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Personalized Mental Health Assessment

Posted by Stephen Lemire on December 8, 2011 at 11:35 AM

The checklists of symptoms that we so often see for various behavioral health problems, such as clinical depression and bipolar disorder, are well documented but, many times, do not take into account the wide range of how the symptoms manifest themselves from person-to-person.

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During my time as Director of the Greater Lowell Behavioral Health Association and board member of the Middlesex North Resource Center and Manic Depressive/Depressive Association of Boston, I explored how clients felt when they reported feeling stable versus when they were symptomatic. I created this tool to fit individual needs. It is best used for clinical depression and bipolar disorder, although it can be adjusted to fit other diagnoses. Please recognize that this is a laymen’s tool and not a clinical document meant to take the place of any formalized treatment that may be required.

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The assessment is completed by a person with a previously diagnosed behavioral health problem when they are feeling well and they update it periodically when feeling stable so that changes in mood may be compared to a baseline. A copy of the tool can be shared with health care providers and support network members (family and friends) upon completion.

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Many individuals with behavioral health issues are not good self-reporters when they are symptomatic. With this plan, providers and supporters can help the person judge, based on the individual’s unique baseline, if they are symptomatic and what they may need for assistance and what their treatment preferences might be.

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This is how I feel when I am well:

  • My mood is stable: yes ___ no___
  • My moods are cycling: yes___ no___
  • I consider this to be my baseline mood: yes___ no ___
  • I feel rested: yes ___ no___
  • I have a good energy level: yes___ no___
  • I am getting an adequate number of hours of sleep per night: yes___ no___
  • My sleep pattern is following a routine schedule: yes___ no___
  • When I wake I feel rested in the morning: yes___ no___
  • I have distinct food cravings: yes ___ no___
  • I have eating binges: yes___ no___
  • I self-medicate with alcohol: yes___ no___
  • I self-medicate with non-prescribed drugs: yes___ no___
  • I take all prescribed medications as ordered: yes___ no___
  • I go to therapy appointments as scheduled: yes___ no___
  • I go to support group meetings as needed: yes___ no___
  • I have no self-destructive thoughts (impulsive nor reckless): yes___ no___
  • I feel productive and creative (no racing nor grandiose thoughts): yes___ no___
  • I am confident, happy, and I interact with others: yes___ no___
  • I am looking forward to future events: yes___ no___
  • I have interest and participate in hobbies and activities I enjoy: yes___ no___
  • I engage in activities that are intellectually stimulating: yes___ no___
  • I have a sense of purpose and worth: yes___ no___
  • I have a normal sex drive: yes___ no___
  • Other _________________________

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This is how I feel when I am depressed:

  • I have a suicide plan: yes___ no___ (If yes, call 911.)
  • I am passively suicidal or think about death often: yes___ no___
  • I have self-destructive (self-injurious) thoughts: yes___ no___
  • I fail to notify my clinicians or support network of at-risk behavior or mood: yes___ no___
  • I have difficulty falling asleep, staying asleep, or I am waking early: yes___ no___
  • I feel constantly fatigued: yes___ no___
  • I have food binges and/or sugar cravings: yes___ no___
  • I am very blue and sad for several consecutive days: yes___ no___
  • I feel a lack of motivation and confidence: yes___ no___
  • I have difficulty with concentration: yes___ no___
  • I feel apathetic: yes___ no___
  • It seems like I have reduced peripheral vision: yes___ no___
  • I feel more anxious than normal: yes___ no___
  • I have a sense of worthlessness, hopelessness, or a lack of purpose: yes___ no___
  • I have difficulty with short-term memory: yes___ no___
  • I am easily distracted: yes___ no___
  • I have body aches and severe joint pain: yes___ no___
  • I have a decreased desire to maintain personal hygiene: yes___ no___
  • I want to isolate and not socialize: yes___ no___
  • I am less able to care for myself: yes___ no___
  • I feel a tremendous sense of loss: yes___ no___
  • I feel a lack of creativity (“writer’s block”;): yes___ no___
  • Other _________________________

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This is how I feel when I am hypo-manic or manic:

  • My behavior is impulsive and/or reckless: yes___ no___
  • I feel aggressive, agitated, or irritable: yes___ no___
  • I feel like I am “crawling out of my skin”: yes___ no___
  • I have difficulty making appropriate decisions: yes___ no___
  • I fail to notify my clinicians or support network of at-risk behavior or mood: yes___ no___
  • I get fewer than 5 hours of sleep per night for several consecutive nights: yes___ no___
  • I have a decreased need for sleep: yes___ no___
  • I have a decreased desire to eat: yes___ no___
  • I have difficulty falling asleep, staying asleep, or I wake early: yes___ no___
  • I spend more money than usual: yes___ no___
  • I crave salt: yes___ no___
  • I am overly motivated to be productive: yes___ no___
  • I want to constantly socialize: yes___ no___
  • I have difficulty with concentration and my thoughts jump from idea to idea: yes___ no___
  • I am overly confident: yes___ no___
  • I have racing thoughts: yes___ no___
  • I have great ideas. I am an “ultra-visionary”: yes___ no___
  • Other _________________________

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This is how I feel when I am rapid-cycling or have mixed moods:

  • I have symptoms of depression and mania within several hours of each other: yes___ no___
  • I have symptoms of depression and mania at the same time: yes___ no___
  • I am passively suicidal: yes___ no___
  • I have reckless thoughts: yes___ no___
  • I fail to notify clinicians or support network of at-risk behavior or mood: yes___ no___
  • I have food binges and cravings which neither sugar nor salt satisfy: yes___ no___
  • I feel creative and energized by low priority issues: yes___ no___
  • I am depressed and sad: yes___ no___
  • I lack motivation: yes___ no___
  • I have difficulty with concentration: yes___ no___
  • I have racing thoughts and am agitated: yes___ no___
  • I feel a lack of purpose: yes___ no___
  • I am easily distracted: yes___ no___
  • Other _________________________

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List the activities that may help reduce or eliminate your symptoms. Refer to this as a reminder when you are symptomatic. For example:

  • Maintain a sleep schedule
  • Get some moderate exercise (such as taking a walk) every day
  • Try to socialize face-to-face or over-the-phone. (Email and social media can add to isolation.)
  • Check in with your support network (listed below)
  • Call your clinicians
  • Do a hobby
  • Restrict spending
  • Call a hotline, attend a support group, or go to the ER as needed
  • Other _________________________

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List what you need from your support network (below) when you are symptomatic. For example:

  • Ensure that you take all medication as prescribed
  • Ensure that you get to scheduled appointments and support group meetings
  • Check-in with you but give you space (do not smother you)
  • Help you keep your living area tidy
  • Help you stick to a daily routine (including hygiene)
  • Monitor your safety needs
  • Discourage you from driving when you are not safe
  • Help you care for your children, if applicable
  • Other _________________________

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Clinicians:

  • Name, address, phone number, and email of your psychiatrist/psycho-pharmacologist
  • Name, address, phone number, and email of your therapist/counselor/social worker
  • Name, address, phone number, and email of your primary care physician

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Support Network: List family members and friends that have your permission to speak with each other and clinicians about your symptoms and treatment options in the event of a crisis. (This does not give them the authority to make a decision without consulting you.)

  • Name, address, phone number, and email for each
  • List in the order of priority that you would wish them to be contacted

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Treatment Considerations:
Provide important additional medical information as well preferences for treatment. For example:

  • List all medications you are currently taking
  • List all medication allergies
  • Medical insurance information: name of insurer, phone number, enrollment number
  • If you have a living will and health care proxy, where are they located?
  • Should you need to be hospitalized, which hospitals do you prefer to go to/not go to?

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Legal Considerations:

  • Name, address, phone number, and email of your attorney(s)

Categories: Behavioral Health, Public Health, Real Life Wisdom

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