Mental State

Examination
A session on examination and
assessment of the Mental Health
Status
By
Christopher Skinner
Mental State Examination

• In this session the learner will learn how

to assess the Mental Status.
• The steps in the Mental Health
Examination.
• The referral pathway resulting from the
status report that you make.
Mental State Examination

• Once learnt, the MSE is relatively easy to

apply.
• The steps are based on observation of
different manifestations of the client’s
presentation.
Mental State Examination
• Appearance: What does the client look like to the
observer using your senses?
• Dress
• Manner
• Smell
• Eye Contact
• Suspicious, Hypervigilant?
• Tremulous, Scared, Frightened, Angry,
Combative, Threatening or Jealous?
• Body Language and Posture
Mental State Examination

• Behaviour
• What is the behaviour like?
• How does the client relate to you?
• Are they co-operative or not?
• Are they listening to you when you ask
questions?
• Are they friendly or distant?
• Are there complaints about the client’s
behaviour?
• Is the client agitated or restless?
Affect

• Is the client happy or sad?

• Are they angry?
• Are they withdrawn or expansive?
• Are they extrovert or introvert?
• Are they jealous?
Mood

• How would you describe the mood?

• Happy or Sad – How does the client tell you
that they feel?
• Are they angry, embarrassed, down or blue?
• Are they threatening to self harm or suicide?
Cognition

• refers to the thinking of the client

• tells us whether thought is ordered or
disordered, coherent or incoherent, clear or
confused, normal or abnormal.
• This is examined by asking the patient a
series of questions
Questions

• What is the day, the date?

• Where are you?
• Who is the Prime Minister of Australia?
• What did you have for breakfast?
• What is your name?
• What is worrying you?
• How did you come to be here?
Answers

• Normal answers to the questions indicate

normal cognition.
• Difficulty in answering the questions or
bizarre answers indicate faults in cognition
or disordered thinking.
Examples

• What is the day, date?

• Most people can answer this – however, if
confused, the client may answer these
simple questions with inaccurate
information.
Examples

• Where are you?

• Most people can tell you where they are.
• Incorrect answers indicate confusion.
Examples

• Who is the Prime Minister of Australia?

• Most people will answer Kevin Rudd, but
people who are confused or delusional will
give alternative answers.
• New Australians and some alternative life
stylers may not be able to answer this
question
Examples

• Similarly, questions about breakfast and

who are you will demonstrate whether the
client is confused or unable to recall basic
information.
Examples

• What is worrying you?

• The client may answer this – the information
provided may give clues as to whether the
client has insight or not.
• Answers may provide clues as to what is
ailing the client.
• May point to suicidal ideation.
Serial Sevens

• Serial sevens is a simple mathematical

exercise, starting with 100, ask the client to
take away seven each time, so the answers
are 93, 86, 79 and so on. Clients who are
unable to do this may have a cognitive
disorder, or be very poor at mental
arithmetic. Most clients can do this.
Cognition

• Disordered thinking is common in the Psychoses

– there is a lack of touch with reality.
• Confused thinking shows a clouded sensorium as
in Delirium, and diseases such as Alzheimer's and
Wernicke's encephalopathy. There may also be
organic or infectious causes, such as Urinary
Tract Infection, Diabetes, Organic Brain
Syndrome.
Insight

• Mentally Ill clients suffering from acute

psychosis often lack insight into the fact that
they are mentally ill, and may deny that
there is anything wrong, when it is clear to
casual observers that their behaviour is
abnormal.
Judgement

• Clients who are severely depressed may be

suicidal and may show evidence of poor
judgement.
• Similarly, Manic clients may show poor
judgement about aspects of self control,
they may plan projects for which they do not
have the pre-requisite resources, either
emotional, financial or health wise.
Plan

• Asking the client what is their plan may

demonstrate disordered thinking, or expose
ideas of self harm/suicide.
• Your plan will depend on your observations
of the MSE (Mental Status Examination).
Summary

• Appearance
• Behaviour
• Affect
• Mood
• Insight
• Judgement
• Plan
• Referral
Referral

• Where the client raises feelings of unease in

you, as the observer, by demonstrating
thought disorder or abnormality, then you
need to refer the client either to their case
manager, the Psychiatrist, or for first aid, via
the ambulance or police.
Ambulance and or Police?

• Where the client threatens self harm or suicide,

says they want to die, or threatens to harm or kill
others, then you need to refer them to the
emergency services, which may be Police (where
they threaten to do harm to others) or Ambulance
(where they threaten harm to themselves, or talk
of suicide)
• In Australia the emergency number is “000”
The Mental Health Act

• enables people to be admitted to hospital for

Psychiatric assessment and treatment
where they are deemed to be a danger to
themselves or others – i.e. where they
threaten to harm themselves or others, or
harm their reputation.
Mental Health Act

• Two medical officers, one a Psychiatrist,

need to assess the admitted patient to
determine whether they have a mental
illness or disorder.
• If not, the admitted patient should not be
kept in hospital against their will.
• (Least Restrictive principle)
The Key

• It is better to be safe than sorry.

• You are not disempowering someone by
reporting them to emergency services when
they threaten harm to themselves or others.
• If you make a mistake, you have only
embarrassed yourself as you acted in good
faith.