You have heard the saying don’t judge a book by its cover. Well that’s exactly what I am going to ask you to do. In the first part of a Mental State Exam we look at a persons appearance and make some judgements on where they are at because of this. Now the politically correct crowd will say that we shouldn’t judge people. That we should make informed decisions or be understanding of their context. Bollocks! We all make judgements and that is OK! If your Judgement is informed by theory and experience then it is an informed judgement. Do not get all mushy about it. It will not help your clients.
We all notice the appearance of others. What they are wearing, are they groomed, their age, weight or perhaps an odour!!! We make observations about this through the lens of our knowledge of the person, society and our experience. Is that young person with their pants hanging down, hair unkempt and malodorous (my favourite clinical word) just part of the teenage stinky boys club or is there something more to it. What if they usually dress very neatly and wear deodorant?
Appearance is possibly the easiest of the Mental State Exam areas to observe. Has your young person recently gained weight…or lost it? Are they smelly or well groomed? Do they stare at the floor or are they making good eye contact? Can you smell alcohol or perhaps their teeth are bad, could they be abusing drugs? Have they stopped wearing clothes that show off their figure and now wear really baggy clothing? Is it a change in fashion or are they self harming???
There are no easy answers when observing a young persons appearance. I have over reached and missed signs throughout my career. Sometimes it is a gut feeling. For the most part it is time, time, time that will be your guide. Meeting people once gives you some data to crunch, but what if they are just having an off day? The more you observe the better your analysis. Take into account cultural issues and the current context for the young person and you should be fine.
This is only one clue in the Mental State Exam. It is however one of the easiest to practice. Look around when next meeting with a young person and ask yourself about their appearance in every way. Ask yourself why they look the way they do and if this is a positive social step or a negative one. Ask yourself if they appear to have them self together or if there seems to be signs that they are letting themselves go. If there are, it doesn’t necessarily mean panic. It does mean be more observant.
See you next week for part two, Behaviour.