MSE Lecture given via Skype to American International College

1. Brock Cook
Occupational Therapist
Townsville Integrated Mental Health
Service

2. Overview of my Acute Mental Health Unit
 34 Bed inpatient unit
○ 8 HDU Beds
○ 26 Open Beds
 Located adjacent to main hospital
 Multidisciplinary Team
○ OT, OT Assistant, Social Worker, ATSI
Worker, Nurses, Psychiatrists, Doctors

3. OT Role
 To assist individuals to maximise
independence in their daily occupations
and life roles
 To assess how an individual‟s mental
illness impacts on their ability to function
in their everyday occupations and roles

4. So what do I do??????
 Clinical reviews
○ Discuss as a multidisciplinary team each clients progress
○ Clients requiring OT assessment identified
○ Treatment plans, assessments, therapy programme input and
discharge planning
 Occupational Therapy Assessment
○ ADL‟s
○ Meal Preparation
○ Reports completed & discussed at clinical review
 Individual Intervention
○ As per recommendations from assessment
○ Eg. Visual Prompting for self care, graded exposure
○ Referral to other agencies eg. SOLAS, Queensland Lifestyle
Services
 Weekly Recovery (Group) programme

5. Recovery Programme
 Provides a structure to the clients day
 Supports the client in recovery by the
utilisation of group work
 Staff involved in the program include
○ OT, OT Assistant, NGO‟s
○ Consumer consultant

6. Recovery Program
 Groups provide an opportunity to
observe within a more informal setting
client skill level and
abilities, motivation, memory, concentrati
on, ability to plan, to organise, to
judge, decision-making skills, self
control, social skills, motor skills, insight
into current admission, social
interactions, etc

7. Therapy/Recovery Groups
Psycho educational
 Self esteem
 Goal setting,
 Social skill groups
 Anger management
 Relaxation techniques
 Stress Management
Health Promotion
 Alcohol and drugs in your
life
 Healthy life style choices
 Healthy eating
 Community Support
Information Group
Recreational
 Community Meetings
 Exercise- Gym, morning
walks
 Pool Competitions
 Pamper Time
 Activity based groups
utilising volunteers
 Art & Craft
 Practical Skills Based
groups that support
existing and/or focus on
developing new skills
 Cooking group
 BBQ

8. Non standardised Assessments
 Observation skills
 Practical activities eg BBQ, cooking
 Social activities eg, Sussex on Quinn
 Liaison with treating team
 Case notes
 Feedback from client & family
 Feedback from community case
managers

9. Standardised Assessments
 OTENT-Occupational Therapy Evaluation of
Needs and Treatment which focuses on
ADL‟s, Task Organisation skills,
Interpersonal abilities and motor tasks
 Modified Barthel Index
 Brookvale Living Skills Assessment
 CAM
 ACLS
 LOTCA

10. Example Role for Occupational Therapy
 Build rapport
 Consumer Screening Tool
○ Explore interests, strengths, goals
 Involvement in recovery programme
○ Healthy Promotion Groups
○ Goal Setting
○ Self Esteem
○ Relaxation
○ Community Support Information Group
○ Recreational Groups
 Assessment
○ ADL‟s
○ Meal Preparation
○ Seek family support/collateral
 Referral to other agencies
○ ATODS, GROW, ROADS, Sussex On Quinn
○ Family Support- Mental Illness Fellowship

11. OT and Mental Health
 Any Questions

13. Mental State Assessment
 Part of „everyday‟ practice in mental
health
 Useful in any direct client care role
 Important for client sensitive practice

14. Mental State Assessment
 Comprehensive initial assessment
includes case history plus mental state
examination
 Many different formats - key elements
remain the same

15. Considerations
 Cultural issues
 Culture specific
phenomena
 Legal issues
 Confidentiality
 Mental Health
Act
 Capacity
 Documentation

16. Rapport
 Think about the individual person, not the mental
illness.
 Treat a person with a mental illness like anyone else,
with the same respect and individuality.
 Even when acutely psychotic, a person can
communicate and interact rationally if interviewed
skillfully.
 Interact directly and openly with the person, using
simple, clear language.
 Do not talk about the person behind their back.

17. Interview and communication
 Adoption of an attentive and unhurried
appearance and attitude.
 Observation of the client for non-verbal cues.
 Effective questioning techniques including:
 Open Ended Questioning e.g. “ tell me what has
been happening”, “tell me more about that”, “how
have you been feeling recently”

18. Interview and communication
 Effective questioning techniques including:
 Listening For Verbal Cues e.g. “I don‟t care what
happens”, “I‟ve given up”, “I can‟t cope”
 Clarifying Questions e.g. “ what do you mean when
you say you feel strange/weird/out of it?”
 Specific Directed Questioning to identify key
symptoms of psychiatric illness
 Screening questions for risk of self-harm in high risk
groups

19. Case History
 Demographic information
 Presenting complaint/problem
Question: “ What has been happening for you that brings you here
today..How can I help?”
 History of the presenting complaint
Question: “How long has this been happening for you?”
 Medical history
Include: Past and present medications.
 Psychiatric history
Question: “Have you ever seen any one in mental health before?”
 Family history
Include: Medical and Psychiatric histories

20. Case History
 Substance Usage
Include: Illicit substances, Prescription medications, alcohol and
tobacco. Quantities and frequencies of use.
 Personal history
Development- Milestone achievement
Education- Grades, enjoyment
Relationships- Past relationships/bonding,? Abuse.
Forensic- Past and current charges, offences
 Premorbid personality
Question: Do you think, or has anyone else commented that you have
changed since this all started?”
 Current situation
Can include: Current residence, current relationships/supports, level
of functioning at work, school, home.

21. Risk Assessment
 On initial assessment importance in 2
key areas.
- Self harm/Suicidal ideation
Include: history of self harm/suicidal ideation, current
acts/ideation, plans for the future.
- Violence/Homicidal ideation
Include: history of aggressive/violent behaviour, current aggressive
behaviour/ideation.

23. Mental State Examination: MSE
 Systematic approach to evaluating a consumer‟s
mental state at a particular point in time.
 Important part of a comprehensive mental health
assessment.
 Commences an MSE immediately by observing
the consumer and continuing to do so throughout
the contact.
 Broken into 9 components.

24. Written MSE
 Professional and objective manner using
terminology that is non-prejudicial of the
consumer in a moral or ethical sense.
 Structured format helps clinicians avoid
oversights and ensures the MSE is
readable and coherent.
 Utilising specific and conventional
terminology helps in communicating to
others, but be aware of misinterpretation.

25. MSE- Appearance and Behaviour
 Detailed description of what you see
 Clothing
 Hygiene
 Physical features
 Behaviour
 Rapport
Whoever reads your notes should be able to have
mental picture of how the client presented.

26. MSE- Speech
 Volume
 Rate
 Tone
 Coherence
 Succinct? Over inclusive?
 Content

27. MSE - Mood and Affect
 Mood = subjective: what the client states
 Affect = objective: what do you see?
Mood: “I feel sad”
Affect: client appeared teary, low range of
emotional
reactivity
Congruent?
Does what is stated match watch you see?

28. Thought Form / Process
 Assessed through observations
 It reflects the persons pattern of
thought
 Loosening of association
 Flight of ideas
 Racing thoughts
 Tangentiality
 Circumstantiality
 Word salad/incoherence
 Neologisms
 Clang/associations
 Thought blocking

29. Thought Content
 Assessed through interviewing
 Describes themes a person is thinking
 Delusions
 Paranoia
 Preoccupation
 Obsessions
 Compulsions
 Phobias
 Suicidal Ideation

30. MSE - Perception
 Hallucinations
 Gustatory= taste
 Auditory
 Visual
 Somatic
 Tactile
 Olfactory= smell
 Vestibular= sensation of movement
 Heightened or Dulled Perception
 Illusions
 Depersonalisation
 Derealisation

31. MSE –Insight, Judgement
Insight
 Knowledge of
medications, experiences, effects of
substance use
Judgement
 Ability to sift through information
 Impulsive
???Capacity to organise and understand???

32. MSE – Cognition
 Alertness / consciousness
 Memory
 Orientation
 Abstract thought
 Concentration

33. MSE – Neurovegatative
Sleep
 quantity, quality, circadian rhythms
Eat
 quantities – lack of or too
much, patterns, dietary balance
Motivation
Energy
Libido

34. Performing an MSE
http://www.youtube.com/watch?v=ZB28gfSmz1Y

35. Discussion & Write Up
 Break into groups
 If this is going to be your
assessment piece to hand in, fill
in the MSE blank form.
 Ask questions if your unsure of
how to describe what you
observed

36. Questions…