Conducting a Mental Status Examination
by Brad Hagen
How do you get the essential mental status information you need from patients who mistrust your intentions? Featuring two contrasting scenarios, this video offers practical and relational tools you can use to assess patients who are difficult to engage.
Conducting a mental status exam can be tougher than we think, particularly with highly defensive or even combative patients in acute distress. In order to be thorough, we must be persistent; but persistence without empathy can potentially alienate our patients. In this video, we are presented with two informative scenarios that contrast inexperienced and experienced interventions with a young woman hospitalized after a recent suicide attempt. Here, you’ll witness the palpable difference that transparent communication, assertive rapport, and humor can make in this essential therapeutic task.

In each vignette, Sue stops in to interview Kristy, a patient with Borderline Personality Disorder who wants to change doctors and leave the hospital as soon as possible to attend to her son. Nervous, stiff, and timid in the first scenario, Sue’s neophyte attempts to engage Kristy quickly fall flat. The nurse is easily steamrolled by Kristy’s anger, and her failure to adequately empathize or keep the interview on track only intensifies her patient’s distress.

The second vignette features a much more assertive, confident, and approachable Sue, who immediately takes charge while using light humor and a matter-of-fact tone to focus the conversation. Sue gives Kristy reflective statements, leverages her desire to see her son as a reason to complete the exam, and enlists her input to better understand her priorities. Though Kristy still challenges her, she is clearly more contained by Sue’s skilled interventions, opening up about her feelings and challenges and allowing Sue to offer options for social support during her recovery.

Whether done formally or informally, mental status exams uncover material necessary for successful treatment, so learning to conduct them thoroughly, even amid strong patient resistance, is crucial. If you’re looking to enhance your own skills in this area, this video is a must-watch.
In Depth
As video host Brad Hagen notes, most mental health practitioners at some point will need to conduct a mental status examination. Moreover, this may need to happen not just once, but continually, to monitor a patient’s ongoing mood, thought patterns, speech, communication, degree of suicidal ideation, and potential for violence, among other important factors. Thus it’s imperative for clinicians to stay focused while engaging patients as effectively as possible.

This video presents two contrasting vignettes in which a novice and an experienced nurse conduct respective mental status interviews with a suicidal hospital patient. In both cases, the patient exhibits borderline dynamics and a potentially aggressive affect, and you’ll see how the confidence, directiveness, and empathy that comes with proficiency leads to greater compliance and a sense of safety.

Although the videos in this series are designed for mental health and psychiatric nurses, the skills demonstrated apply for any mental health care worker dealing with patients with these psychiatric conditions. If you’re a therapist, counselor, psychiatric nurse, or other helping professional conducting intakes or mental status exams, this video will give you valuable takeaways you can start using today.

Note: A more formal, and thorough example of how to conduct a mental status exam is available in the video Clinical Interviewing: Intake, Assessment and Therapeutic Alliance.

By watching this video, you will:
  • Learn about the challenges of conducting thorough mental status examinations.
  • Understand how novice interventions can disrupt treatment goals and exacerbate patient distress.
  • Identify effective skills and interventions that build patient rapport and increase the likelihood of compliance.

Length of video: 00:24:00

English subtitles available

Group ISBN-10 #: 1-60124-443-6

Group ISBN-13 #: 978-1-60124-443-7

Brad Hagen, PhD, RN, is a registered nurse, a registered psychologist, and an associate professor in the faculty of health sciences, at the University of Lethbridge in Alberta, Canada, where he teaches in the nursing and addictions counseling programs. Hagen's main research and teaching interests include the broad areas of mental health, gerontology, long-term care, psychotropic drug use, and how to bring critical social theory and/or feminist approaches to these topics.

See all Brad Hagen videos.
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