Mental State

Examination
A session on examination and
assessment of the Mental Health
Status
By
Christopher Skinner
Mental State Examination

In this session the learner will learn how

to assess the Mental Status.
The steps in the Mental Health
Examination.
The referral pathway resulting from the
status report that you make.
Mental State Examination

Once learnt, the MSE is relatively easy to

apply.
The steps are based on observation of
different manifestations of the client’s
presentation.
Mental State Examination
Appearance: What does the client look like to the
observer using your senses?
Dress
Manner
Smell
Eye Contact
Suspicious, Hypervigilant?
Tremulous, Scared, Frightened, Angry,
Combative, Threatening or Jealous?
Body Language and Posture
Mental State Examination

Behaviour
What is the behaviour like?
How does the client relate to you?
Are they co-operative or not?
Are they listening to you when you ask
questions?
Are they friendly or distant?
Are there complaints about the client’s
behaviour?
Is the client agitated or restless?
Affect

Is the client happy or sad?

Are they angry?
Are they withdrawn or expansive?
Are they extrovert or introvert?
Are they jealous?
Mood

How would you describe the mood?

Happy or Sad – How does the client tell
you that they feel?
Are they angry, embarrassed, down or
blue?
Are they threatening to self harm or
suicide?
Cognition

refers to the thinking of the client

tells us whether thought is ordered or
disordered, coherent or incoherent, clear
or confused, normal or abnormal.
This is examined by asking the patient a
series of questions
Questions

What is the day, the date?

Where are you?
Who is the Prime Minister of Australia?
What did you have for breakfast?
What is your name?
What is worrying you?
How did you come to be here?
Answers

Normal answers to the questions indicate

normal cognition.
Difficulty in answering the questions or
bizarre answers indicate faults in cognition
or disordered thinking.
Examples

What is the day, date?

Most people can answer this – however, if
confused, the client may answer these
simple questions with inaccurate
information.
Examples

Where are you?

Most people can tell you where they are.
Incorrect answers indicate confusion.
Examples

Who is the Prime Minister of Australia?

Most people will answer Kevin Rudd, but
people who are confused or delusional will
give alternative answers.
New Australians and some alternative life
stylers may not be able to answer this
question
Examples

Similarly, questions about breakfast and

who are you will demonstrate whether the
client is confused or unable to recall basic
information.
Examples

What is worrying you?

The client may answer this – the
information provided may give clues as to
whether the client has insight or not.
Answers may provide clues as to what is
ailing the client.
May point to suicidal ideation.
Serial Sevens

Serial sevens is a simple mathematical

exercise, starting with 100, ask the client to
take away seven each time, so the
answers are 93, 86, 79 and so on. Clients
who are unable to do this may have a
cognitive disorder, or be very poor at
mental arithmetic. Most clients can do this.
Cognition

Disordered thinking is common in the Psychoses

– there is a lack of touch with reality.
Confused thinking shows a clouded sensorium
as in Delirium, and diseases such as Alzheimer's
and Wernicke's encephalopathy. There may also
be organic or infectious causes, such as Urinary
Tract Infection, Diabetes, Organic Brain
Syndrome.
Insight

Mentally Ill clients suffering from acute

psychosis often lack insight into the fact
that they are mentally ill, and may deny
that there is anything wrong, when it is
clear to casual observers that their
behaviour is abnormal.
Judgement

Clients who are severely depressed may

be suicidal and may show evidence of
poor judgement.
Similarly, Manic clients may show poor
judgement about aspects of self control,
they may plan projects for which they do
not have the pre-requisite resources, either
emotional, financial or health wise.
Plan

Asking the client what is their plan may

demonstrate disordered thinking, or
expose ideas of self harm/suicide.
Your plan will depend on your
observations of the MSE (Mental Status
Examination).
Summary

Appearance
Behaviour
Affect
Mood
Insight
Judgement
Plan
Referral
Referral

Where the client raises feelings of unease

in you, as the observer, by demonstrating
thought disorder or abnormality, then you
need to refer the client either to their case
manager, the Psychiatrist, or for first aid,
via the ambulance or police.
Ambulance and or Police?

Where the client threatens self harm or suicide,

says they want to die, or threatens to harm or kill
others, then you need to refer them to the
emergency services, which may be Police
(where they threaten to do harm to others) or
Ambulance (where they threaten harm to
themselves, or talk of suicide)
In Australia the emergency number is “000”
The Mental Health Act

enables people to be admitted to hospital

for Psychiatric assessment and treatment
where they are deemed to be a danger to
themselves or others – i.e. where they
threaten to harm themselves or others, or
harm their reputation.
Mental Health Act

Two medical officers, one a Psychiatrist,

need to assess the admitted patient to
determine whether they have a mental
illness or disorder.
If not, the admitted patient should not be
kept in hospital against their will.
(Least Restrictive principle)
The Key

It is better to be safe than sorry.

You are not disempowering someone by
reporting them to emergency services
when they threaten harm to themselves or
others.
If you make a mistake, you have only
embarrassed yourself as you acted in
good faith.