This study explored the efficacy of using depression and similar selfrating scales with clients who have severe schizophrenia and whether clinical procedures or instructions must be significantly changed before severely mentally ill clients can complete self-rating instruments. A literature review found that none of the depression rating scales most widely used in the past ten years have been studied for reliability and validity with individuals who have schizophrenia and extremely severe chronic symptoms. The ability of individuals with mild versus severe symptoms to report problems may differ greatly. This is particularly true when one considers the amount of abstract thinking required for completing self-rating scales. Clients must determine the question’s meaning, contextually relate each item to their personal situation, and quickly transform responses into broad ranking numerical categories. In addition, scales tend to infer rather than explicitly define time and boundaries. Therefore, completing self-rating scales becomes more difficult as a client’s thoughts are disrupted by increased anxiety, hallucinations, and delusions. Nonetheless, economically tracking when and how depression symptoms change in people with the most severe forms of schizophrenia is highly advantageous for clinical programs, families, and the individual client. Accurate self-rating scales can assist in evaluating treatment effectiveness and help identify clients who are at an increased risk for suicide.