Mental health assessments are the foundation for understanding your symptoms and creating a treatment plan. While it may seem like a formality, an assessment is an essential tool in helping you receive the care you deserve.
During an assessment, you’ll answer a series of questions that include ratings or questionnaires, and written or verbal tests. These tools help a psychiatrist gather data to understand the severity of your symptoms at a particular time.
Mood and Affect
Many people mistakenly believe that when they seek mental health treatment, they will be lying on a couch chatting with a therapist. This is not always the case, but an important part of a mental health assessment is observing a client’s appearance, behavior and thought process (ability to concentrate).
An experienced interviewer will observe how a client’s mood impacts their thinking, feelings and functioning throughout the course of an interview. Various self-report inventories are used to assess mood. The MCMI-III, for example, contains three scales that assess problematic moods: the 14-item Dysthymia scale includes a loss of pleasure, guilt feelings, low energy and general disparagement; the 17-item Major Depression scale addresses low self-esteem, difficulty sleeping, lack of motivation, feelings of emptiness, suicidal thoughts, admission of past suicide attempts, reports of repression and repressed anger and a feeling of hopelessness.
There is also a 13-item Bipolar: Manic scale which measures overactivity, elation and inflatedness, flight of ideas, variable moods and overtalkativeness. There are also a number of adjective checklists which direct clients to endorse statements that describe how they feel, for example the Depression Adjective Checklist (DACL).
An essential component of a mental health assessment is determining the patient’s thought content. This includes assessing the quantity of thoughts, whether they are blocked or unblocked and how logical they are (eg consistent or disorganized). It is also important to assess for any thought broadcasting, insertion or withdrawal. It is also important to determine if the thought content includes obsessions, delusions, paranoia or phobias.
It is also important to assess the patient’s level of insight (intact, impaired or absent). Additionally, it is helpful to determine if the patient is self-aware or not and if they have difficulty recognizing the existence of their illness. Using a mental status examination with multiple patients over time will allow you to see how the MSE varies from one point in time to another. For example, a psychotic patient’s MSE may change significantly over the course of an hour or two. This is particularly useful in guiding future treatment and prognosis.
During mental health assessments, providers assess a patient’s behavioral patterns. This can include their ability to maintain healthy sleep, eating, and exercise habits or their ability to cope with challenging events. It can also involve their ability to recognize familiar faces, solve problems, and make informed choices.
Traditionally, mental health assessment tools focus on determining the presence, severity, and duration of symptoms using interviews or questionnaires. However, the results of these tools vary significantly based on the type of disorder for which they are designed. Additionally, memory bias and social desirability bias may affect patients’ responses.
As such, there is a need for standardized assessment tools that are more disorder agnostic to provide a more complete picture of symptom presentation and aid in the discovery of underlying etiologies. This is especially true for disorders where external factors are known to contribute to the development of symptoms and their trajectories.
Cognitive functioning in mental health assessments involves intellectual abilities such as reading and writing, concentration, and ability to solve problems and make choices. It also determines a person’s fund of knowledge and the depth of their insight. It is essential to determine a person’s thought content, particularly suicidal or homicidal ideations and delusions (firmly held false beliefs that persist despite contradictory evidence) and whether they are having trouble remembering things.
A healthcare provider will typically ask a series of questions and observe your behavior. If you are having difficulty talking about personal subjects or you feel uncomfortable, try to bring a friend or advocate, like a mental health charity worker or council advocate. These can help you get the support you need to have a safe and effective assessment. They can also represent your interests when you go to see a psychiatrist. This helps your care co-ordinator and the psychiatrist find a service that will work for you.