Mental Status Exams

 We used the Mini-Mental Status Exam (MMSE) at the neuropsychology clinic I used to work at. Most of our patient population was there for memory disturbances, but the MMSE was useful even in clients without a memory problem. Sometimes the reaction to taking the MMSE told me a lot about the patient. It was the first assessment I gave patients so it was my first impression of them per se. Some clients would really struggle and become upset, some would struggle but not care, and others would get very angry if it was difficult for them. Younger clients who did not have memory concerns would sometimes become defensive as if the test was insulting them or laugh it off as if the assessments were dumb. It was a good assessment to begin our five to six hours session with as it gave me a small understanding of the patient and gave the patient a taste of what we would be doing. I like that the article mentioned the limitations of the MMSE. I found that the same score could look different in five different people. Since the items are all weighted the same, the same scores do not reflect the same struggles. Some patients struggled with finding words to use, while others weren't oriented to the day but could perform well on other tasks. Would it be more useful to look at the items than the overall scores in mental status exams? Though it is a good screener tool to get a snapshot of your client, I would always follow up with additional assessments.

Interestingly, the authors recommended CT, MRI, and EEG scans. From my experience with this clientele, the finances/insurance would not allow for these scans in addition to comprehensive assessments. Though it would be nice to have, it is not reflective of the reality that clients can afford or have access to these procedures. In my small town, clients would have to drive two and a half hours to receive a scan. We have tools in assessment batteries that can provide functional considerations that scans cannot, such as the WCS, Stroop, and Trail Making as discussed in the paper.  How can clinicians provide comprehensive, thorough assessments to clients who do not have the same financial opportunities? The doctor I worked for created his own assessment that provided an overall mental status score along with a report of memory, executive functioning, mental flexibility, and overall functioning. Fun fact- he pitched it to the Dallas Cowboys to use as a sideline concussion assessment and was told by the trainers that the Cowboys would never buy it because they would not have any players left! So it sounds like the scales with terrible reliability and validity might have people using them after all! 

A lesser-known area in forensic/ correctional psychology is geriatric correctional services. We don't often think about 70-year-olds being sentenced to prison, but 30 and 40-year-olds are often sentenced to 30 to 40 years in prison.  I think mental status exams and mental health recovery can be useful in correctional settings just as they are outside of corrections. They provide clinicians with an initial understanding and can be helpful in monitoring inmates' psychological state throughout their incarceration. Are there times when screener tools like the MMSE are not useful?  I often ask how treatment or services look different for people who spend that long incarcerated. Ideally, these individuals would still receive services, but I don't know if that is often the case since much of the treatment is focused on reducing the risk to reoffend. If someone is not getting out of prison for 40 years, their risk decreases naturally or they may not make it that long. This is an area that could use additional research and resources. 

Grade: 19/20