Mental Status Examination (MSE) Teaching activities and resources
This section provides educators with increased understanding regarding the purpose and implementation of the Mental Status Examination (MSE) across the lifespan and in different types of populations/contexts.
At the end of this section, the educator will:
- Understand the purpose of the MSE.
- Understand the MSE in relation to health assessment and care planning.
- Identify the different components and terminology of the MSE.
- Be able to perform and document a MSE.
The Mental Status Examination (MSE)
The Mental Status Examination (MSE)—a structured assessment of client’s behavioural and cognitive functioning—is a vital component of nursing care that assists with evaluation of mental health conditions. The MSE is analogous to the physical examination and is used to evaluate an individual’s current cogitative, affective and behavioural functioning (Varcarolis, 2014). Specifically, the MSE assesses a client’s current state including general appearance, mood and affect, speech, thought process and content, perceptual disturbances, impulse control, cognition, knowledge, judgment and insight (Lasiuk, 2015). The MSE can be used across clinical settings, not just in a psychiatric context, takes only a few minutes to administer and can generate information that is crucial for creating a plan of care (Robinson, 2008).
The acronym BEST PICK can assist with learning the main elements of an MSE (Carniaux-Moran, 2008). A brief description of the elements that are assessed includes:
- Behaviour and general appearance - age, sex, gender, cultural background, posture, dress/ grooming, manner, alertness, as well as agitation, hyperactivity, psychomotor retardation, unusual movements, catatonia, etc.
- Emotions: mood and state, emotional state and visible expression (state) including description and variability.
- Speech—rate, amount, style and tone of speech.
- Thought content and processes—abnormalities, obsessions, delusions and suicidal and homicidal thoughts and thought process as well as loose associations, tangential thinking, word salad, and neologisms, circumstantial thought, and concrete versus abstract thought.
- Perceptual disturbances—illusions and hallucinations.
- Impulse control—ability to delay, modulate or inhibit expressions or behaviours.
- Cognition—consciousness, orientation, concentration and memory.
- Knowledge, insights and judgment—the capacity to identify possible courses of action, anticipate consequences, and choose appropriate behaviour, and extent of awareness of illness and maladaptive behaviours.
Source: Carniaux-Moran, C. (2008). The Psychiatric Nursing Assessement. In O’Brien, P.G., Kennedy, W.Z., Ballard, K.A. Psychiatric mental health nursing: an introduction to theory and practice.,Sudbury, MA: Jones & Bartlett.
Based primarily on observational data gathered by nurses and interview questions, the MSE can be used to establish a baseline, evaluate changes over time, facilitate diagnosis, plan effective care, and evaluate response to treatment in clients with mental health and addiction.
For more information, see Appendix I: Components of a Mental Status Assessment, pg. 96 in RNAO’s BPG Assessment and Care of Adults at Risk for Suicide Ideation and Behaviour.
Teaching and Learning Activities
The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of the MSE.
- Video demonstration
- Simulation—Section 7.2
- Case studies (across lifespan; different populations)—Section 9.3
- Group discussion
- Assignments related to MSE
- Quick reference cards with questions
- Practice application
Learner Engagement Questions
The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding MSE. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.
- What are the benefits and challenges of conducting a MSE?
- When should the MSE be conducted?
- Discuss how the MSE contributes to the health assessment.
- What elements of the MSE relate to risk?
- Why are some components of the MSE observed and other components inquired?
Evaluation and Self-reflection
The following tools can be used to evaluate students in their understanding and application of MSE
- Return demonstration
Self-reflection questions: How did you feel when conducting MSE? How did you feel in the client role?
Mental Status Exam
- Butler, K. (2015). On the Frontline with voices - A grassroots handbook for voice-hearers, carers and clinicians. London, UK: Speechmark Publishing Limited.
- Erwin, E. H., & Colson, C. W. (2014). Disorders of children and adolescents. Adapted by R. J. Meadus. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 29, pp. 586–612). Toronto, ON: Elsevier Canada. Mental Status Exam (chapter 29, p. 592–593).
- Halter (2014). Mental Status Exam. In M. J. Halter, Varcaroli (Eds.). Canadian psychiatric mental health nursing: A clinical approach (1st ed.) (pp. pp. 138 & pp. 592 – 593). Toronto, ON: Elsevier Canada.
- Jarvis, C. (2014). Physical examination & health assessment. Toronto: Elsevier Canada.
- Lasiuk, G. (2015). The assessment process. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 10, pp. 148–164). Philadelphia, PA: Wolters Kluwer.
- Robinson, D. (2008). The Mental Status Exam Explained, 2nd Edition. London, ON: Rapid Psychler Press. ISBN (13) 978-1-894328-25-8 (2015).