What is the theory behind this Looking after your mental health worksheet?
The Mental state examination is a tool for assessing a person’s fundamental cognitive, emotional, and behavioural functioning at a specific time. A planned interview and methodical behavioural observations are typically part of the strategy.
How will the worksheet help?
The mental state examination is used to assess a client’s cognition, emotional and behavioural functioning. It is a useful tool for mental health practitioners to get the idea of a client’s psychological functioning before planning further treatment.
How to use the worksheet?
The mental state examination worksheet can be used by therapists during sessions. It is beneficial for therapists to get an idea about a client’s cognitive, emotional and behavioural functioning.
Mental Status Exam Worksheet
| Client name: | Age: |
| Gender: | Date of Birth: |
| Level of consciuosness How alert, aware, responsive the client is? | AlertHypervigilantDrowsy lethargicstuporous asleep | comatose confused Fluctuatingother |
| Orientation Is the client aware of time, place & the nature of stituation? | Oriented (if knows time, date and situation)Partially oriented (eg, if knows time and situation but not the date) |
| Quality of movement Include motor behaviour | normal movement postural instabilitytremors, Restlessness | delayed movementsother |
| Affect Include the observation of emotional expressions | Normal rangesituationally relevantMood-appropriateFlat labile TearfulConstricted | blunted or confined (little expressed emotion).other |
| Mood Include the observation of emotional expressions | Normal or euthymicHopeless Euthymic Anxious IrritableDepressed | Elevatedother |
| Speech Include the fluency, volume, rate | Normal rateFluent volumeHalting speechword-finding difficultiespressured speech.Loud or soft volume. | Monotoneother |
| Thought process Include the form and flow of thoughts | Goal oriented LinearTangential flight of ideas,racing thoughtsthought blocking. | loosening of associationsother |
| Thought Content It includes the nature of ideas. | Normal thought contentFixed ideasdelusionshallucinations Suicidal thoughtsGrandiosity | Obsessions/compulsionsother |
| Attention It is the ability to focus | AttentivedistractedHyper-vigilant Variable attentionother |
| Memory It is Information encoding, storing, and retrieval capabilities | Short term memory intactLong term memory intactAttentiveDistractible Limited for recent memoryOther |
| Insight How well the client knows him/herself (weakness & strenghts) | Intact insight Limited insight No insight |
| Judgement Include the observation of emotional expressions | Intact Judgement Fair judgement Poor Judgement |
| Motivation Client effort or motivation of participation in session or towards change. | Good motivationRigidity toward changeNo motivation |
Use this space to write a report/summary.
References
Gaines, J. (2022, March 14). Mental status exams: 10 best templates, questions & examples. PositivePsychology.com. https://positivepsychology.com/mental-status-examination/
You can download this worksheet here.