Assessment of Mental Illness

Although carers do not undertake psychiatric assessment it is useful to have an understanding of what this involves so they can assist with the process. Broadly speaking, the assessment approach for people with intellectual disability is the same as for anyone else, although in some circumstances modifications may need to be made which will be described later. To assess a patient a mental health professional obtains a psychiatric history and undertakes a mental state examination (see below). The process involves interviewing the patient as well as getting a history from other sources including previous assessments and interviewing people who know the person (collateral history). The key tasks are to obtain an accurate history of the patient’s problems, assess the personality and other relevant factors that may have contributed to the current problems.  The purpose is to make a formulation that describes why a person has developed this illness at this time and lists probable diagnoses and generates an appropriate treatment and management plan. Another important component of a psychiatric assessment is a physical examination, although this is often done by the GP.

Psychiatric history

In taking a person’s history the aim is to obtain an accurate picture of the person’s current

difficulties, their pre-morbid personality (what their personality was like before they

became unwell) and their background.  It is useful to consider history under the following

sections.

Demographic Information

For instance: Name (and previous names if this has changed), age, date of birth, address and type of accommodation.

Presenting Complaint

A brief description of the problem, using the person’s own words if possible. For instance, “I feel sad and I don’t want to do anything any more.”

History of the presenting complaint

Here the presenting complaint is fully explored. Obtaining this history includes asking about the nature and severity of symptoms, when they started and if this represents a change from normal. E.g., “Was there anything that happened that changed how you are feeling? How has this affected you?” Enquiries should be made about related symptoms, for example self-harm and suicidal ideas in a person presenting with depression. 

Current Treatment

This section would include a list of medications, and other ongoing treatments (for example behavioural or psychological therapies, speech and language therapy, counselling).  

Psychiatric History

This section will cover previous episodes of mental illness and treatment. It should include a drug and alcohol history.

Medical History

Medical history includes current and past physical disorders. A list of current medications is also usually taken at this point.

Family History

In taking a family history one asks about the physical and mental health of parents, siblings and other relatives. It can help determine if there is a genetic cause to the illness but also may reveal how the person has experienced the impact of illness on their close relatives. However, be careful in how sensitive information about others is stored and used, and consult the privacy principles of your organisation if you are in any doubt.

Personal History

The personal history covers all aspects of a person’s life in chronological order. The aim is to gain an understanding of the individual’s personality, relationships and life experiences It includes details of a person’s pregnancy, birth, early development, schooling, employment, relationships and any history of violence or criminal activity.

Intellectual Disability

If there is a specific diagnosis giving rise to the intellectual disability then this should be recorded here.  The person’s usual function should be described, in terms of self-care skills, activities of daily living, academic abilities, independence and need for support.

Premorbid personality

There are many aspects to personality including a person’s temperament; social interactions and relationships; interests and hobbies; moral, political and religious beliefs; ambitions, aspirations confidence and motivation; coping skills and response to stress.

Current social circumstances

This section brings the chronological history up to the current date in terms of where, and with whom a person lives. It describes the daily activities, interactions and relationships of the people in the household, including employment, supports, financial arrangements and any difficulties.