Ten Point Guide to Mental State Examination (MSE) in Psychiatry

Posted on:November 30, 2020
Last Updated: November 30, 2020
Time to read: 14–17 minutes

The mental state examination [MSE] is an integral, and essential, skill to develop in a psychiatric evaluation.  The undertaking of an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors.

  • The MSE is a structured tool and process that allows you to observe and assess a patient’s current mental state. It can also be helpful to use as part of a working diagnosis and identifies possible areas for intervention. MSEs are usually incorporated into every mental health assessment and clinical contact.

Key principles in the approach to MSE: 

  • Welcome the patient, state the reasons for meeting and make them feel comfortable.
  • Maintain privacy, encourage open conversation and always acknowledge and respect the patient’s concerns and distress.
  • Write down the patient’s words and the order in which they are expressed verbatim. This should avoid misinterpretation.
  • Take into account the patient’s age, culture, ethnicity, language and level of premorbid functioning. (e.g. Is an interpreter required to make the assessment fair and accurate?)
  • Consider physical health problems which can impact the mental state.
  • The MSE is not to be confused with the Mini-Mental State Examination (MMSE), which is a brief neuropsychological screening test for cognitive impairment and suspected dementia. However, the MMSE can be used for more detailed testing in the cognitive section of this MSE.
  • This MSE includes all 10 aspects: appearance, behaviour, speech, mood, affect, thoughts, perception, cognition, insight and judgement and clinical judgement. Rapport may also be included.
  • The undertaking of an MSE requires time. If this is not possible [perhaps due to environmental pressures], the focus must be upon risk. (See later)