Mental State Exam

Podcast 019: Mental State Exams

Mental State Exams
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Mental State Exams

In todays episode of the Ultimate Youth Worker Podcast Aaron and Jessy look at the Mental State Exam and how it can help youth workers in recognising mental health issues in their young people and how it can aid in making referrals. The Mental State Exam is a comprehensive tool that brings together the subjective views of your young person and your objective views to help recognise the symptoms of mental health issues.

One of the best tools for recognising mental health issues and referring young people to clinical mental health services we have come across over the years is a Mental State Exam. It is simple to use, it covers all the bases and it gives your gut feeling a set of clear indicators to work through. It makes referring easier as it gives you language to use that clinical services understand. It also gives you some objective information to have a good conversation with your young person.

In this Podcast Aaron will show you how to complete a Mental State Exam, what to look out for and when to refer on to the proper treatment. The Mental State Exam is a tool, and like any tool it takes practice to master. When we have a good understanding then we can put it in the toolbox and use it when the need arises.

Resources

Download our MSE Cheat Sheet

Read our blog posts on each of the eight areas of the MSE

  1. Appearance
  2. Behaviour
  3. Speech and Language
  4. Mood and Affect
  5. Thought process and content
  6. Perception
  7. Cognition
  8. Insight and judgement

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Mental State Exam for youth workers: Insight and Judgement

We are finally here our series on mental state exams is in its last week. Over the past eight weeks we have built an understanding of the core components of a mental state exam so that we can support our young people as best we can. This week I was speaking with a youth worker in one of Victoria’s largest Christian denominations about a mental health conference he was at. I was reminded about how important it is for all youth workers to have a strong understanding of mental health. So far we have discussed how a young persons appearance, behaviour, speech and language, mood and affect, thought process and content, their perceptions and how their cognition can provide indicators as to their mental state. Today we discuss how a young persons insight and judgement can provide insight into their current mental health status.
 

Insight

A young persons insight into their own mental health and possible treatment options is key to the extent to which effective support can be provided. The young persons understanding of his or her mental illness is evaluated by exploring their explanation of the problem, and their understanding of the potential treatment options. The three main areas in which we need to be aware when assessing a young persons insight: recognition that they have a mental health issue, compliance with a treatment plan, and the ability to describe unusual mental events (such as delusions and hallucinations) as abnormal.

 

Insight is assessed on a continuum and therefore youth workers should not describe it as simply present or absent, but should descriptively assess the young persons ability. Impaired insight is characteristic of disorders such as psychosis and dementia, and is an important consideration in the development of treatment plans and in assessing the capacity of a young person to consent to treatment.
 
Mental health issues have become more frequently reported and diagnosed however the ability for many people including young people to accept that they have a mental health issue is still a concern. Insight is linked closely to cultural, religious and societal norms and these things should be considered while supporting a young person.

Judgment

When we are observing judgment it refers to the young persons ability to make reasonable, sound and responsible decisions. Contemporary use of this in a mental state exam asks us to inquire about how the young person has responded or would respond to real-life challenges and contingencies; for example, ‘What would you do if your mother stated that she thought you were depressed?‘. In this form of questioning we are looking to see if the young person is able to respond in a way that shows insight into their situation and possible next steps. 
 
Assessment of the young persons judgement would include amongst other areas the individual’s executive capacity in terms of impulsiveness, social cognition, self-awareness and planning ability. If the young person appears to be providing abnormal judgement it is not necessarily a link to a mental health issue as it is not part of any diagnosis. However, if there is an impairment in judgement it may be an issue of safety for the person and the community.
 
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Mental state exams are a skill that needs to be practiced and refined. The basic ideas that we have discussed over the past eight weeks are just that the basics. These tools will not make you a psychiatrist!!! If you believe that a young person is having some mental health struggles then you can use these tools to support your case. 

 

Good luck. Use these tools wisely.
 

If you have any questions contact us.

 

Mental state exam for youth workers: Cognition

Second last post this week for our series on Mental State Exams. Over the past few weeks we have been building an understanding of the core components of a mental state exam so that we can support our young people as best we can. This week I was speaking with a youth worker in one of Victoria’s largest Christian denominations about a mental health conference he was at. I was reminded about how important it is for all youth workers to have a strong understanding of mental health. So far we have discussed how a young persons appearance, behaviour, speech and language, mood and affect, thought process and content and their perceptions can provide indicators as to their mental state. Today we discuss how a young persons cognition can provide insight into their current mental health status.

 
In this section of the Mental State Exam we are looking at a young person’s level of alertness, orientation, attention, memory and executive functions. It is often this part of the MSE which requires the use of structured tests in conjunction to unstructured observation. However, an astute youth worker can use the basic understanding learnt here to gain a base level to work from. Cognition is observed through judging alertness, orientation, attention and concentration, memory and executive functioning.

When observing alertness we are looking into the young person’s level of consciousness i.e. awareness of, and responsiveness to their environment. Their level of alertness may be described as alert, vigilant, clouded, drowsy, or stuporous. If you are on a camp or at the end of a long Friday night youth group then alertness may be low. Conversely, on your way to a concert or game of laser tag alertness may be quite high. There are many factors which you must take into account when observing alertness. Rock, paper, scissors is a great game for testing the alertness of a young person.
 
Orientation is assessed by asking the young person their name, age etc (orientation to person) where he or she is (for example what building, town and state) and what time it is (time, day, date). What we are looking for is that they are oriented in person, place and time. People who have taken a big knock on the football field and are dazed are often asked these questions to observe whether they have a concussion. In the drug and alcohol field we often use these questions when people seem substance affected to judge how affected they are.

Attention and concentration are assessed by using structured tests such as series seven tests, or if you are in a pinch getting them to spell a five-letter word backwards), and by testing digit span. Here we are looking to see if the young person can keep their focus and concentration whilst completing given tasks. These tests are great for judging inebriation, attention deficits and anxiety.

Memory is assessed in terms of immediate registration (repeating a set of words), short-term memory (recalling the set of words after an interval, or recalling a short paragraph), and long-term memory (recollection of well known historical or geographical facts). If there is a severe issue with memory it may indicate dementia or neurological issues. Short term memory loss can be a symptom of anxiety.

Executive functioning can be screened for by asking the “similarities” questions (“what do x and y have in common?”) and by means of a verbal fluency task (e.g. “list as many words as you can starting with the letter F, in one minute”). The mini-mental state examination is a simple structured cognitive assessment which is in widespread use as a component of the MSE. These tests are looking at higher order brain functioning and a persons ability to stay on task. This is important for their ability to think in a critical way.

Note: The kind of brief cognitive testing discussed here are regarded as a screening process only, and any abnormalities should be more carefully assessed using formal neuropsychological testing.

Stay tuned for our final segment next week: Insight and Judgement.

 

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