshold for "associated harmful behavior" under USCIS guidelines

How Findings Are Documented on Form I-693

If the civil surgeon identifies a mental health condition without associated harmful behavior, the civil surgeon will note the condition in the examination section of Form I-693 but will not classify it as a Class A finding. The form will reflect that a mental health condition is present but that it does not constitute a ground of inadmissibility.

If the civil surgeon identifies a mental health condition with associated harmful behavior, the civil surgeon will classify the finding as a Class A condition. This requires the civil surgeon to document the specific behavior that constitutes the harmful behavior finding and to explain the clinical basis for the determination.

In cases where the civil surgeon is uncertain, the civil surgeon may refer the applicant to a mental health specialist for further evaluation before completing Form I-693.

What Attorneys Should Do Before the Exam

Attorneys with clients who have mental health histories should take several preparatory steps:

Review the client's mental health history in detail before the exam. Identify any incidents of harmful behavior — hospitalizations, involuntary commitments, restraining orders, or violent incidents — that the civil surgeon is likely to ask about.

If the client has a treating mental health provider, consider obtaining a letter from that provider documenting the diagnosis, current treatment status, and the provider's assessment of whether the client poses any risk of harmful behavior. This documentation can be presented to the civil surgeon and can support a finding that no harmful behavior is associated with the condition.

Advise the client to be honest and accurate in their responses. Inconsistencies between the medical history and other records can create credibility problems.