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Addiction Counseling Tools: The MSE – Mental Status Exam

The Mental Status Exam (MSE)

The Mental Status Exam is part of the assessment process. Skillful counselors and therapists are able to identify clients with co-occurring disorders. Well-trained substance abuse counselors and therapists can provide a more competent service when they possess the basic knowledge in mental disorders that co-occurred with substance abuse problems. The following is a brief outline of the MSE.
1. The Mental Status Exam (MSE)

  •  It is the process of noting the observable in some systematic way
  • It is different from the biopsychosocial assessment
    • Based mostly on facts about the client’s life
    • Description of the problem provided by the client
  • The MSE is basically our observations
  • It’s a very useful tool for assessing a client over time

2. Helpful questions for the MSE

  • What has changed?
  • When did it change?
  • Has it change for the better or the worse?
3. Two things to keep in mind
  •  Ask for further explanation when you don’t understand something the client has told you
  • Document what is worth noting
 4. Where to begin
  •  Start by describing those things that anyone looking at the client would notice
  • It does not matter when the MSE is completed
  • Remember that a good clinician is a good observer
 5. Avoid two real temptations
  • To infer meaning from what you are actually seeing
  • To see things that are in reality just your assumptions
 6.  Areas to address in the MSE
  •  Appearance
    • How does the client look and behave?
  • Speech
    • How does the client speak?
  • Emotions
    • What is the client’s mood/affect?
    • How does the client feel most of the time?
    • How does the client appear to be feeling during the interview with you?
  • Thought process and content
    • How does the client think?
      • Circumstantiality – takes a while to get to the point
      • Perseveration – repeating phrase or returning to same subject
      • Association – how does the client get from one idea to the next?
  • What does the client think about?
    • Delusions?
    • Compulsions?
  • Sensory perception
    • Illusions?
    • Hallucinations?
  • Mental Capacities
    • Is the client oriented in time, place, and person?
    • What is your estimate of the client’s intellingence?
    • Can the client remember and concentrate?
    • How are the client’s judgment and insight?
  • Attitude toward the interviewer
    • Client’s attitude towards you
    • Does it change over time?
    • Does he/she respond to empathy?
    • Does he/she appear to be capable of empathy?

Reference: Where to Start and What to Ask – Susan Lukas. (This is by far one of my favorite books. I highly recommend it) 
 Dual Disorders – David O’Connell

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