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Flashcards in L2b comprehensive mental health assessment Deck (28):
1

define mental health

Mental health is defined as a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

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what r the key components of mental health

 Emotional wellbeing  Psychological wellbeing  Social wellbeing

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what is mental illness problem

 A mental health problem is diminished cognitive, emotional or social abilities, but not to the extent that criteria for a mental illness are met.

4

what is mental illness

Mental illness is “the term most commonly used in health care to describe the spectrum of cognitive, emotional and behavioural conditions that interfere with social and emotional wellbeing and the lives and productivity of people” - A condition that seriously impairs, temporarily or permanently, the mental functioning of a person; characterised by any one or more of the following symptoms: (a) delusions, (b) hallucinations,(c) serious disorder of thought form, (d) severe disturbance of mood, (e) sustained or repeated irrational behaviour indicating the presence of any one or more of the symptoms referred to in (a)-(d).

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mental health and illness - 2 continua model

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holstic framework of assessment

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comprehensive mental health assessment (MHA)

  Structured process of gathering relevant history/information

  Comprising purposeful enquiry to determine what events and factors may have influenced or precipitated a person’s current mental state and health

  Explore all aspects of the person

  Identify areas of unmet needs; changes, issues, symptoms; resources, strengths, supports (inform the clinical decision making process and collaborative care and treatment planning)

  Process of therapeutic engagement

  Creates opportunity for person to tell their story/journey

  Is conducted by a mental health clinician

  Is usually conducted:

o on admission or intake to a mental health service

o with anyone presenting with primary (first-onsetorrelapse) signs/ symptoms of mental health problems and/or where behaviour includes an element of risk

 Can be conducted in varied health care settings
(e.g. Emergency department; PECC; general hospital; community/ primary healthcare setting)

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Components of Comprehensive MHA

 Demographic data/identifying information
 Reason for referral/who made referral
 Presenting problem/precipitating factors
 Previous and current mental health/medical/D&A history

 Developmental/psychosocial/relationship history

 Current functioning and supports
 Physical Assessment
 Risk Assessment
 Mental State Examination (MSE) [aka: mental state assessment]

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Problem and Triggers - History of presenting problem

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Bographiclhistory - developmental and personal history, functioning and supports

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collaorative history

 The experience of health and illness occurs within personal, social and cultural networks.

  Assists in obtaining an in-depth understanding of the person and their circumstances

  Collaborative and corroborative history can minimise confusion and distress

  In an emergency/crisis situation it make be difficult to acquire information from the individual and therefore information from family/friends is helpful.

12

engagement and interviewing

The impression you give at the outset may affect the entire outcome

 Introduce self
 Ask person to introduce others who may be present  Provide message that you are interested in him/her

Don’t begin interview asking ‘why are you here?’

  Provide an outline of what is going to happen

  Prepare them for the sensitive nature of some questions

  Chat initially about lighter, non-threatening topics

  Create an empathic stance by acknowledging they may feel uncomfortable at times

Build rapport so person feels their concerns are heard

  Person should come away feeling that someone cares and that something useful might happen

  Ask open ended questions so that there is opportunity for rapport building and engagement

  The goal is not just to elicit information about what might be ‘wrong’ with the person

Ask for feedback

  Check you understand the person’s concerns and difficulties

  Clarify the person’s goal s around assessment

  Before concluding, ask if they have any questions or anything to add

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Health Practitioner’s Beliefs and Assumptions

 Nurses bring their own beliefs and assumptions, based on own knowledge and experience, which can result in varying levels of tolerance dealing with particular situations (particular health risk behaviours)

 Take a respectful stance and aim to build collaboration
 Ask questions in a non-judgemental way, that does not imply assumptions

– questions to young women about boyfriends assumes heterosexuality

–  when asking questions about employment and living situation, don’t assume a person has a job or lives in the same type of accommodation you do

–  when asking about family, check you understandings and assumptions about what ‘family’ means

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Mental State Examination (MSE)

  Forms part of comprehensive MHA or stand alone.

  Done at admission/intake, during treatment, discharge; re-assessed

over time

  Used to determine changes in patterns of thinking, feeling and behaviour (mental state) over a period of time.

  Systematic method for organising data (acquired through observation and interaction) about a person’s CURRENT and PRESENT mental state/functioning.

  Focuses on signs and symptoms (not history).

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MSE components

 Appearance

 Behaviour

 Mood
 Affect

 Speech
 Thought form
 Thought content
 Perception
 Sensorium and cognition

 Insight and judgement

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MSE - Appearance

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MSE - behaviour (and attitude)

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MSE-speech

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MSE- mood

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MSSE - affect

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MSE - thought form

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MSE- thought content

Possible Questions

–  What has been on your mind lately?

–  Are there thoughts or images that you have a difficult time getting out of your head?

–  Are you worried/scared/frightened about something?

–  Do you ever feel different from others around you?

–  What do you think about when you are sad/angry?

–  Do you think someone intends to harm you in some way?

–  Does it ever seem like people are stealing your thoughts? Inserting thoughts into your head? That your thoughts are broadcast out loud?

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MSE - perception

–  Do you ever see, hear, smell, taste or feel things that are other people do not? Things that are not really there?

–  Do you ever feel detached/removed/changed/different from others around you?

–  Do things seem unnatural or unreal to you?

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MSE - sensorium and cognition

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insight and judgement

–  Whatbringsyouheretoday?

–  What do you think is causing your problems?

–  How do you plan to get help for this issue?

–  How will you manage if .... happens?

–  What will you do when .... occurs?

–  If you were in a cinema and smelled smoke, what would you do?

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Potential Barriers Influencing a Comprehensive MHA and MSE

– ‘ESCAPADE’

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documentation

  Use simple, clear, descriptive, professional language

  Must be comprehensive (try not leave blanks

  Must be objective - Your professional determination of your findings and supported by subjective evidence - What the person is expressing (verbal and non-verbal); or in some instances, what the person is not doing/saying.

  Remember: your documentation is a written expression of your professional observations, clinical judgement and skill. Professional language reflects your understanding of the patient’s subjective experience as observed by you.

  Other health professionals who read your assessment should be able to gain a clear understanding of the health issues identified.

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a comprehensive MHA

  Is a structured process of gathering relevant and accurate information/history

  Comprises deliberate professional enquiry to determine what events and factors have influenced a person’s current mental state and health (constructs a ‘picture’)

  Explores all ‘aspects’ of the person and includes existing/ presenting risk and protective factors

  Incorporates therapeutic engagement

  Informs the clinical decision making process to formulate relevant

interventions, treatment and diagnosis

  Forms a legal document

  Is only as good as the clinician who is conducting it