Mental health assessment

Assessment

• To avoid escalation of behaviour, only collect information that will assist in initiating care and keeping the patient safe. The mental health team or medical or nurse practitioner will undertake a full history on examination.
• Find out if there are dependent children, and if they are currently safe.
• Find out what has worked in the past, and if there is an existing behaviour management plan.
• If the patient has a history of acute behavioural disturbance (ABD), find out what supports are already in place.
• Discuss the history of the episode, e.g. details of what happened today.

De-escalation

• Approach in a calm, confident and non-threatening manner.
• Be empathic, non-judgmental and respectful.
• Introduce yourself, your role and the purpose of the discussion. Lead the conversation and engage the patient while other staff remain nearby. Only one staff member should speak with the patient.
• Ask what the patient wants and what they are worried about. Identify what is achievable rather than declining all requests. Small concessions can build trust and rapport.
• Use short, clear statements which do not include medical jargon.
• Use a slow, clear and steady voice. If the patient raises their voice, pause and wait for an opening and allow the patient to vent some of their frustrations.
• Offering food or a drink, giving access to a telephone, or a staff member making a phone call on their behalf can be very helpful.
• If the patient asks for a cigarette, offer a choice of nicotine replacement therapy (NRT), e.g. gum, lozenges, patches or a nicotine inhaler. Avoid discussions about leaving for a cigarette and focus on keeping the patient within the safety of the emergency department.
• Avoid provocative statements such as:
  • "calm down"
  • "if you don't settle down … will happen" or
  • "you better stop that right now or else …"

Observation

ABC mental health assessment

• Appearance – includes affect and mood:

• Observe if the patient is engaging with staff and/or family.
• Describe the patient's emotional state and mood, e.g. euthymic (normal), depressed, teary, withdrawn, angry, flat
• Look at their posture, grooming, body appearance and condition.

• Behaviour – includes cooperation:

• Describe features, such as mannerisms and descriptors of the patient's behaviour, e.g. agitated, distressed, aggressive or impassive.
• Look for escalating behaviours.

• Cognition and conversation – includes speech and thought:

• • Level of consciousness, e.g. alert, drowsy, stupor or coma, orientation, attention and concentration
  • Rate of speech, e.g. slow, normal, rapid or pressured
  • The volume of speech, e.g. soft, normal or loud
  • Quantity of speech, e.g. spontaneous, normal or talkative
  • Quality of speech, e.g. accent, rhythm or impediments.