Mental Health Screening and Assessments
Introduction to Mental Health Screening
A litlle more than 40 million people per year are diagnosed with a mental health condition and a little more than 80 million people per year are on some kind of psychiatric medication !
More than 60% of individuals identified with some form of a mental health condition, have never received treatment.!
More impressive is the fact that Public Mental Health and Addiction facilities are staffed with minimally trained professionals providing inadequate and/or inept services; largely depending on medications, and CBT (a one shoe fits all approach).!
To add insult to injury, screening and assessment tools being used are for the most part archaic, unreliable, and their validity is highly questionable.!
Neither primary care physicians, nor other professionals in the medical fields, are trained to detect mental health conditions, nor do their routine evaluations include a generic mental health work-up.!
Finally, millions of individuals being evaluated, or treated for mental health issues, were never referred for comprehensive medical, and/or neuromedical screening prior to a a diagnostic impression. Implied in that, is the fact that people with medically-based emotional and/or functional distress, are readily medicated with psychotropics that all too often lead to serious complications.!
The Assessment Process
First off, screenings and assessments ought to be done by well trained and qualified professionals whose knowledge is supplemented with experience.!
Though States sanction many professionals to perform "Diagnostic Assessments", the truth is that the greatest majority of professionals have had little, if any, training -other than the DSM- in this crucial area of mental health service.!
Moreover, because of insurance mandates and guidelines, the diagnostic process MUST lead to a reimbursable medical, or mental health condition; The result being that about 90% of all people being diagnosed are labeled as Depressed, Bipolar, Add/Adhd, Ptsd, or some form of a Dual Diagnosis that includes addiction.!
Of interest to us here are tools, and/or techniques that can identify one, or more of the following 12 Mental Health Disorders. More so than that, to assess the degrees of functional impairments in direct correlation to any one of them.!
Going further; not only do we need to tweak the general category detected, but to hone into the sub-categories under each label. e.g.
Mood Disorder : Bipolar mixed, Bipolar Depressed, Bipolar Manic, Dysthymia, cyclothymia, Grieving, ...
Doing so, involves diligence in recognizing that many depressive symptoms may not be the result of a mood disorder, but rather of the presence of addiction, or anxiety, or OCD.
Failure to do so, may result in offering anti-depressants like "zoloft" to an individual with substance abuse, or one suffering with panic attacks.!
Mental Health Conditions Major Categories
- Thought Disorder
- Schizophrenia, Paranoia, Derailment.
- Mood Disorder
- Bipolar mixed, Bipolar Depressed, Bipolar Manic, Dysthymia, Cyclothymia, Grieving, Reactive Depression.
- Schizo-Affective Disorder
- A mix of Thought and Mood Disorder (Very Rare)
- Pervasive Developmental Disorder
- Autistic Spectrum, Aspergers, Kanner's syndrome / Autism, Infantile psychosis.
- Post-Traumatic Stress Disorder
- A pervasive transient episodic situational state of mental anguish and emotional stress resulting from shock, trauma, near-death experience,
or injury.
- Delusional Disorder
- A Delusional disorder may not be diagnosed in individuals with schizophrenia, or other psychotic disorders. Aside from their specific delusional
system, they are neither odd, nor are they eccentric, or otherwise impaired.
- Personality Disorder
- In so far as functional levels go, or possible ramifications to themselves, or others, personality disorders are rather serious and more often than
not, psychiatry ignores them, and mental health professionals fail to accurately diagnose them.
Cluster A ("odd, eccentric") - Paranoid, Schizoid, and Schizotypal.
Cluster B ("dramatic, emotional, erratic") - Antisocial, Borderline, Histrionic, Narcissistic.
Cluster C ("anxious, fearful") - Avoidant, Passive-Aggressive, Dependent, Obsessive-compulsive.
- Anxiety/Panic Disorder
- A state of freight, or uneasiness with concerns about impending doom, catastrophy, or colapse, ...
- Somatoform Disorder
- Individuals with somatoform disorders present with a variety of medical complaints absent any identifiable known medical conditions.
- Obsessive Compulsive Disorder
- Individuals are obsessed with ideas, or intrusive thoughts followed by compulsions to act upon them in spite of the fact they recognize their thoughts
are irrational, or unreasonable.
- Substance Use Disorder
- Excessive use, and/or abuse of mind-altering substances with an inability to abstain for more than 30 days regardless of occassion, as well as ritualistic
actions, and/or behaviors surrounding the use ...
- Dementia Spectrum (Syndrome)
- A group of degenerative diseases of the brain with most prominent being Alzheimer's (80%). It is progressive and affects cognitive functions,
such as spatial skills, judgment, language, planning, organization, attention, and problem solving.
- Mental Derangement
- Hardly anywhere in the literature will one find this term; and yet it is Mental Derangement that is responsible for unthinkable violence.
This author proposes that this condition is underscored with an incidiously progressive dis-arrangement of social, moral, ethical, and human codes and values,
leading to endorsement and ratification of the constructs of disregard, apathy, and violence.
Screening and Assessment Tools
There are literally, hundreds of instruments and tools that may assist professionals in arriving at a diagnostic impression. Aside for the interview and psychosocial intake process, only phd/psyd psychologists can perform a "pencil-paper" psychometric evaluations.!
What needs to be noted is the fact that "psychometrics" are impersonal, perfunctory, and highly unreliable tools that offer nothing more than a cursory view of an individual.
One might even go as far as to say that they are "cookie-cutter" approaches that are dispassionate, and totally detached from the essence of a living-breathing person.!
Here we present what we regard as the most usefull mental health screening and assessment tools :
MSE (Mental Status Assessment)
One of the oldest and most widely used mode of a structured interview and observations whose objective is to describe an individual's psycho-social functions in reference to appearance, attitude, speech, thought process, thought content, perception, behavior, mood, and affect, cognition, insight, and judgment.
MMSE (Mini–Mental State Examination)
Not to be confused with the MSE, (The Folstein test. A 30-point questionnaire). This is a widely used set of instructions to the patient targeting
Language, Orientation, memory retention and recall, Attention. ...
Used as a preliminary screening tool for dementia, cognitive changes,
and neuro-medical conditions.
Ego Functions Assessment
In contrast to a psychiatric, or nosological diagnoses defining conditions via labels, the Ego-Functions’ assessment is based on the rationale that all individuals require desires, willingness, facilities, and competence to carry on their day to day affairs. Some are innate, others endowed, and many acquired, or developed.
They are known as Ego-Functions and occasionally some, or all, might be impaired, or impeded by disease, illness, of conditions.
The objective here, is to assess each one of the 18 primary functions, and tailor the treatment plan accordingly.
- AUTONOMOUS EGO FUNCTIONS,
- SENSE OF REALITY,
- REALITY TESTING,
- ANALYTIC EGO FUNCTIONS,
- SYNTHETIC EGO FUNCTIONS,
- INSIGHT – AUTOMATIC,
- INSIGHT – RETROSPECTIVE,
- JUDGMENT,
- SELF OBSERVING EGO,
- IMPULSE CONTROL,
- DRIVE AND AFFECT MODULATION
- OBJECT RELATIONS,
- OBJECT CONSTANCY / PERMANENCE,
- THOUGHT PROCESS,
- CONSCIOUSNESS,
- MOTORIC ACTIVITY,
- ADAPTIVE REGRESSION
- DEFENSE MECHANISMS.
BAP Brief Assessment Protocol - The Kasdaglis Model - Intake
This assessment tool evaluates all of the following areas of an individual's personality constellation.
To ensure accuracy in the final clinical impression, it is imperative that colateral information is collected from the pt's family members, and/or from close friends, or confidants ...
Our inquiries collect data related to the following :
Abstraction, Affect, Affection, Affiliation, Aggression, Agitation, Alertness, Alexithymia, Aloofness, Ambivalence, Anergia, Anhedonia, Anxiety, Apathy, Approach-Demeanor, Appetite, Appropriateness, Aprosodia, Arrogance, Asomnia, Associations, Ataxia, Autism, Dereistic Thinking, Forgiving, Haplessness, Hopelessness, Jealousy, Mood Lability, Motor-behavior, Pressure of speech, Relatedness.
Addictions - The Kasdaglis Drug Addiction Screening and Assessment Protocol (KADS)
An assessment in this area ought not to focus on only detecting, but also on the probability of risk.
We readily observe that individuals actively engaging in the addictive use of a substance, or action, are the following:
Please bear in mind, that addiction may not only manifest in the use of alcohol, or illegal drugs; it may include prescription medications, video games, sexual indiscretions, erotomania, thrill seeking actions, and/or behaviors, ...
- Though they may acknowledge they are addicts, users, or abusers, they fail to recognize and acknowledge the magnitude and impact their addiction has upon themselves and/or others.
- The presence of unremitting intrusive thoughts associated with a particular act, or substance, directly interfering with Focusing, Attention, and Concentration.
- The performance of the act, or use of the substance is ritualistic. e.g. The minute pieces of behaviors leading to the use or action are underscored with specific sequences.
- The act or use persists in spite of known and previously experienced averse, or negative consequences to themselves, or others around them.
- A profound inability to abstain from the act, or use, for a period of 30 days, regardless of occasion.
- Either EPS, (Extrapyramidal Syndrome, and/or Affective impairment - However minute, or insignificant !