“I thought this was going to be my worst experience, but Karinn is different.”
Ralph articulated these words to Wayne, the psychiatrist, meeting him for the first time, for his initial psychiatric evaluation.
In our first article entitled, New Strategies for Mental Health Assessment: 6 Reasons Why, I introduced Ralph, who threatened to sue the HOPE Clinic after he received the news from Jaisa about restrictions on his medication. Ralph subsequently met with Karinn for his initial mental health assessment and later said, “I thought this was going to be my worst experience, but Karinn is different.”
Below are the seven principles Karrin used that you could implement for an effective mental health assessment.
1. Meet them where they are at
In two previous articles entitled, 5 Tips to Help Engage Your Patients and Clients, Part 1 and Part 2, I explained how meeting patients and clients where they are at was a crucial element of engagement, for which the completion of an initial mental health assessment can be a decisive factor.
I often mention how the initial mental health assessment can be misunderstood, and that it needs to be both diagnostic and therapeutic. However, for this to happen, there needs to be a reframing of how we think about mental health assessments. One first principle of an effective initial mental health assessment centers on engagement and meeting patients and clients where they are at.
2. Establish and maintain safety
During an initial mental health assessment, safety needs to be established, in all its forms. Is there any acute risk for suicide or violence against others in the community? This needs to be adequately assessed and established and promptly and properly managed. The caveat is how to do so and still overall remain thorough, and the answer lies in mastering the new strategies for mental health assessment.
3. Start with the end in mind
If you do not know where you are going, you may end up distracted, lost, and may miss opportunities to adequately plan and direct where you would like to be. The same applies to the initial mental health assessment. Having goals, objectives, strategies and tactics, and even some deliverables in mind will make the process much easier and more feasible. So, start with the end in mind.
4. Be and remain therapeutic
As I mentioned earlier, the initial mental health assessment is most effective when viewed as both diagnostic and therapeutic. The principle of being and remaining therapeutic during the initial mental health assessment is crucial, and it can be learned. It starts with an understanding that everything we do needs to be done in the most therapeutic way possible.
5. Seek to understand
Jaisa told Ralph he could not receive Klonopin at the clinic. She told Ralph what he could not do, before taking the time to listen to and hear his story, or understand his circumstances. She did not seek to understand Ralph. When we seek to understand our patients and clients, they feel it. The opposite is also true. When we seek to understand, it helps establish rapport and trust, and it is more likely that our patients and clients will be receptive to our recommendations.
6. Be and remain collaborative
As I explained above, our patients and clients are more likely to become receptive to us when we seek to understand them. An additional way to reach this goal involves being and remaining collaborative. Being and remaining collaborative does not mean we are to do exactly what our patients and clients want. Rather, it means there is no longer “them and us,” but “us in this together,” as partners, seeking to understand the shared purpose, power, and decision-making authority. My colleague, Karen, often says, “It is about doing with, not to.” Set yourself apart from the common practice and usual experience of our patients and clients by being collaborative and not doing to them, but rather, with them.
7. Make them a priority
You have been able to meet them where they are at, you were able to establish and maintain safety, you have started with the end in mind, and part of the beginning, middle, and end, is to make your patients and clients a priority.
Making your patients and clients a priority is therefore both part of the goal of an initial mental health assessment, as well as a principle for ongoing meaningful work together. In this vein, part of making your patients and clients a priority also entails being and remaining therapeutic, seeking to understand them better, and being and remaining collaborative. In an era where there is never enough time, we may easily be forced to prioritize finishing our note over making our patients and clients a priority. However, I assure you that it will pay off, in the long term, if you follow this principle.
“I thought this was going to be my worst experience, but Karinn is different.” Ralph articulated these words to Wayne, the psychiatrist, meeting him for the first time for his initial psychiatric evaluation. During his first visit, he threatened to sue the HOPE clinic after he had received the news from Jaisa about restrictions on his medication. He subsequently met with Karinn for his initial mental health assessment and later said, “I thought this was going to be my worst experience, but Karinn is different.”
Throughout her visit with Ralph, Karinn used the following principles:
(1) Meet him where he was at;
(2) Establish and maintain safety;
(3) Start with the end in mind;
(4) Remain therapeutic; and
(5) Seek to understand. She also
(6) Remained collaborative and
(7) Made him a priority.
Karinn transformed Ralph’s experience, and the benefits were not limited to him only, but shared with Karinn herself, as well as the agency and the system, as a whole.
For more in this serie of articles, check below!
Treatment Protocol Project (2004). Management of mental disorders (4th ed.). Darlinghurst, Australia: World Health Organization Collaborating Centre for Evidence in Mental Health Policy.
Lin, K. M., Inui, T. S., Kleinman, A. M., & Womack, W. M. (1982). Sociocultural determinants of help-seeking behavior of patients with mental illness. Journal of Nervous and Mental Disease, 170(2), 78–85.
Pope C., Mays N. (1995( Reaching the parts other methods cannot reach: An introduction to qualitative methods in health and health services research, British Medical Journal, 311, 42-5.
Whitley R., Crawford M. (2005) Qualitative research in psychiatry, Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 50, 108-14.