LAST YEAR’S CHALLENGE:
Allan Turner, PhD, LSW, ACSW
Multicultural Community
Resource Center
Culturally
Competent Use
of the Mental
Status Exam
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


Emotional State (Mood & Affect)




blocking; illogical connections; flight-of-ideas; hallucinations, illusions,
etc.
Mental Capacity / Intellectual Functioning


obsessions and ruminations; delusions; suicidal/homicidal content;
ideas-of-reference, etc.
Thought Process


should be some congruence between the mood and affect.
vegetative / somatic signs
Thought Content


volume, rate, pressure, mute, etc.
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 predoctoral 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??
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Culturally Competent Use of the Mental Status Exam