The mental status examination: its use by professional counselors: EBSCOhost

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• attend to detail and subtlety in behavior, such as the level of affect accompanying the client's thoughts or ideas, the significance of mannerisms and nonverbal behaviors, and the unspoken message associated with conversation.

• Any counselor can have a conversation with a client, but appropriate knowledge, vocabulary, and skills can transform this "conversation" into a "mental status examination."

• The MSE is used to obtain information about the client's level of functioning and self-presentation

• Generally conducted (formally or informally) during the initial or intake interview, the MSE can also provide counselors with a helpful format for organizing objective (observations of clients) and subjective (data provided by clients) information to use in diagnosis and treatment planning.

• not a formal psychometric instrument

• the skillful application of the MSE is a useful technique for those counselors working in clinical settings requiring the assessment and diagnosis of mental disorders

• the information gathered by the MSE provides a foundation for evaluating individuals, across the life span, who present in crisis or with any variety of concerns in schools, colleges and universities, the workplace, or other settings in which counselors may provide clinical services.

• area of managed care, the MSE is recognized as an appropriate assessment tool used to determine the necessity of treatment and to monitor treatment progress

• The MSE can be organized under the following categories: (a) appearance, attitude, and activity; (b) mood and affect; (c) speech and language; (d) thought process, thought content, and perception; (e) cognition; and (f) insight and judgment

• format for organizing objective (observations of clients) and subjective (data provided by clients) screening information to use in diagnosis and treatment planning and to monitor treatment progress

• information needed for a useful MSE is best gathered during the course of the interview

• integrated into the entire initial counseling process without interfering with the flow of the interview and the establishment of rapport

• Such observation begins with noting appearance and interaction with others and the environment

• Features to be observed include physical characteristics, nonverbal communications, and motor function (e.g., gait)

• important for the counselor to be objective and nonjudgmental

• Appearance refers to physical disabilities or abnormalities, dress, grooming, and cleanliness and can be a clue to the client's mood, rate of aging, cognitive state, self-awareness, presence of a thought disorder, motor condition, and general physical health

• level of consciousness, apparent age, position, posture, eye contact, and other striking features. Along with race, skin color, and sex, other characteristics worthy of note include scars from prior suicide attempts or self-mutilation, tattoos, body piercings, obesity or thinness, sweating, amputated limbs, and body odors

• The level of engagement is instrumental in the process of gaining information that is accurate and comprehensive, and thus counseling skills related to forming a therapeutic relationship with the client are key to the effective use of the MSE

• counselor's case conceptualization skills enable the optimal use of that information to form an accurate diagnosis and an effective counseling intervention

• Building rapport is essential to good interviewing as well as applying the MSE