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Mental Health Assessment Template
Title: Mental Health Assessment
Introduction:
Begin by explaining the purpose of the mental health assessment and establishing a safe and confidential environment for the individual.
Personal Information:
Full Name:
Date of Birth:
Gender:
Contact Information:
Phone:
Email:
Address:
Background Information:
Briefly inquire about the individual's personal background, including family, education, and occupation.
Presenting Concerns:
Ask the individual to describe their current mental health concerns, symptoms, or challenges they are facing.
Medical History:
Inquire about any relevant medical conditions, medications, or past treatments related to mental health.
Mental Health History:
Explore the individual's past experiences with mental health, including any previous diagnoses, therapies, or hospitalizations.
Support System:
Assess the individual's support system, including relationships with family, friends, and significant others.
Substance Use:
Ask about the individual's history of substance use or any current substance use patterns.
Daily Functioning:
Inquire about the individual's ability to carry out daily activities, such as work, self-care, and maintaining relationships.
Symptom Assessment:
Utilize established scales or questionnaires to assess the severity of specific symptoms, such as anxiety, depression, or sleep disturbances.
Coping Strategies:
Discuss the individual's current coping mechanisms and strategies for managing stress or emotional difficulties.
Risk Assessment:
Evaluate the individual's risk of self-harm or harm to others and their current safety measures in place.
Goals:
Collaboratively establish goals for the assessment process and treatment, considering the individual's desires and expectations.
Summary and Recommendations:
Summarize the assessment findings and provide initial recommendations for treatment or further evaluations if necessary.
Confidentiality and Consent:
Reiterate the importance of confidentiality and obtain the individual's consent for sharing information with appropriate healthcare providers if needed.
Follow-Up:
Schedule a follow-up appointment or refer the individual to appropriate mental health professionals for further evaluation or treatment.
Note: This template serves as a general outline for a mental health assessment. It is important to tailor the questions and sections to the specific needs and requirements of the assessment process. Additionally, maintaining a supportive and non-judgmental approach throughout the assessment is crucial for building trust and ensuring an accurate evaluation.
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