The Mental Status Examination (MES) is an important standardized tool in psychosocial assessment. It is believed to be the equivalent of a standard physical examination.
When planning a systematic individual health care program for patients, especially elderly patients, patients of substance abuse, or those in palliative care, utmost care has to be taken that it has been preceded by a thorough and comprehensive evaluation of the patient in every way.
This is where psychosocial assessment comes in. It involves studying a patient carefully in the greatest possible detail in order to provide him/her the best possible care.
Psychosocial assessment is carried out by medical experts, generally psychologists and psychiatrists, psychiatric social workers, etc. Nurses are also familiar with psychosocial assessments as they often assist doctors for the same. Our next section talks about what exactly is psychosocial assessment. * Click on the tabs for more information.
Psychosocial Assessment: Meaning and Purpose
A psychosocial assessment is actually a thorough and comprehensive evaluation of an individual patient's physical, mental, and emotional health, along with his ability to function within a community and his perception of himself. It is mainly conducted by social workers and medical experts, and is a tool to learn facts about a person, as well as determine his present and future behavior. It is a very important part of every health care program that helps to set up a plan of management and action for the medical team.
Psychosocial assessment generally is conducted in a question-answer format, where a medical expert asks a series of questions and the patient is expected to answer them truthfully. Questions vary according to the state of the patient, and the problems he may be facing at the time. The answers received in this way are then used to create an individual health care plan which serves to provide the best possible treatment or care to that patient.
The nature of psychosocial assessment varies too, depending upon the patient's health condition. Generally doctors tend to do a quick and basic psychosocial assessment of their patients during check-ups. On a more grave note, psychosocial assessments are also conducted in health care institutions where someone might be wanting to receive treatment for a mental health problem. Additionally, it might also be observed that psychosocial assessment is conducted in an unplanned or unorganized setting, such as a slum, as opposed to a hospital, depending upon the situation.
In hospitals, authorities generally conduct an extensive psychosocial assessment of palliative patients, victims of a crime or disaster, criminals, etc. This helps them come up with a health care plan that will ease the stress on both mind and body of the patient, and will help in quick recovery or at least stabilization of health. The evaluation is then repeated every few weeks or months in order to check if the health care plan is still right for that patient. If it isn't, then corrective measures can be taken based on the new assessment. In case of victims of wars or natural disasters, experts believe that psychosocial assessment is very necessary to heal them not just physically but also mentally and emotionally. Research suggests that mental and emotional healing is vital if improvements in physical health are desired. For this purpose, the depth of any emotional scars can be determined, and solutions can be suggested accordingly.
What Should An Ideal Psychosocial Assessment Include?
It doesn't matter what the reason behind a psychosocial assessment is, what is important is that it should be equally comprehensive and thorough regardless of the magnitude of the patient's problem. An ideal evaluation must include all the aspects of a patient's life, along with his good memories and troublesome memories, his medical history, his current perception of himself, his problems, as well as society, to get a clear idea of his current mental and emotional state. Information of these aspects, along with the patient's ideas about treatment will make it clear to the medical team how long it might take for the patient to reach optimum health. The psychosocial assessment is expected to highlight both the negative as well as positive elements in a patient, as they are equally crucial when deciding an appropriate health care plan.
Conducting A Psychosocial Assessment
Medical experts conduct this evaluation to shed light on some social or psychological factor that may be affecting a person's health, be it physical or mental. Hence, it is very important that this examination be conducted in a way that puts the patient at ease with the examiner.
The one who is conducting the evaluation establishes a friendly rapport with the patient so that the patient feels like opening up to the examiner.
The physical or mental problem(s) faced by the patient are carefully studied so that the examiner has a complete idea of the causes, symptoms, and impact of that problem.
The patient's strengths and weaknesses are all taken into consideration, along with his personality, his likes and dislikes, his temperament, etc.
The evaluator also tries to gain maximum information about any recent social incidents or psychological factors that may have affected the patient significantly.
The assessment also takes into consideration the patient's current and previous lifestyle, along with his diet, addictions (if any) and relationships.
This information is then cross-checked with friends and relatives of the patient to assure that the answers given in the examination are correct.
The assessment formed after the cross-checking is then written in a detailed format, which will be used to provide information about a patient to any expert who might require it, not necessarily only the examiner.
The assessment is expected to be a detailed report of the patient's medical history, psychological history, reason for required treatment, information about patient's previous medications, allergies, any legal issues, social functioning of the patient, history of substance abuse (if applicable), history of violence or victimization, suicidal tendencies, etc.
Some Questions Asked During A Psychosocial Assessment
Generally, this kind of assessment is conducted on adult patients and elderly patients. However, it is also conducted in the case of an abused or victimized minor. Generally, adult and elderly patients are asked the following questions during their psychosocial examination. It should be noted that this is just a basic idea of the questions asked, and not all of them are applicable to every patient. Given below are some basic questions asked in an assessment.
- Do you have a primary caregiver? If yes, who is he/she, and what is your relationship with him/her?
- Do you have secondary caregivers? If yes, how is your relationship with each one of them?
- How do you think your health condition has impacted your relationships and your perception of them?
- What is your current financial status? Do you have any debts to repay? Do you own any assets?
- How many jobs have you worked at?
- Are you facing any legal issues?
- Do you believe in religion?
- What do you like to do in your spare time?
- Have you ever indulged in any sort of substance abuse? Do you drink regularly/do drugs?
- What are your priorities in your life? What goals are most important to you currently?
- What is your perception about yourself?
- Have you ever physically hurt yourself/others?
- Have you ever attempted suicide?
- Do you ever feel like committing suicide? Do you think you might try to do so in future?
- Do you ever feel like greatly harming others? If yes, how do you intend to do it?
- Do you cut yourself or try to harm yourself?
- Do you have an eating disorder?
- Do you have a sleep disorder?
- In the past one year, have you been physically abused by another person?
- Are you in any abusive relationship?
- If you ever been sexually abused? If yes, by whom?
- Have you witnessed any form of abuse?
- Do you ever experience hallucinations?
Some of the questions mentioned above are helpful in assessing the risk factor of a patient. In case he is found to have suicidal tendencies or self-harming tendencies, appropriate psychological interventions can be arranged in order to find a solution.
Skills Required For Psychosocial Assessment
Aside from being knowledgeable about the approach of psychosocial assessment, there are a few other skills which are required to be present in the examiner.
- Excellent communication skills
- Ability to pose questions with tact
- Sympathetic nature
- Ability to bond with the patient
Examples of Psychosocial Assessment
Buzzle gives you two examples of psychosocial assessments―one is a brief example of what it is like, while the other is more detailed. It should be remembered that these are just sample assessments and the names and other details used in the articles are purely fictional. Any resemblance of these details to any person is purely and absolutely coincidental.
Mr. Burke is a 45-year-old male, estranged, and lives in Orange County, California. He is seeking aid for depression and guilt which he faces because of his infidelity. Mr. Burke feels lonely and sad most of the time, and his depression sometimes makes him have suicidal thoughts. He has been feeling this way ever since his pregnant wife left him three months ago after she found out about his infidelity. His family, too, has cut all ties with him following his separation with his wife. Additionally, a month ago, his friend passed away in a car accident. Mr. Burke feels he has been isolated by the world, and that nobody cares about him. Mr. Burke owns a hardware store which is running quite successfully despite his depression.
Mr. Burke is eager to receive treatment, and is friendly and co-operative with those who talk to him. His clients claim he is a very nice man, and despite all that has happened, tries to maintain a very positive approach towards his work. He wants to change himself and re-establish a good relationship with his estranged wife and family.
: Nina Fletcher is a 30-year-old heterosexual female. She has been injecting heroin for the past six years, about four times a day. Personal Status
: Nina is divorced and lives with her younger sister in Houston, Texas. Nina was born and raised outside Dallas, and she originally moved to Houston when she was 19. She lived in Chicago for a while when she was married, and moved back to Houston following her divorce. Nina has a daughter from her marriage, who is 9 years old and lives with her father in Chicago. Nina is not on speaking terms with both her daughter and ex-husband. Drug History and Current Use
: Nina regularly indulged in marijuana and cocaine from when she was 18, and drank alcohol almost every other day. Nina was first exposed to heroin when she was 23. Initially, she inhaled the drug about two-three times a day, and within a month, began injecting it. She now injects it about four times a day. Treatment History
: Apart from a few sessions with a therapist, Nina has not had any treatment for her addiction. Her refusal to go into rehabilitation has severed her relationship with her family.Legal Issues
: Nina has been arrested for illegal possession of the drug. She is now expected to receive intensive treatment or face a prison term. Family History and Current Status
: Nina's parents have cut all ties with her following her intravenous drug use and refusal to go into rehabilitation and have now moved across the country. Her relationship with her sister is heavily strained because of Nina's addiction. However, her sister is a positive support and wants Nina to receive appropriate treatment as soon as possible. Nina also has a brother in California who she is not in contact with.Education
: Nina is a high-school graduate. Initially, she attended college in Houston, but dropped out after a year.Work History
: Currently unemployed, Nina has worked at 7 jobs, and has lost each one of them owing to her addiction. Her last job was of a saleswoman in a clothing store, which she lost because of her lack of responsibility and absence of any dedication towards her work. Attitude Towards Treatment
: Nina knows she needs treatment to avoid going to prison. She appears to be ready and co-operative.
Following these aspects, the counselor should then include results of the tool (mostly the Mental Status Examination) used for assessing the patient, as well as the kind of treatment required.
Biopsychosocial assessment is an approach that determines the social functioning abilities of patients by assessing three primary factors―biological, psychological, and social factors. This approach states that it is much easier to understand a patient's illness or problems based on this three-factor model, rather than just biological factors alone. Unlike the psychosocial assessment approach, this assessment takes into consideration all three factors, and is popularly called the mind-body connection. The approach of biopsychosocial assessment was developed in 1977 by George L. Engel, an American psychiatrist. This approach towards health care has been met with both applause and wide criticism.
This article is for informative purposes only, and the examples of an assessment provided by the author are just meant to give the reader a brief idea of what it is like. This article should not be confused with expert advice of any kind.