mental status examination
(MSE) is a structured interview-based assessment, usually performed by a mental health and addictions service provider to observe a client’s behavioural, emotional and cognitive state.1,3,6
The MSE can be used to monitor a client’s mental state over time by conducting it at every visit. It consists of the following ten components:2,3,7
- thought content (including suicidal ideation, homicidal ideation, etc.)
- thought form or process (including coherence, logic, and attention, etc.)
- cognition (including orientation, memory, planning, alertness, etc.)
Seventy five per cent of people who seek treatment for gambling problems will develop another psychiatric condition.8 The most commonly reported co-occurring mental health problems, or
concurrent disorders, are substance use disorders (57.5 per cent), followed by mood disorders (37.9 per cent) and anxiety disorders (37.4 per cent).9
If concurrent disorders are left undiagnosed, the gambling problems can worsen over time. Therefore, one of the main goals of using the MSE is to help identify the presence of a concurrent disorder.6
This webpage discusses the evidence supporting the use of the MSE and how it can be used in a clinical setting to identify people with gambling problems who have concurrent disorders. This information for providers of mental health and addiction services is based on a review of the literature and was reviewed by an expert in the field.
About the Mental Status Examination (MSE)
The MSE, also known as a “brain stethoscope,” is an integral component of a client’s cognitive function assessment.2,3 This tool is based on early psychiatric principles and has been widely used for years.3-5
The MSE is performed by using active observations, clinical judgment, and specific questioning.2,3,6 A number of checklists and scales are available to ensure the MSE is delivered in a systematic way.
It is not a diagnostic tool but instead helps you monitor your clients’ mental state over time, the effectiveness of ongoing treatment(s), the presence of co-occurring mental health problems, and/or the need for further supports and referrals.3-5,10 The MSE does not replace the psychosocial assessment. It should be done as part of the client’s overall assessment to capture interests, values, experiences, and goals.3,11
Learn more about the different components of the MSE and sample questions to ask during each component.
What does the evidence say?
While research looking at the utility and efficacy of the MSE is scarce, it has been used in the mental health field since the 1800s and has been documented to be clinically beneficial based on observational data.4,12 The APA endorses this tool as one of the essential components of a clinical evaluation.13,14
The information that is gathered from the MSE can be used to develop treatment as well as safety and referral plans for clients who have sudden changes in functioning, are in crisis, or experience suicidal thoughts.3,5
Putting the evidence into practice
As mentioned above, there are advantages to conducting the MSE at every interaction with a client who has a gambling problem, regardless of how often you meet with them or in what context (both individual and group sessions).5 The APA recommends using the MSE in the following situations:13
- when you would like to determine whether a client with a gambling problem has a mental health problem
- when you believe they may be a danger to themselves and/or others
- when they are showing shifts in insight, judgment, and capacity for abstract reasoning
- when you would like to measure the effectiveness of their treatment plan over time.
It is important to conduct an MSE via an interview because this will enable you to gather information directly from your client as well as through your own observations.5 This information can help you provide support in a consistent, structured, and concrete manner.5 Table 1 shows which MSE components can be assessed through observation and which through inquiry.3
Sharing your overarching impressions of the MSE results will help you engage your client in a conversation and understand their perspective. It might also help them build their own self-awareness. Listen to this audio clip for an example.
There are reference cards available that describe the different components of the MSE and provide guidelines on how to conduct and document the findings. It can be helpful to keep a reference card on hand so that you can easily refer to it as needed.
If your client’s MSE findings show a possible undiagnosed mental health problem or symptom, it is important to:4
- conduct further screening for these issues (for more information see
Additional Resources below)
- refer the client to specialized mental health supports, as needed
- provide care in an integrated, collaborative fashion along with their mental health team.
Suicide assessment is an important part of the MSE.3,5 Several resources are available to guide you in conducting a safe and effective suicide assessment (see
Additional Resources below).
Table 1. Assessing the MSE components (observation vs. inquiry)
|Commonly assessed through observation
||Commonly assessed through inquiry
- Thought form (also referred to as thought process)
- Cognition (including orientation, memory, planning, alertness, etc.)
- Thought content (including suicidal ideation, homicidal ideation, etc.
Suicide assessment and prevention
- Webinars related to the Mental Status Examination:
Comorbidity: Mental Health Disorders and PG and the Mental Status Exam (MSE) – Fall 2013, Presenter: Dr. Daniela Lobo, Clinician-Scientist, Staff Psychiatrist, CAMH, Assistant Professor, University of Toronto
Problem Gambling, Concurrent Disorders and the Mental Status Exam – August 8, 2018, Presenter: Matt Tsuda, Education Specialist/Therapist with Gambling, Gaming & Technology Use, Centre for Addiction and Mental Health
Click to show references
- Martin, D.C. (1990). The Mental Status Examination.
In Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths. Available: http://www.ncbi.nlm.nih.gov/pubmed/21250162. Accessed November 19, 2018.
- Robinson, D.J. (2016).
The Mental Status Exam Explained. 3rd ed. Port Huron: Rapid Psychler Press.
- Trzepacz, P.T. & Baker, R.W. (1993).
The Psychiatric Mental Status Examination. New York: Oxford University Press.
- Snyderman, D. & Rovner, B.W. (2009). Mental status examination in primary care: A review.
American Family Physician, 80 (8), 809–814. doi:10.1603/033.046.0324
- Sadock, B.J., Sadock, V.A. & Ruiz, P. (2015).
Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Philadelphia: Wolters Kluwer.
- Cooper, C. & Lobo, D. Problem Gambling Provincial Training Webcast: Comorbidity: Mental Health Disorders and PG and the Mental Status Exam (MSE). Available: https://pgiotraining.net/a/mse/story.html. Published 2013. Accessed November 14, 2018.
- Components of a Mental Status Assessment | Nursing Best Practice Guidelines. Registered Nurses’ Association of Ontario. Available: https://bpgmobile.rnao.ca/content/components-mental-status-assessment. Accessed November 15, 2018.
- Dowling, N.A., Cowlishaw, S., Jackson, A.C., Merkouris, S.S., Francis, K.L. & Christensen, D.R. (2015). Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis.
Australian and New Zealand Journal of Psychiatry, 49(6), 519-539. doi:10.1177/0004867415575774
- Lorains, F.K., Cowlishaw, S. & Thomas, S.A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys.
Addiction, 106 (3), 490–498. doi:10.1111/j.1360-0443.2010.03300.x
- Sadock, B.J & Sadock, V.A. (2009).
Kaplan and Sadock’s Concise Textbook of Child and Adolescent Psychiatry. 10th ed. Philadelphia: Lippincott Williams & Wilkins.
- Finney, G.R., Minagar, A. & Heilman, K.M. (2016). Assessment of Mental Status.
Neurologic Clinics, 34 (1), 1–16. doi:10.1016/j.ncl.2015.08.001
- Huline-Dickens, S. (2013). The mental state examination.
Advances in Psychiatric Treatment, 19 (2), 97–98. doi:10.1192/apt.bp.112.010215
- Silverman, J.J., Marc Galanter, C., Jackson-Triche, M., et al. (2016).
The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults, 3rd Ed. Arlington. www.appi.org/specialdiscounts.
American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. Arlington; 2006.