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Mental Health Assessments using a Bio-Psycho-Social-Cultural Model

Mental Health Assessments
Photo: Mental Health Assessments
A patient’s mental health can be evaluated in two dimensions:
1) The absence of mental illness, and
2) The presence of a well-adjusted individual who is able to participate in society.

A holistic assessment of a patient must consider a range of factors in assessing their mental health, not just in terms of whether or not the patient is displaying symptoms of a mental illness, but also with a view to assessing other factors that could give rise to concerns about depression and/or anxiety.

Factors that nurses should consider in performing a mental health assessment include:

Biological
The physical health of the patient and the effect this could be having on the client’s mental health is of prime importance. Some of the commonly known conditions that can affect mental state include thyroid function abnormalities, vitamin deficiencies e.g. B12 in the elderly causing fatigue, lack of appetite and weight loss, apathy and depression. Infections, especially in the elderly, can be responsible for confusion e.g. UTIs. It is thought that low levels of vitamin D may also cause confusion in the elderly and possible depression in persons of all ages. Low blood sugar levels can also cause confusion and medication toxicity can lead to an impaired mental state. Diabetes has been linked with depression. Other contributing factors to depression include sleep disturbances and obesity, which can cause sleep apnea.

Psychological
The patient’s developmental history must be considered.  Have there been any previous diagnoses? Is there a history of trauma that could affect the person’s mental state either recently or long term? Is the person cognitively impaired?

Social factors
Social factors alone cannot be responsible for making someone happy or unhappy as the level of satisfaction of individuals can be highly variable.  However, it is important to gather information about someone’s circumstances. Maslow’s hierarchy of needs is a good starting point to determine if someone’s social factors could be affecting their mental health.

Cultural
Cultural background is a major determinant of beliefs, morals, customs and consequently our behaviour. It is important to know that different cultures define health differently. Anglo-Celtic culture classifies health and illness into different specific categories; however it is important to know that some cultures find this very strange. Health can be defined very broadly, in a way that does not distinguish between physical and mental health, but also may not distinguish between an individual’s health and that of the community in which that individual lives, or indeed the relationship to their land and surroundings.  All practitioners must practise in a culturally sensitive manner and this involves having an understanding of the issues and beliefs of culturally diverse patients who may come to you for care and help.

Appearance
What distinctive features does the client have?Describe and assess the patient’s clothing for its appropriateness to the current weather and situation. Assess their level of grooming and hygiene and their cultural appropriateness.Do these considerations give rise to any concerns that may require further investigation?

Behaviour
Consider the client’sbehavioural style, their eye contact (knowing this may vary culturally), psychomotor behavior including agitation, and any inappropriate or unusual behavior.

Conversation
Evaluate both the content of the conversation, as well as the form - which includes the rate of the conversation, as well as logic and thought processes. Are there any abnormalities involving speech? What is the rate and volume of their speech? Is it logical? Is it tangential? Is it sparse?

Mood
Mood descriptors are many and varied. Some key questions or considerations include: can they concentrate and do they get enjoyment from activities? Do they have an appetite? How is their sleep? Do they have trouble getting off to sleep or do they have a problem waking up too early?

Perceptions
Assess any dissociative symptoms e.g. derealization, depersonalization.If any dissociative symptoms are prevalent, is the patient ‘aware’ that the way they perceive their surroundings is abnormal? Note any psychotic symptoms or other perceptual abnormalities including hallucinations and delusions. These perceptual abnormalities can occur in any of the five senses.

Cognition
Describe orientation, memory and attention, or ability to concentrate. The Mini Mental State Examination MMSE is an excellent and brief cognitive assessment that can be performed by most clinicians in three to five minutes. There are apps available that will assist with this or it can be performed on paper.

Insight and Judgment
This is important, especially regarding any safety issues. Does the patient acknowledge a possible mental health problem? Does the client understand the possible treatment options? What is their ability to identify potentially pathological events (e.g. suicidal impulses and hallucinations)? Judgment refers to a person’s problem solving abilities. Often the answers to this component of the MMSE will determine what actions as an assessor you need to take or offer.

In closing, utilizing collaborative evidence when performing mental health assessments is essential. When conducting any assessment on a patient or client it is important to consider the range of factors that could have a bearing on the patient’s mental health. Treating the whole individual will result in better outcomes for them and their family and community.

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