LAST YEAR’S CHALLENGE:

Culturally Competent Use of the Mental Status Exam Allan Turner, PhD, LSW, ACSW Multicultural Community Resource Center

Culturally Competent Use of the M.S.E. General Community M.H. profile trained professionals: psychologists, psychiatrists, social workers, nurses, counselors. expertise in the M.H. area, but… lack of knowledge regarding individuals outside their specific culture.

Culturally Competent Use of the M.S.E. What is the Mental Status Exam? the most widely-used tool utilized to assess the current M.H. conditions of an individual. should be utilized, to some extent, during each contact with the client. used by skilled clinicians sometimes presented in a brief checklist format, but best utilized via an interview process.

Culturally Competent Use of the M.S.E. What is the Mental Status Exam? The mental status examination is a structured assessment of the patient's behavioral and cognitive functioning.

Culturally Competent Use of the M.S.E. the M.S.E. is a specific, standardized, set of observed attributes that allow clinicians to communicate these attributes to other clinicians and for diagnosis and prognosis. no one observation in itself, is of value… rather combinations describe diagnostic patterns “this guy is really ‘off-the-wall’!”.. not very useful observation.

Culturally Competent Use of the M.S.E. like Sherlock Holmes, observation is the key. Holmes would tell Watson that Watson observes, but Watson doesn’t know what he is observing. Likewise, in mental health, assessment relies on clinicians knowing what they are observing.

Culturally Competent Use of the M.S.E. WHAT DOES THE MENTAL STATUS CONSIDER? General Appearance, Attitude and Behavior the first thing we observe is the person’s behavior in the waiting room; then his/her movement and gait; facial expression; injuries; etc. then his/her greeting; eye contact; attitude toward you and being here; language capability, etc. behavior while seated?

Culturally Competent Use of the M.S.E. General Appearance How aware are clinicians of the customs of other cultures, their dress & regalia; when is it being worn appropriately or inappropriately?? How aware are clinicians of their public social interactions? Male or Female? How aware are clinicians of the appropriate greeting or inappropriate greeting when meeting people of other cultures? How does the clinician’s lack of awareness affect their clinical assessment/judgement?

Culturally Competent Use of the M.S.E. Speech volume, rate, pressure, mute, etc. Emotional State (Mood & Affect) should be some congruence between the mood and affect. vegetative / somatic signs Thought Content obsessions and ruminations; delusions; suicidal/homicidal content; ideas-of-reference, etc. Thought Process blocking; illogical connections; flight-of-ideas; hallucinations, illusions, etc. Mental Capacity / Intellectual Functioning abstractions; serial 7’s; presidents; Orientation X3 – time, place & personal identity Insight & Judgment

Culturally Competent Use of the M.S.E. Good clinicians are identifying these attributes during each meeting with the client… based on the standards established for Western culture. How do they observe and identify outside of these Western norms?? With few exceptions, the education and experience of clinicians in the U.S. fails to provide any understanding (or minimal) regarding application of this commonly used assessment tool to individuals from other cultures!!

Culturally Competent Use of the M.S.E. EXAMPLE: Using the MSE to Assess Depression usually, someone who is depressed doesn’t invest too much energy into his/her appearance (concern if too immaculate?). speech often forced (language issues?) lack of eye contact (cultural?) difficulty concentrating (serial 7’s) blocking of thoughts ruminations / obsessions?

Culturally Competent Use of the M.S.E. How can we help mental health community become more culturally competent?? Possibly, cultural competence related to all cultures is not a reasonable goal… versus seeking higher levels of cultural sensitivity. help our MH clinicians rethink using Western norms as the standard. Strategies we are trying at MCRC in Erie.

Culturally Competent Use of the M.S.E. Diversity Training following discussions with the MH providers in Erie, we became aware of a need for diversity training for all social service agencies. developed a formal set of trainings and a catalog of these trainings to distribute to the community. currently we are marketing these to a broad array of social service providers, including the mental health community.

Culturally Competent Use of the M.S.E. Pre-Doctoral Interns engaged with the Sarah Reed Children’s Center to utilize 3 pre-doctoral interns to work with children, adolescents and their families. 1 day per week Case consultation with the case management staff to address case managers needs.

Culturally Competent Use of the M.S.E. BHUTANESE COMMUNITY ASSOCIATION GRANT worked with the BCAE to develop a grant with the PA Disabilities Council to provide rehabilitation services to refugees coming to Erie with physical and emotional needs. designed to link with the universities in the community to provide supervised interns to complete rehab assessments & treat.

Culturally Competent Use of the M.S.E. You have your own resources and your own needs. There are always ways to create a response to the needs that our clients present. QUESTIONS??