The Mental Status Exam: What You Need to Know

Since the 1960s, various mental health and medical professionals have performed the Mental Status Exam (MSE) to assess for a variety of psychiatric and neurological conditions such as bipolar disease and Alzheimer’s disease. MSEs provide objective and subjective data about clients experiencing a milieu of cognitive, psychiatric, and neurological issues. Conducting an MSE aids in making an accurate diagnosis during critical situations such as new onset stroke symptoms or immediately following head trauma.

When a client’s psychological and mental state must be evaluated, conducting an MSE is often the first step in the assessment process. The MSE is often described as the psychological equivalent of a physical exam, as it evaluates a person’s mental state and behaviors, rather than only biological data. Clinicians use the MSE to evaluate various characteristics and psychosocial attributes through observation and conversations with the client, including physical appearance, speech patterns, mood, and coherence.

Here are key circumstances when it is appropriate to perform an MSE:

1. Initial Psychiatric Evaluation

• When to use: During the first meeting with a client seeking mental health care.
• Why: Establishes a baseline of mental functioning, helps diagnose mental health conditions, and provides a framework for future evaluations and treatment planning.

2. Change in Mental Status

• When to use: When there is a noticeable or reported change in behavior, mood, or cognitive abilities.
• Why: Sudden changes in mood, thought processes, or cognition could indicate a new or worsening mental health condition (e.g., onset of psychosis, delirium, or depression).

3. Monitoring Progress in Ongoing Treatment

• When to use: At regular intervals during treatment, particularly in mental health settings such as therapy, inpatient care, or outpatient follow-up appointments.
• Why: Allows clinicians to track the client’s response to interventions and medications while noting improvements or deteriorations in symptoms like mood, thought clarity, or behavior.

4. Emergency Situations

• When to use: In crisis or emergency settings, such as emergency rooms or psychiatric inpatient units, especially if the client presents with suicidal ideation, aggression, confusion, or erratic behavior.
• Why: An MSE can quickly assess the severity of symptoms (e.g., psychosis or suicidal thoughts) and determine immediate safety needs and interventions.

5. Neurological Concerns

• When to use: When there are concerns about neurological conditions affecting mental status, such as head trauma, stroke, dementia, or brain injury.
• Why: Cognitive and behavioral changes are common in neurological conditions, and an MSE can help distinguish between psychiatric and neurological causes.

6. Substance Abuse or Intoxication

• When to use: If a client is suspected of being under the influence of drugs or alcohol or experiencing withdrawal.
• Why: Substance use can profoundly affect cognition, mood, and perception. An MSE can help evaluate the impact of substances and guide necessary interventions.

7. Legal or Forensic Evaluation

• When to use: When a client is involved in legal proceedings, such as during competency evaluations or when mental health is relevant in criminal or civil cases.
• Why: An MSE helps assess the individual’s mental state regarding their legal responsibilities, decision-making capacity, and potential risk to themselves or others.

8. Assessment for Cognitive Decline

• When to use: For older adults or individuals presenting with memory problems, confusion, or signs of dementia.
• Why: The MSE helps evaluate cognitive functions like memory, orientation, and judgment, which are crucial in diagnosing conditions such as Alzheimer’s disease or other forms of dementia.

9. Pre-Employment or Occupational Assessments

• When to use: For jobs that require mental fitness evaluations, such as in law enforcement, military, or aviation.
• Why: The MSE ensures that individuals are mentally fit to perform duties where mental clarity and emotional stability are critical.

10. Assessing Risk for Self-Harm or Harm to Others

• When to use: If there is concern about a client’s risk of suicidal or violent behavior, or they present with threatening behavior or thoughts.
• Why: An MSE can uncover warning signs such as suicidal ideation, hallucinations, or paranoia, which require immediate intervention to ensure safety.

The MSE is an essential tool to use when concerned about a person’s mental or cognitive functioning. It provides valuable insights in a variety of settings, from routine mental health evaluations to emergencies, and should be employed whenever a clinician needs to assess psychological well-being, risk, or capacity for decision-making.