New Strategies for Mental Health Assessment: 5 Required Techniques

“The Hope Clinic has saved my life. I am grateful, and I am so sorry for exploding on you on my first day here.” Ralph articulated these words to Jaisa, the case manager described in the first article of this series entitled, New Strategies for Mental Health Assessment: 6 Reasons Why.  Ralph threatened to “do something bad” to Jaisa when they first met.  However, using the principles and techniques of effective and comprehensive mental health assessment, the clinic staff transformed Ralph into an ally and ambassador.

The five techniques used as part of the new strategies for patient and client mental health assessment are found below.

Humanize and attend to basic needs

During SWEET seminars, I often cite Maslow’s hierarchy of needs, because full recovery will be rather impossible, unless we do our best to first address the basic needs of our patients and clients.  Humanizing is also a principle and technique promoted by SWEET, as the opposite has been shown to be the root of major, unfortunate events against humanity.  From slavery to the holocaust and from Jim Crow to the Tuskegee study, history has proven that dehumanizing other people makes it easy for some to demonstrate brutality without showing much guilt, remorse, or empathy.  The good news is that the reverse is also true.  By humanizing our patients and clients, it is easier for us to think about and help attend to their basic needs.  This in turn sets the tone for an effective and comprehensive mental health assessment.

Karinn, Ralph’s clinician, started her visit with Ralph by asking, “How was it for you getting here? Did you get here by bus or train?”  “I almost did not make it here,” responded Ralph, “I had no money for the bus fare, but when I explained this to my girlfriend, she came to the house and helped me get here.”  These basic questions helped Karinn humanize (Ralph) and afforded the opportunity both to hear about a potential barrier and problem solve for future appointments.

Briefly explain the process and what to expect

“We are going to meet for about 90 minutes…I would like to hear as much as possible about why you are here; so, together, we can do our best to get to the bottom of it…I will also need to ask you some specific questions for clarification, to help me complete my note. However, we want to let this time be about you, your needs, and your safety.”  As Karinn articulated these words to Ralph, his affect brightened and his pupils widened.  “What do you prefer me to call you?” added Karinn. “Oh, Ralph, Ralph is ok, Miss.” “You can call me Karinn,” she replied.  Our patients and clients come to us with all forms of fears, feelings, and preconceived thoughts.  Briefly explaining the process to them, telling them what to expect is one good way to address or attend to their preoccupations.

Review the statement of confidentiality

“If I tell you what I am thinking about, you will just call the ambulance on me.” Matthew told this to Eileen, his therapist.  Patients and clients will commonly voice this to their clinicians.  Also common, “Had I known he was going to call the ambulance, I would not have told him what was really going on with me,” Ralph explained to Karinn.  “Whatever we are going to discuss today is meant to stay between you, me, and the rest of the team taking care of you at the clinic.  The exception to this would be if you told me you are planning to hurt yourself or anyone else.  I will be required by law to help prevent you from doing that, and it may lead me to involve additional people, who may not be part of your treatment team here at the clinic.  Do you have any related questions?”

Statements of confidentiality help to:

1. Establish trust and rapport;

2. Prevent surprises and misunderstandings;

3. Empower patients and clients; and

4. Make it easier for you and your patients or clients when it becomes necessary to involve a third party in the decision-making process related to safety.

Strive to balance your goal with that of your client

The mental health assessment template at several agencies contains several screenings and a lot of paperwork to complete.  This can create “worries” for the clinician, as he or she strives to engage the patients or clients, establish rapport, and work on the therapeutic relationship, listening with the third ear, paying attention to both the verbal and body language, demonstrate diagnostic skills, staying in the moment and staying attuned or ready to “switch gears,” as needed, always meeting the patients or clients where they are at.

The amount of paperwork involved at the Hope Clinic was not considerably less.  However, following the principles and techniques of the effective and comprehensive mental health assessment, Karinn felt a sense of empowerment.  She had started by humanizing Ralph, explaining to him the process and what to expect, and at the appropriate time, it was easy for her to transition, stating, “Ralph, thank you for sharing all this very useful information with me.  And I would like us to get back to them. You may also remember I explained in the beginning, that I may have to stop and ask you for some specific information. I am going to ask your permission for us to switch gears in the next 30 minutes or so to do that.” “Yes, you did tell me. Sorry I spoke too much. I hope I was not too boring, but I felt listened to, and I thank you for that.” “I am glad to hear that, Ralph, and you were far from boring. This was essential information, and I look forward to getting back to all of it.” Ralph felt heard, respected, listened to, and rapport and trust were being established.

Know when and how to obtain essential information

Ralph spoke about his early losses, his trauma history, followed by his episodes of depression and suicide attempts.  Tears welled up as he spoke about his time in prison and the premature death of his son, Ralph Junior.  Karinn listened attentively, turning away from her computer, her notes, and made full eye contact with Ralph, as he narrated these parts of his story.  Later on, Ralph transitioned to talk about some less sensitive and less emotional information, a moment Karinn used to jot some notes (past suicide attempts, trauma history, early losses, and legal history), as she continued to maintain eye contact with Ralph.

Conducting an effective and comprehensive mental health assessment is a combination of art and science, and it includes the mastering of the when and the how of obtaining essential information.  Karinn made sure to stay away from interrupting Ralph, as he talked about emotionally laden information, putting aside her need to obtain specific information.  And, as stated above, Karinn thanked Ralph for sharing, told him she looked forward to discussing further, and she reminded him that she needed to ask some specific questions to proceed.

“The Hope Clinic has changed my life and I am grateful…” Ralph articulated these words and was alluding to the thoughtful and humanizing encounters he experienced, including the one illustrated with Karinn.

As stated above, completing an effective and comprehensive mental health assessment involves the use of art and science, and some of the techniques include:

1. Humanize and attend to basic needs;

2. Briefly explain the process and what to expect;

3. Review the statement of confidentiality;

4. Strive to balance your goal with that of your client; and

5. Know when and how to obtain essential information.

The principles and these five techniques of effective and comprehensive mental health assessment are empowering tools for all of us who strive to make a difference in the lives of our patents and clients.

References:

1. Kirby GH. Guides for history taking and clinical examination of psychiatric cases, 1921. In: Slater E, Roth M, editors. Examination of the patient. Clinical Psychiatry. London: Bailliere Tindall; 1985

2. Rowe, M., Carlyle, D., and Farmar, R. (2008). Clinical formulation for mental health nursing practice. Journal of Psychiatric and Mental Health Nursing, 15(10), pp.800-807.

3. WHO (2001b). Mental health: New understanding, new hope. The World Health Report. Geneva, World Health Organization.