Essential Clinical Skills for Counselors Mental Status Exam & Suicide Assessment

1. Essential Clinical Skills for CounselorsMental Status Exam &Suicide Assessment Sidney L. Shaw, EdD John Sommers-Flanagan, PhD Rita Sommers-Flanagan, PhD

2. Why the Clinical Interview? • Assessment & Intervention are ubiquitous counselor roles • Conducting Clinical Interviews can become automatic over time • The challenge of gathering assessment data while establishing rapport & emphasizing strengths

3. The Plan • Very quick overview of MSE • Specific focus on MSE categories of assessing affect/mood & judgment • Suicide assessment • The emphasis is on integrating strengths-based, constructive approaches

4. MSE Purpose • The MSE is a method of organizing clinical observations about current mental functioning. • The MSE is a primary method for communicating about cognitive or psychiatric symptoms in medical settings • Sample MSE reports are available at johnsommersflanagan.com

5. MSE General Categories • Appearance • Behavior/psychomotor activity • Attitude toward examiner (interviewer) • Affect and mood • Speech and thought • Perceptual disturbances • Orientation and consciousness • Memory and intelligence • Reliability, judgment, and insight

6. Evaluating Affect & Mood • Where are the struggles? • Where are the strengths? • Gathering assessment information. • Integrating strength-based, solution focused interventions.

7. judgment • Questions should address: • What are the impulses? • What are the responses to impulses? • Are there areas where judgment is clearly poor? • What sound judgments are exhibited? • Integrating strengths-based, solution focused interventions.

8. Video Clip – Carl • Watch for movement back and forth from the technical task of the MSE interview and less directive listening or strength-based intervention • Think about what symptoms you see and hear and how you might articulate them in an MSE report • The protocol being used is published and also available online

9. Cultural Issues • How does culture affect MSE process and MSE reports

10. Cultural issues: Generating Possible invalid conclusions

11. MSE Common Pitfalls • 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 • Can, in a traditional method, reinforce or emphasize what’s wrong with the client.

12. Transforming the MSE • MSE to gather data about client deficits or pathology; also about client strengths • MSE as rapport enhancing • Focus the MSE also on wellness – integrating solution-focused interventions

13. Part II: Suicide Assessment • Preparation • Busting the Big MYTH • The New Narrative • The “state of the art (and science)” suicide assessment clinical interviewing • Suicide interventions • Resources

14. Preparation • Self-Preparation: Questions to ask yourself • What issues/ideas, etc., activate my suicide buttons? • What are my beliefs and attitudes about suicide? • What are my aims in approaching suicide assessment?

15. 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

16. The New Narrative • Suicide thoughts and gestures don’t represent deviance • Suicide thoughts and gestures represent DISTRESS • We have empathy WITH clients and their distress, viewing suicide ideation and behavior as a means through which they express their distress or unhappiness

17. New Narrative II • The old narrative emphasized diagnostic interviewing • The new narrative implies: • Using strength-based paraphrases • Carl Rogers with a twist (O’Hanlon) • Exception and externalizing questions • Resource questions • No assumption of mental illness

18. Video Clip • Tommie and John • Watch for directness • Watch for strength-based and solution-focused methods

19. Suicide Narratives Adapted from Meichenbaum • “I can't stand being so depressed anymore.” “I can stop this pain by killing myself.” (Schneidman, 2001 psychache and mental constriction) • “Suicide is the only choice I have.” (The word “only” is considered one of the most dangerous words in suicidology)

20. Suicide Interview Components • Suicide risk factors • Suicide ideation • Suicide plan (SLAP) • Self-control

21. Reformulating Suicide Assessment & Intervention • BALANCING YOUR QUESTIONING • Traditional suicide assessment and depression assessment focuses on asking about risk factors and depressive symptoms • We should balance this with positive questions about protective factors (reasons for living), hope, and positive behaviors (scaling) • Rationale: Differential activation theory

22. Brief Suicide Interventions • No suicide contracts vs. safety plans • Explore alternatives to suicide • 3rd person exploration • Separate suicidal feelings from the self (the desire is to eradicate the feelings – not the self)

23. Decision-Making • Frequency and intensity and power of SI • Specificity and lethality of plan • Other risk factors and protective factors (RFL) • Self-control and intent • Responsiveness to interventions • Develop safety plan and/or hospitalize • Consultation and documentation

24. Closing Comments • Thanks for listening and participating • You can access free resources at: johnsommersflanagan.com • For detailed information on MSE & suicide assessment interviewing, see: Sommers-Flanagan & Sommers-Flanagan (2014). Clinical Interviewing (5th ed.). Chapters 8 & 9; Hoboken, NJ: Wiley