Mental State Assessment Module

Teaching and Learning Guide

Table of contents

Page

Avatar basics2

Featured areas in the learning together project3

Students and facilitators FlindersIsland guide4

Reading preparation for Avatar scenarios on5

Further reading and resources8

Schizophrenia module11

Learning outcomes11

Psychosis scenario12

Anxiety module15

Learning outcomes15

Anxiety scenario17

Mood module20

Learning outcomes20

Depression scenario22

Student assessment activities26

Teaching and Learning Guide

Avatar basics

How to Speak

  1. Plug in your headsets and ensure they are operating correctly

(if not you may have a firewall preventing you from speaking – call 12345 – then select 2 in the menu) – you can be shadowed to remove the firewall).

  1. Press the “speak” button on your toolbar to activate voice/chat. (you don’t need to hold it down). If you press the arrow beside the speak button you can also see who is voice active around you.
  2. When speaking in second Life you should be able to see green sound waves emanating from above your avatar’s head. This means you are chat active.

How to Sit – versions 2.0

  1. Click on the object that you want to sit on– right click for menu – then select “sit here”

How to Stand

  1. Click on your avatar – right click and select stand

How to Fly

  1. Press the “move” button – (in the centre bottom toolbar) - select the “fly” icon (little superman flying image). To stop flying, press “stop” button that appears above your bottom toolbar.

How to Teleport

  1. There are teleport stations located throughout FlindersIsland. Simply touch the teleport station (use your mouse to click on the object) and your avatars arm will reach out and touch the teleport.
  2. From there, select from the menu that appears e.g. “Auditorium” and your avatar will be transported to your allocated area.

Inventory

Details about your avatar and the project can be found in your inventory.Access inventory by pressing the “suitcase” icon located on the right hand side toolbar. Depending on the scenario, if you are playing “Paramedic Sam Piers” you can change the sex of your avatar using the inventory menu.

Featured areas in the learning together project

Meeting Point

The meeting point is a centralised area on FlindersIsland that incorporates landmarks and tools to assist your avatar to negotiate and navigate its surroundings. Surrounded by three footbridges, within this area there are 3 distinct objects that can help you.

Although inactive, the Flinders sign is of note. It lets you know that you are on FlindersUniversity property and subject to its regulations and standards. If in doubt where to meet in Second Life – this is a great spot with convenient access to all areas.

The Information Post (labelled with an “I”) is also located in the meeting point area within a large rotunda. There you can touch the screen to view information about the Island.

Mental Health Teaching Space – (Home of Elaine Tachor and Jarod Mearcus)

The Mental Health Teaching Space is located 180 degrees opposite the Meeting Point area. You can elect to walk or fly to this specially designed suburb. The area is land marked by a Mental Health Teaching Space sign (clickable for resources) at the access point to the suburb. The house is occupied by Elaine Tachor (mother) and Jarod Mearcus (patient). An ambulance is also stationed in the driveway ready for any medical emergency.

Internally the house is wired to reflect Jared’s mental state complete with roaming paranoia cameras, shabbily maintained room, mirrors that reflect his paranoia and sound scaping befitting a man experiencing disturbed thoughts and feelings This area is where the psychosis mental health scenarios take place.

Auditorium

The Auditorium can be accessed by clicking on the blue teleport station beside the rotunda. Once teleported, your avatar will find itself on a grassy amphitheatre where students can sit and listen to mental health information delivered from the podium beside a large display screen. PowerPoint slide shows, lecture materials and other e-deliverables can be plugged in and played.

Hospital

The hospital ward is accessed either by flying, walking or teleporting. The bay is equipped with medical facilities where avatars can sit, stand and reveal a range of scripted symptoms for medical practitioners to assess. This is where the anxiety scenario takes place.

Community Health Centre

The Community Health Centre is another building in the suite of learning centres located on FlindersIsland. It is a neutral space can be used for consultations and other learning practices. This is where the depression scenario takes place.

Teleport Stations

There are two major teleport stations located on FlindersIsland to access the hospital and auditorium. One teleport station is located at the meeting point (next to the rotunda) to access the auditorium and the other is situated at the Community Health Centre by which the hospital can be accessed.

Clickable Objects and Information Posts.

The following objects can be clicked to retrieve information:

  1. Mental Health Teaching Space (located at the Mental Health teaching Space) – touch this sign to access note cards.
  2. Mental State Assessment (located with the other information boards in the research area) – touch this sign to access mental health resources.
  3. Information sign (located in the rotunda) – click this for “welcome and information”.

Students and facilitators FlindersIsland guide

Read the materials supplied regarding orientation and practice in the virtual reality medium Second Life. Second Life is the platform that we use for teaching in virtual reality. Only students and staff are allowed access to FlindersIsland teaching areas. The general public on Second Life do not have access.

You will be given the time and activity/activities that you are expected to complete by your tutor/facilitator, so pay attention to this. It is important that you do pre-readings to familiarise yourself with the specific phenomena we are exploring each week.

We have a number of learning areas, like virtual teaching spaces that we can use on FlindersIsland. You will see in your learning materials that we have developed three modules on symptoms associated with anxiety, psychosis/schizophrenia and depression. Each of these takes place in a different virtual teaching space and you will be guided there by your facilitator, flying, running or teleporting around the various areas on the island! Please refer to your FlindersIsland map so that you can orient yourself to the island.

Before and after each of the three role play sessions, that will occur on three consecutive weeks, you will go to the auditorium on the island where the facilitator will brief and debrief you in a small group. You will then have activities to complete and submit as part of the assessments for that topic. Please remember that the role plays are being undertaken in real time with real students in the specially designed avatars. The idea is to provide you with an opportunity to be immersed in a clinical situation, where you can experience what it is like to be in a clinical setting (or patient’s home), before you encounter a real situation. In these role plays you can make mistakes (you are students and making mistakes is part of leaning) and try out and develop new skills apply knowledge, decide on interventions, apply tests and undertake mental state assessments in a safe environment.

The role plays will involve each of the students being assigned a role to play nurse, paramedic, observer, parent or patient. Specific instructions are given for each role so please read these carefully! The facilitator will be present in the area in which you undertake the role play and will provide guidance and advice as the activity is completed. It is anticipated that each role play will take about twenty minutes and be part of a two tutorial session. In each of the three weeks covering mental state assessment, you will have an opportunity to play each of the roles and experience what it is like to be anxious and experience disturbed thoughts and visions and hear voices (through special effects that we can recreate in this virtual reality). This can all take place in a supportive learning environment.

Other learning activities

On FlindersIsland it is possible to have highly structured learning activities with the presence of a facilitator AND unstructured activities where the student is assigned a series of activities that they work through in their own time. For example students and staff can:

  • Undertake fully interactive tutorials using powerpoints and video and audio podcasts in real time, so is great for external students and students who cannot get to class during the day or at all.
  • Be guided to many ‘found objects’ that you can touch such as the learning resources area that can take you to other mental health interactive resources, government and non-government websites, You Tube clips and interactive online libraries.

Each of our learning areas is set up so that it is multipurpose and can be used in multidisciplinary format, thus maximising the potential for its use!

Reading preparation for Avatar scenarios on

  1. Anxiety
  2. Depression
  3. Psychosis

Read these text readings and make notes

Barling. J 2009, chapter 11 ‘Assessment & diagnosis’, in R Elder, K Evans & D Nizette (eds), Psychiatric and mental health nursing, 2nd edn. Elsevier Australia, Chatswood, pp. 174-199.

Muir-Cochrane, E., Barkway, P., Nizette D (2010) Mobsy’s Pocket Book of Mental Health Elsevier, NSW

Read this section

There are numerous forms of assessment that can be used in mental health, with the mental health history and the mental state examination (MSE) being the most common starting points of assessment. Though you may never need to undertake either of these in their entirety, it is a good idea to have a basic understanding of what they are and what is covered within them as this may assist you to provide accurate information if a referral to a mental health service is required.

The reason these assessments are undertaken is primarily to provide a baseline of behaviours and presentation to help with diagnosis. This can help the worker to understand the factors that influence the symptoms or problems and help in developing individualised treatment/management plans. Such assessments can also be used as tools for mapping change and assisting with the transfer of information between staff. And they can help to rule out physical illness. For instance, because of the nature of some mental health problems, individuals may present with symptoms that at first appear to be psychiatric in origin but may end up being something entirely different, such as an organic or metabolic disturbance. You must remember that physical illness and mental health disorders commonly coexist and that some medications can cause side effects that imitate psychiatric symptoms!

When assessing someone for a mental health problem for the first time, we need to find out several things, such as:

  • Is there any immediate risk to the individual or another person?
  • Is it a mental health problem, a physical problem or both?
  • If the individual has a mental health problem, what are its specifics?
  • How are we best going to treat the person?
  • Can we provide treatment using the available health care workers or do we need to refer this person to other services?
  • Are there any coexisting social or health problems that need urgent attention first before we provide the mental health treatment (for example, lack of housing, suitable clothing, finances or social support)?
  • What effect will the treatment have for this individual’s health status?

You are more than likely familiar with the general assessment interview, including checking the person’s vital signs, taking the person’s history and a physical examination.

The mental health assessment covers the same areas but with much more focus on the mental health problem and its history. Unlike the general history-taking, the mental health history concentrates on the individual’s pre-morbid personality to help form a picture of what the person was like before developing a mental health problem. This is sometimes referred to as a mental health or case history.

Complete this activity

Below is a list of some of the most common assessment tools used. Before your tutorial session, find out as much information as you can about two of these tools and in which context they may be used.

Beck depression inventory (BDI) is a self- administered 21-item self-report scale measuring supposed manifestations of depression.

HoNOS, the health of the nation outcome scales instrument, designed in Britain, is a brief, easily administered tool to gather information on mental health and social functioning.

Kessler psychological distress scale (K-10) is widely recommended as a simple measure of psychological distress and as a measure of outcomes following treatment for common mental health disorders.

Depression anxiety stress scale (DASS) is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress.

Life skills profile (LSP) is a measure of those aspects of functioning (‘life skills’) that affect how successfully people with schizophrenia live in the community or hospital. Because many of the skills are relevant in other major psychiatric disorders and in some organic conditions the LSP can also be applied to a broad range of other diagnoses. Mental health inventory

(MHI-5) is a five-item scale that is used for measuring wellbeing and psychological distress.

The mental health history is the subjective portion of the assessment, based on the client’s experiences and their memory of them. This is often seen as a subjective element of assessment because as one would expect the client is going to be biased in their understanding, experience, intellect and personality. In contrast, the MSE is objective and is based on the current state of the client rather than what has happened previously. It includes observing the client’s behaviour and describing it in an objective non-judgmental manner and, like a medical examination, it seeks to reveal signs of illness.

The mental state examination (MSE) is undertaken to obtain information about specific aspects of the individual’s experience and behaviour concerning their mental health at the time of the interview/assessment. In the general setting it would be similar to a general nurse doing a blood pressure evaluation. An individual’s mental state, like blood pressure, can vary significantly over time and in different settings.

Some components of the MSE may be completed purely through observation; for example, from their dress or facial expressions, whereas other components require direct questioning or specific testing.

An MSE usually involves several headings to guide you in making observations and asking questions. The following lists of physical, emotional and cognitive characteristics demonstrate areas that are likely to be covered in an MSE.

Mini mental state examination (MMSE) is a brief instrument/assessment tool consisting of eleven questions intended to evaluate an adult patient’s level of cognitive functioning. It was introduced in 1975 and designed for use to evaluate older adults for delirium or dementia (Folstein, Folstein & McHugh 1975).

The MMSE concentrates on the cognitive aspects of mental functioning, excluding questions about the client’s mood or abnormal experiences. It evaluates six areas of cognitive function: orientation, attention, immediate recall, short-term recall, language, and the ability to follow simple verbal and written commands.

The MMSE has gained popularity with clinicians and researchers as it can be completed fairly quickly, has ease of administration and scoring, and when used repeatedly is able to measure changes in cognitive status.

The examination is divided into two parts. The first part tests the patient’s orientation, memory and attention and requires verbal responses to the examiner’s questions. These questions often include the client being asked to repeat a short phrase after the examiner; to count backwards from 100 by sevens; to name the current prime minister and similar brief items. The client is scored for each answer.

In the second part of the examination, the client is asked to follow verbal and written instructions, such as writing a sentence spontaneously, copying a complex geometric figure and explaining the meaning of a simple proverb such as ‘people who live in glass houses shouldn’t throw stones’.

The maximum total score on the MMSE is 30. As a rule, scores of 20 or lower can indicate some problem with cognitive functioning that requires further assessment.

As with all assessment tools you must also recognise the limitations of the MMSE. The MMSE is not able to diagnose changes in cognitive function and should not replace a complete clinical assessment of mental status. In addition, the instrument relies heavily on verbal responses and reading and writing. Therefore, hearing and visually impaired clients and individuals with low English literacy or communication disorders may perform poorly even when cognitively intact.