Mental health assessment

• Always consider drug or alcohol problems that may also be present 
• Talk with family and ATSIHP about person, their behaviour, who is best to sit with them while talking with you
• If person violent or seriously disturbed — see Mental health emergency
• If person talking about suicide

Children and young people

• Always consult with child and adolescent mental health team
• Before giving mental health medicines — medical/child and adolescent mental health consult
• Make sure there are family or carers to provide support, check on their safety and wellbeing while care and management is being arranged

The interview

Consider  safety first — in some circumstances you may need to involve police

• Talk with person in quiet place with lots of light — speak calmly and clearly, use simple language and listen carefully
• Use interpreter if needed and available
• Cultural support person present is always helpful to have 
• Allow time for person to tell their story
• Be aware of non-verbal cues. Be calm and non-threatening with open relaxed body posture
• Develop relationship and trust by talking about familiar things (eg family, country) and person’s strengths before talking about problems
• Explain what you are doing, what is happening and that you need to ask a lot of questions to work out how to help and what to do
• Work with person to solve the problems. Mental health problems are very common and most people recover — encourage positive outlook
• Work on strengths that you find in/around person’s life (eg Stay Strong Plan). Brief intervention style tools for talking about what keeps them strong, what takes away their strength and staying in balance.
• Introduce goal setting

Ask 

• Why they have come — ask person, family or other observers for their parts of the story
• Personal, family, community problems
• Ask screening questions for anxiety, psychosis, depression — see Mental health emergency
• Any mental health problems or treatment in the past — what helped
• About sleep patterns, any changes in appetite
• Any medical sickness and current treatments
• Alcohol (grog) or other drug use — see alcohol assessment
• Is there a cultural reason/explanation — is this presentation outside what is culturally appropriate now

Check

• U/A, pregnancy test
• Coma scale
• Head-to-toe exam — with attention to head injury, infection (eg chest, ear, UTI), epilepsy (fits), encephalitis, medicine toxicity, hearing impairment, electrolyte imbalance, thyroid dysfunction, anaemia

Do

• Blood for UEC, FBC, LFT, HbA1c, TFT, syphilis, urine MC&S and drug screen
• Mental health assessment — how does person seem to you, use prompts below to help you to describe person’s presentation
• Risk assessment 
• Cognitive assessment — if worried that person is not thinking clearly. Screen for cognition (whether brain is working properly)

Mental status examination

Consider how person usually is (or ask observer who knows them) and in the cultural context, how are they different now. Most of this will be observed during consultation, rather than needing a separate assessment

Consider

• Appearance (as if looking at a photo) — facial expression, clothes, jewellery, make-up, sunglasses, personal care, skin condition and body size
• Behaviour (as if looking at a video with sound off) — how are they acting (normal or bizarre), calm, agitated, cooperative, distracted, withdrawn, restless, overactive, posture and movements including walking
• Mood (what person describes) — sad, worried, nervous, cranky, happy, angry/wild
• Affect (what you describe) — flat, crying, irritable, mood swings, angry, too happy, frightened, unconcerned, excited, aroused. Comment on whether mood and affect  are congruent (match)
• Speech (as if listening to tape recorder) — absent, faster or slower than usual, unstoppable, pressured, slurred and loud or soft
• Thoughts
• Form — lose track of conversation, mixed up talk, not making sense
• Content — suicide talk, talking about hurting self or others, paranoia (overly suspicious), delusions (excessively grand beliefs or believing things that are not true)
• Perception — does person have auditory, visual or sensory hallucinations (hear, see or taste things that are not really present). Consider cultural context
• Cognition — can person remember things, recognise people. Are they confused about who they are, where they are and why they are there
• Insight/judgement — does person realise there is a problem, do they understand what the problem is, are they doing silly or dangerous things

Risk assessment

Use to help decide if person can be safely managed in community or needs to be sent to hospital for further mental health assessments and treatment. Mental health crisis lines in each state/territory can help with risk assessment (eg NT Mental Health Access Team)

Consider

• Serious or unstable medical condition
• Risk to others — if issue of public safety, police must be contacted
• Children — can't make themselves safe
• Violence, intimidation or sexual risk
• Risk to person
• Suicide or self-harm
• Vulnerability — financial or sexual exploitation, neglect, accidents, physical deterioration, victim of violence (eg domestic and family violence)
• Absconding, wandering
• Reputation, poor judgement, unrestrained spending, manic behaviour (poor decisions)
• Protective factors (things that keep person safe in community)
• Responsible person or carer they will respect, listen to
• Level of insight, ability to accept help, support, treatment
• No history of significant violence, self-harm, suicide attempts
• Community capacity to support and care for person

Possible diagnosis

• Recently confused, unable to concentrate, poor orientation — see Acute assessment of new onset confusion (delerium) —  potential medical emergency
• Talking about suicide or self harm — medical consult
• Hallucinations, delusions, bizarre behaviour — see Psychosis
• Overactive, grand ideas, not sleeping, pressured speech — may be manic phase of bipolar disorder — see Psychosis
• Withdrawn, sad, not eating or drinking, not talking, not getting out of bed, poor hygiene — see Depression
• Edgy, worried, restless — see Anxiety
• Poor orientation, poor memory, slowly getting worse — see dementia
• Consider effect of alcohol, cannabis, kava, volatile substances, amphetamines, prescribed medicines

Supporting resources

• Stay strong planning — brief treatment manual
• Stay strong plan — four page assessment tool
• Kimberley Indigenous Cognitive Assessment — cognitive component (KICA-COG) 
• Mini Mental State Examination (MMSE)