Recognising and responding to deterioration in mental state

CPD Hours: 1
Current as at 23 February 2022
Research on the signs of deterioration in a person's mental state. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) suggested that signs of deterioration could be identified using the mental state examination.

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“Explore the signs of mental state deterioration”

Course Content

Research on the signs of deterioration in a person’s mental state is underdeveloped.

In a submission to the Scoping Review, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) suggested that signs of deterioration could be identified using the mental state examination.

With this approach, deterioration would be observed as adverse changes in one or more features of mental state, such as affect and mood, thought (stream, form, and content), cognition (memory and orientation), perception, and behaviour.

Another possible way of recognising deterioration emerged from research conducted for the second report. Here, five indicators of deterioration were identified: reported change; distress; loss of touch with reality or consequences of behaviours; loss of function; and elevated risk to self, others or property.

For either of these approaches to be fit for purpose they would need to undergo an extensive evaluation of their validity, reliability, and utility across the diversity of healthcare professions, settings, and people requiring care. One of the most extensively used definitions for mental health is the one by the World Health Organization (WHO), which defines it as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. This definition indicates that the absence of mental disorder is not sufficient to experience good mental health. As such, the prevention of mental disorders and mental health promotion strategies may well overlap but at the same time differ.

The focus on early identification and prompt intervention for clinical deterioration enshrined in patient safety research is equally relevant to mental health, especially in triage and crisis care contexts, yet the knowledge gap in this area is substantial. Being able to recognise and respond to clinical deterioration depends upon knowing what signs to look for. When it comes to identifying acute physiological deterioration, several signs are well-established, including respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, and level of consciousness.

Learning Outcomes

In this session, you will:

  • Discuss the available literature in research on mental health deterioration
  • Explore the signs of mental state deterioration
  • Investigate the research findings stated in this literature review
  • Gain an understanding of the work still needed in this field
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