TWO ESSENTIAL CLINICAL SKILL-SETS FOR

COUNSELORS:

THE MENTAL STATUS EXAM AND SUICIDE

ASSESSMENT

Very quick overview of MSE and suicide assessment procedures

The emphasis is on material you can use in your courses

THE PLAN

The MSE is a method of organizing clinical observations pertaining to current mental status or mental condition.

The MSE is also a primary method for communicating about cognitive or psychiatric symptoms within medical settings

Sample MSE reports are available at johnsommersflanagan.com

MSE PURPOSE

AppearanceBehavior/psychomotor activityAttitude toward examiner (interviewer)Affect and moodSpeech and thoughtPerceptual disturbancesOrientation and consciousnessMemory and intelligenceReliability, judgment, and insight

MSE GENERAL CATEGORIES

Watch for movement back and forth from the technical task of conducting the MSE interview and less directive listening

Think about what symptoms you see and hear about and how you might articulate them in an MSE report

The protocol I’m using is published and also available online

VIDEO CLIP – CARL

Lack of focus on or knowledge of the categories

Single symptom generalization

Interpretation of client symptoms can become very idiosyncratic and based on our own experiences

MSE COMMON PITFALLS

It’s important for students to understand how culture can affect MSE process and MSE reports

Examples from my favorite MSE and Culture assignment follow

CULTURAL ISSUES

Category ObservationInvalid Conclusion Explanation

Attitude toward examiner

Uncooperative and hostile

Oppositional-defiant or personality disorder

Has had abusive experiences from dominant culture

Affect and mood

No affect linked to son’s death

Inappropriately constricted affect

Expression of emotion about death is unaccepted in client’s culture

Reliability, judgment, and insight

Lies about personal history

Poor reliability

Does not trust White interviewer from dominant culture

CULTURAL ISSUES – ASSIGNMENT: GENERATING POSSIBLE INVALID

CONCLUSIONS

PART II: SUICIDE ASSESSMENT

PREPARATION ISelf-Preparation: Questions to ask yourselfWhat issues/ideas, etc., activate my suicide buttons?

What content is most important for me to cover?What skills, if any, do I want to integrate into this suicide assessment presentation?

More extensive info is available online

PREPARATION IIClass Preparation: Ideally, do this the week before, by looking forward to talking about suicide and emphasize: Suicide is a provocative topic

We need to be skilled talking about it directly

We face the issue and side with life

Please come to class ready to deal with this issue

SETTING THE TONEOpening with a personal story about working with a suicidal client can help set the tone as:SeriousReflectivePersonalProfessionalOpen

ESSENTIAL CONTENT1. Bust the big myth2. Get students more comfortable with this topic

and with asking about suicide3. Introduce core knowledge (suicide

assessment interview components and a good reading assignment)

4. Practice a few skills (make it real)5. Emphasize professional and ethical standards6. Introduce suicide intervention7. Outline decision-making components

BUSTING THE BIG MYTH (NARRATIVE)

The Big Myth or Old Narrative

Suicide ideation and gestures are signs of DEVIANCE

This is the old medical model perspective

It suggests that we, as medical authorities, assess and intervene with suicidal patients

THE NEW NARRATIVESuicide thoughts and gestures don’t

represent devianceSuicide thoughts and gestures represent

DISTRESSAnd so we have empathy WITH clients and

their distress, viewing suicide ideation and behavior as a means through which they express their distress or unhappiness

NEW NARRATIVE IIThe old narrative emphasized

diagnostic interviewing

The new narrative implies:Using strength-based paraphrasesCarl Rogers with a twist (O’Hanlon)Exception and externalizing questionsResource questionsNo assumption of mental illness

VIDEO CLIPTommie and John

Watch for directness

Watch for Tommie’s not always positive or cooperative responses

SUICIDE INTERVIEW COMPONENTS

Suicide risk factors Suicide ideationSuicide plan (SLAP)Self-controlSuicide intent

CLASSROOM ACTIVITY IPractice asking directly about suicidal

thoughts

Pair up

Say the words – don’t beat around the bush . . . use “suicide” or “kill yourself”

Rita S-F and the Cincinnati police

CLASSROOM ACTIVITY IIUse interview tag-team to practice interview partsRapport and exploring risk factors and depression

Exploring suicide ideation and planEvaluating suicide intent and self-controlTry out an intervention or twoCaucus together to talk about ethics, professional standards, and decision-making

Thanks for listening and participating

Feel free to access free resources at: johnsommersflanagan.com

For detailed information on suicide assessment interview content, see: Sommers-Flanagan & Sommers-Flanagan (2012). Clinical Interviewing (4th ed., update). Chapter 9; Hoboken, NJ: Wiley

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