Harm to self or others

“If you knew their full story, everyone’s behavior makes sense.”  ― Unknown

DEFINING

"RISK OF HARM

TO SELF OR OTHERS"

This phrase refers to the potential risk that someone has to killing themselves (suicidal) or killing someone else (homicidal).

It also refers to the situation where an individual may not have the insight into their own mental wellbeing to the point where they could accidentally injure or kill themselves or others.

insight

Insight refers to an individual’s ability to accurately understand their current situation and environment. Insight is referred to as a “continuum of thinking and feeling”1  related to many different internal and external contexts.

Some ways to determine someone’s current level of insight is learning whether they know and are able to express certain things (known as Oriented x4):

  • Who they are
  • Where they are
  • The time of day/week/year
  • The situation they are currently in 

judgment

Judgment refers to an individual’s ability to make logical and safe decisions2. Judgment and insight are often interrelated due to the need to properly understand their situation in order to make appropriate actions and decisions. 

Determining whether someone has poor or fair judgment is challenging due to the subjective nature of what it means to act appropriately in their society. The ability to determine which actions are safe or not should be the primary focus on deciding level of judgment.

 

Play Video

Mental Status Exam Mnemonics
(Memorable Psychiatry Lecture)

“The mental status exam is psychiatry’s equivalent of the physical exam … Intended for all healthcare providers, including doctors, medical students, psychologists, nurses, nurse practitioners, physician assistants, social workers, and more.”

mental status exams

A Mental Status Exam (MSE) is a formal process of determining a person’s emotional, behavioral, cognitive functioning at one moment in time. The majority of the test is based on observation rather than asking questions, and seeks to3:

  • Evaluate danger to self and others
  • Inform your assessment of the person’s needs
  • Evaluate progress over time
  • Is only one piece of the puzzle that informs assessment, needs, and treatment
 

It’s important to remember that perceptions of mental status are intricately informed by cultural context. “Symptoms” should be viewed as hypotheses that require more investigation. (Stay curious about symptoms – what could be the cause?)

Cultural Context & Differential diagnosis

Many things should be considered when performing a Mental Status Exam (or anytime you are making assumptions about a person’s presentation). Rather than immediately assuming that someone’s behaviors are caused by a mental health condition, first consider whether the individual: has a physical condition, is experiencing a medication side-effect, stimming, or behaving in a way that is acceptable in their native culture/community. Always be aware of your own baises and positionality when judging others.