MSA and Mental Health Conditions

Question 1

Outline the purpose of the mental status assessment.

Answer 1

A systematic method used to evaluate a patients mental function, placing emphasis on their behaviours.

Question 2

When may a patient meeting the criteria for requiring immediate support be considered for non-transport?

Answer 2

If the available options for further care are suitable to meet the needs of the patient and address the crisis.

Question 3

List the 4 elements of the OBSERVE stage of the MSA.

Outline the considerations for each.

Answer 3

1. Safety - scene safety, DRA, weapons, police support.
2. Appearance -uncleanliness, malnourished, signs of addiction, posture, pupils, odour.
3. Behaviour - mannerisms, gait, eye contact, violence, motor activity levels, pacing, reactions to stimuli.
4. Affect - flat, agitated, excited, bizarre, hostile etc.

Question 4

List the 3 elements of the LISTEN stage of the MSA.

Outline the considerations for each.

Answer 4

1. Speech - volume, pace, inflections, engaged etc.
2. Thought process - consistent or erratic – thought flow?
3. Cognition - memory, judgement, insight, attention span

Question 5

List the 4 elements of the DISCUSS stage of the MSA.

Outline the considerations for each.

Answer 5

1. Thought Content - delusions, obsessions, suicidal/violent ideations, compulsions
2. Self-Harm - current thoughts, previous attempts
3. Perceptions auditory/visual/command hallucinations
4. Environment - support, stressors, addiction, SES, comorbidities

Question 6

What assessment tool is used to rule out clinical causes other than mental health issues?

Answer 6

AEIOUTIPS
A - Alcohol/drug intoxication
E - Epilepsy (post-ictal)
I - Insulin or other metabolic cause eg. hypo/hyperglycaemia, renal/liver failure
O – oxygen/overdose
U – underdose (including withdrawals)
T – trauma (head trauma)
I – Infection/sepsis
P – pain/psychiatric condition
S – stroke/TIA

Question 7

What are the 4 points of the STOP note in the Mental Health Conditions guideline?

Answer 7

1. Assess scene for dangers
2. Ensure safe environment for paramedics, pt and BS’s
3. Continually reassess for changes to pt/BS behaviour
4. Consider CPG Agitation

Question 8

Violent or agitated behaviour is considered…

Answer 8

A High Risk symptom, requiring patient transport.

Question 9

If mental health issue identified, apply MSA and consider excluding …?

Answer 9

Clinical or organic causes using AEIOUTIPS.

Question 10

List the 5 symptoms that indicate a patient to be High Risk.

Answer 10

1. Suicidal ideation - attempt, thoughts, plan, intent
2. Self-harming behaviours or actions
3. Intentional overdose/poisoning
4. Cognitive impairment (unless normal for pt)
5. Erroneous or altered perceptions (delusions/hallucinations etc)

Question 11

List the 3 signs that the Pt requires immediate support..

Answer 11

1. Pt lacks readily available support
2. Evidence of not coping - can be environmental cues or pt statements
3. Pt is in dangerous social situation eg. domestic violence

Question 12

If a pt is not indicated for immediate transport under the Mental Health Conditions guideline, what are the 4 possible alternatives?

If these are insufficient, what is required?

Answer 12

Contact:

1. Pts mental health practictioner OR
2. Pts GP for an appt. to discuss Mental Health Plan/Assessment OR
3. Contact relevant CAT team for pt’s catchment OR
4. Contact pt’s family member or friend - wait on scene for their arrival.

Must Tx otherwise.