New Strategies for Mental Health Assessment: 6 Reasons Why

“If I don’t get this medication, I will do something bad, and I will sue all of you.” Ralph walked out of the room, yelling these words at Jaisa, the case manager at the HOPE Clinic, who was meeting him for the first time to do his intake.

Ralph was transferred from a different clinic, where he received Klonopin, a medication for anxiety.  Jaisa reviewed the clinic policies with Ralph and told him he had to first be evaluated, using a thorough and full mental health assessment before the treatment team could decide whether he would continue with the same medications.

“How important is diagnosis, if the patients or clients will end up with the same type of medications anyway?” Valerie, a psychiatric nurse practitioner student asked Wayne, the psychiatrist at the HOPE clinic, in charge of evaluating Ralph, who was still threatening to sue, if he did not receive Klonopin.

Mental health assessment is one of the most miss-conceptualized activities performed in the field of mental health.  It is either easy or difficult, one either knows it all or not at all.  Its purpose is also often misunderstood—fill out or complete the paper work, get the note done, get someone admitted to a program or to the clinic.  What if, as a whole, we had the wrong concept regarding mental health assessment?  What if we could learn to harness and leverage the significance of the mental health assessment, in order to make a difference in the lives of our patients and clients, as well as in our career?

Below are 6 reasons why it is essential to learn how to conduct an effective mental health assessment:

Patient and client perspective

• Engagement

Establishing a second visit is one of the main goals of a mental health assessment oriented towards treatment. To achieve this goal, engagement is essential, and mastering the art and science of an effective mental health assessment is a pre-requisite.  In previous articles entitled, Tips to Engage Your Patient or Client, I outlined the promoting factors of engagement, which include and are not limited to focusing on the patient or client, including them in all decisions, and identifying barriers, and problem solving.  All this can take place through an effective mental health assessment.

Jaisa started meeting with Ralph and told him there was no guarantee they would give him the medications he received at his previous clinic.  A practice of first assessing instead of reflexively renewing medications for patients or clients is always encouraged.  However, this situation required a thoughtful discussion; one more likely to succeed through engagement, which can be achieved through an effective mental health assessment.

• Therapeutic Relationship:

Establishing a therapeutic relationship is necessary for meaningful changes to take place in treatment, and, like engagement, an effective mental health assessment is an essential component of a therapeutic relationship. When a therapeutic relationship is established, it is easier to hold difficult conversations.  With an established therapeutic relationship, you are able to put things into context.

Telling Ralph there was no guarantee he would continue to be on Klonopin without putting it into context was a recipe for disaster, one that could have been prevented with a strong therapeutic relationship.

• Accurate understanding of the problem:

Valerie asked Wayne, “How important is the diagnosis in mental health…?”  The importance of diagnosis in mental health is more controversial than it may seem and is beyond the scope of this article.  Nonetheless, having an accurate understanding of the problem with which our patients and clients present is required if we are to problem solve effectively.  Often enough, we attempt to bring solutions to a problem without fully understanding the problem, and these solutions lead to more problems than when started.  Effective problem solving first requires an accurate understanding of the problem, and an effective mental health assessment will help provide this.

Clinician Perspective:

• Comprehensive and effective treatment plan:

Treatment plans can be an emotionally loaded topic. It can be that which needs to happen to submit the claim for insurance to pay, or to admit a patient or client to the clinic or the agency. Treatment plans can also become an activity about which you receive incessant emails from your supervisor or administrators: “Treatment plan renewals are due; signatures are missing; and initial treatment plans are overdue.” Treatment plans can easily become detached from the essence of the work and dreaded by almost all of us. However, an effective mental health assessment will help set the tone for a comprehensive and effective treatment plan, which can then become more meaningful and more enjoyable.

Ralph had been on Klonopin for two years and the indication was “anxiety.”  Jaisa reviewed his records and associated treatment plans and there was no mention of anxiety in the problem list.  An effective mental health assessment is the foundation for a comprehensive and effective treatment plan.

• A road map:

During my rotation in infectious disease, for each infection, we made an assessment then sent samples to the laboratory and then started a broad spectrum antibiotic (antibiotic effective for a wide variety of germs).  The tests to determine which specific microorganism (germ) caused the infection took some time to provide conclusive results.  At times, these tests return after the patient or client has improved and has already been discharged from the hospital.  However, these methods continue to be the standard of practice that guide treatment in infectious disease, and they have been shown to be effective.

Why is this the case?

1. An effective initial assessment provides a solid hypothesis about what may be the underlying cause of the infection, which helps guide the appropriate starting antibiotic, but a confirmation is still required;

2. Some patients or clients do not get better on the first antibiotic. In this case, the results from the sample serve as a road map for the best way to proceed.

An effective mental health assessment serves the same purpose.  It allows clinicians to know the best next steps should the first intervention fail to work.

Agency and System and Clinician and Patient or Client Perspective:

• Clinical outcomes:

Good clinical outcomes depend on good engagement, a good therapeutic relationship, an accurate understanding of the presenting problem, and a comprehensive and effective treatment plan.  Good clinical outcomes also depend on having the right road map to follow.  While all this may sound like a daunting task, an effective mental health assessment makes it all possible and makes it easier in the end.  Have you ever felt helpless with a patient or client and uncertain of what the next step should be?  The next time that happens, look back into your initial mental health assessment note.  You may find crucial pieces of information initially overlooked.  You may also realize there was essential information missing and the need to meet with your patient or client to “fill the gaps.”

Roland, a 20 year-old patient and client had been threatening staff at the HOPE Clinic, and the working decision concerned whether to discharge him from the clinic or not.

Rodis, who was consulted on the case, asked: “Why was this patient referred to the clinic?” “Oh, I am unsure, I have to check,” answered the team.  Priscilla, the clinician, looked up the initial mental health assessment note and realized that Roland had been transferred to the HOPE Clinic, because of similar threats to staff at the prior clinic where he had been receiving treatment.  “Did we manage to understand what was behind these threats? Did this presenting problem become part of Roland’s treatment plan; and, was there a stepwise plan to get to the bottom of it?” Rodis had thoughtful questions.  The answers to all three questions were the same—“no”—and the failure traced back to a limited mental health assessment.

“If I don’t get this medication, I will do something bad, and I will sue all of you.” Ralph yelled at Jaisa, who had started speaking with him about a “treatment plan,” without first effectively completing a mental health assessment.  An effective mental health assessment would have allowed the treatment team to engage Ralph, establish a therapeutic relationship with him, accurately understand his presenting problem, and collaboratively design a comprehensive and effective treatment plan, as well as develop a road map to guide the course of the treatment.

References:

1. Redder, Peter; Lucey, Clare, eds. (2002). Assessment of parenting: Psychiatric and psychological contributions. London: Routledge

2. Yellowlees, Peter. Psychiatric assessment in community. Mental Health Information Centre. eMJA.

3. Comprehensive Psychiatric Assessment Service. Menninger. 2008. Retrieved 2008-06-29.