We often only consider mental health assessments when things have broken down to an extent, either an individual is, and has been abusing drugs or alcohol, engaging in aggressive, abusive, neglectful or violent activities
By Psychotherapist Mertha Mo Nyamande
This week on the Mertha Mo Nyamande page on the Digital Sunday Express, I would like to talk about Mental Health Assessments
Mental health is essentially the total sum of our beliefs, emotions, and habits; whether these are helpful or constructive, disruptive or destructive to our livelihoods.
So, when one gets to a point where there are struggling to the point of causing harm to themselves or to others, it is essential to get an understanding of how they arrived at that stage before any intervention can be considered. This is what a mental health assessment seeks to clarify, conceptualise, and remedy.
We often only consider mental health assessments when things have broken down to an extent, either an individual is, and has been abusing drugs or alcohol, engaging in aggressive, abusive, neglectful or violent activities, unable to sleep or eat, their memory and concentration has been affected to the severity of making them prone or vulnerable to accidents and generally struggling to function normally, as expected.
A lot of these point to symptoms or unhelpful coping that the individuals employ in their bid to find ways to cope with daily life’s pressures and unbearable mental pains.
Whereas if we prioritised and attended to mental health check-ups regularly, most issues could be avoided or prevented, even the most commonly used excuse of poverty and needs hierarchy.
Poorer communities largely neglect mental health issues in pursuit of bread and butter issues, while the 2 are intrinsically linked, for without mental stability, there can be no physical or economical stability.
When we neglect mental health issues, we may as well forget about everything else because they all work together – even running becomes difficult when a little finger is in pain.
The African mindset is said to generally never seeking help until things are almost beyond repair or there is intolerable pain, or a limb is broken.
We often do not prioritise health check-ups which usually sees us neglecting general health. This makes us more vulnerable as we would be in desperate spaces, and often seeking immediate remedies to problems that we would have kept for years.
So, when we conduct mental health assessments, the structure is more of a holistic and structured exploration of what is perceived as the problem versus the actual, its severity and frequency but most importantly the duration.
The American model uses the 5 axis exploration that looks at the 1) mental issues presented and 2) any comorbidities, 3) any physical implications, 4) social issues and lastly, 5) the individuals’ functioning abilities, measured by the General Assessment of Functioning (GAF) scores.
The most commonly used however, is the 5Ps formulation that outlines the Presenting issues, problems or concerns, predisposing factors or underlying, perpetuating factors or maintaining, precipitating factors or triggers, and protective factors that include strengths as well as the action plan.
The initial aspect to be explored is the presenting problem, often it is during this stage that looks at whether the symptoms presented cause harm to the individual and or others. At times, due to the presentation, it is often at this point that most assessments stop, in order to address the priority need of safety over all the other aspects of the presentation.
Risk assessment is critical in all mental health presentations as the level of risk may mean life or death.
There is little value in coming up with a great assessment and plan of care when the individual being assessed has a plan to end their life or that of another or others that very day or at any chance they get.
Following the initial assessment and management of the presented problem(s) and the risks associated, the underlying issues can then be explored to help understand the root cause of the problem, otherwise it will simply sprout up again and again.
The underlying issues do not only look at the individual, but holistically through their family, upbringing, social support networks and significant others.
A thorough assessment also seeks to understand where this problem has come from and why it has surfaced the way it has in the here and now, which may have been a breakdown of a relationship or a death of a loved one or family member that would have triggered the mental deterioration.
The deterioration may be a single reaction to an identified event or may be what has been termed endogenous with no clear or easily identifiable triggers or origins.
Adjustment Reactions may resolve on their own in time without intervention, but if there are other unresolved underlying issues, they quickly escalate to Adjustment Disorders.
The likes of family history and early life experiences are helpful to conceptualised what would have been lost by parental ill-health or absence as well as associated abandonment type schemas that may have resulted. It is also particularly important to understand the triggers and the maladaptive coping that is applied as these are neither random but learnt behaviours.
More importantly however is the understanding of dynamics in the home that lay the foundations for later life.
Mental Health Assessment is followed by a clear and agreed plan of action between all parties involved to validate the perceived need as well as address the actual need.
Care or treatment plans should include families as much as possible as they are largely a part of the problem, and they can be an essential part of the solution.
By Psychotherapist Mertha Mo Nyamande @ www.i-wellbeing.weebly.com. Insightwellbeing.firstname.lastname@example.org
Mertha Mo Nyamande @InsightWellbeing Ltd #Monya-Mental February 2021. Feedback email@example.com
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