It is also important that physical health issues are addressed alongside the mental health issues, if not before, wherever possible
Mertha Mo Nyamande
This week I continue with my regular column in the Sunday Express on the Monya-Mental series. Hoping that you are following and that you are learning something. The following is the Structure of Mental Health Assessments:
Biographical details present a picture of the age, weight, height of the individual to give an indication of the risk group and category, body mass index, and any features that are visible on the surface before the actual assessment even begins.
This is usually the critical focal point to get to understand why the individual has presented, not just what they are saying, but what they are not saying as well. This also looks to assess the risks posed by the individual to themselves or to others, as well as their vulnerability to abuse by others.
Mental Health Presentation History
Here we look to see if there have been any other mental health issues apart from the one being presented currently, particularly how these have been resolved, any prior treatments, and admissions to hospital. What has worked in the past and why that has been stopped.
This history can also point to triggers to the problems that the individual is vulnerable to.
Physical Health History
This plays a big part on one’s mental health, in particular if there is pain. Chronic pain is a strong predictor of suicide, so this is crucial especially in managing risk. It is also important that the physical health issues are also being addressed alongside the mental health issues, if not before, wherever possible.
Personal and Family History Genogram
Family history speaks volumes to highlight why the problem exists – the root causes, and how long it has existed. Recent problems can simply be reactions that pass with time and without treatment.
But if its a problem that has been on and off for many years – a chronic problem, it can be a bit more complicated to remedy as often people get to a place where they identify with their struggles to the point that removing the problem may feel like they also lose their identity.
This is common with the Personality Disorders.
What is happening in the now are usually an accumulation of what has been happening for a long time to the point that one can no longer cope.
Often earlier on in life, children may have been protected by their parents and shielded from the harsh realities of life. So when they eventually go out there and are now being faced with the things that they have been shielded from, they just wont know how to respond or protect themselves.
We also see how taking up responsibilities can be exceedingly difficult when parent have always been making decisions all along. We see how people struggle in adulthood even when a parent or both die off.
Most feel lost, not necessarily because of the death itself, but in a lot of circumstances genuinely not knowing what to do without the guidance they had become dependent on.
Being in trouble with the law also highlights certain elements of one’s schemas and support in early life which can help clinicians navigate through the difficulties. Also having current criminal proceedings can increase one’s impulsivity due to the fears associated, be it incarceration or loss of occupations and or livelihoods if convicted.
Mental State Examination (MSE)
MSE is a balance between what is being reported and the body language presented, for example, one may be narrating a very emotional story but laughing in the process. The contradiction between what is being said and the expected emotion can indicate a disconnect within the individual.
People prone to substance misuse often struggle to recognise most emotions but are very sensitive to disgust, which is the emotion often shown to them by those close to them.
MSE is also crucial in the prediction of risk, in how someone maintains or avoids eye contact save the cultural norms, as well as the clear indication of risk, should be taken seriously, although some are veiled threats to get a response.
These require expertise in assessing to know which is meant.
Summary and Formulation
This aspect is like the conclusion that most referrals focus on, as most practitioners don’t often have time to go through the full assessment report, unless the summary and formulation is not clear. This seeks to draw all the highlighted aspects of deviation from expected psychological concepts and conceptualise them in how they maintain or trigger the current presentation.
This is the critical part that looks at what treatment can be provided for the individual. As highlighted earlier, the key aspect is to ensure safety, then establish what type of treatment is suitable and effective, whether if appropriate and safe at home or requires inpatient admission.
Prescribed medication and possible side effects must also be explained to prepare them for what may occur, and to know what to do.
If a working individual, practitioner will consider time off work to help settle on the new medication and be stable, depending on the presentation.
Finally, is to outlines the frequency of contact, follow up and reviews of the treatment.
It is important to explain all this to patient/client as well as their family or informal carers for support and prompting especially where medications have been prescribed.
Assessments may be conducted over one or many different sessions and there may also be several other tests to ascertain specific diagnoses.
The entire process can be done in a manner that is less threatening than most think of Mental Health Assessments. Help is available, for communication is the most powerful tool for problem-solving.
By Psychotherapist Mertha Mo Nyamande @ www.i-wellbeing.weebly.com. Insightwellbeing.firstname.lastname@example.org
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