Mental Health Assessment Skill

Conduct standardized mental health screenings, generate session notes, and provide crisis intervention guidance. Designed with safety-first principles and validated assessment instruments.

Overview

This skill enables clinical AI agents to:

• Administer validated screening instruments (PHQ-9, GAD-7, AUDIT, etc.)
• Assess suicide and self-harm risk with appropriate escalation
• Generate structured therapy session notes
• Provide crisis intervention guidance
• Document mental status examinations

Safety First

Critical Safety Requirements

Mental health assessments carry elevated risk. This skill enforces:

1. Mandatory Crisis Screening - All assessments include passive suicidal ideation screening
2. Immediate Escalation - Active suicidal ideation with plan triggers immediate human handoff
3. No Diagnostic Closure - AI never provides definitive psychiatric diagnoses
4. Scope Limitations - Complex presentations require clinician review

Crisis Indicators

ESCALATE IMMEDIATELY when patient expresses:

• Active suicidal ideation with plan or intent
• Homicidal ideation
• Self-harm in progress
• Severe psychotic symptoms
• Acute intoxication with safety concern

Validated Assessment Instruments

PHQ-9 (Patient Health Questionnaire-9)

Depression screening tool with 9 questions scored 0-3.

Scoring: | Score | Severity | Recommended Action | |-------|----------|-------------------| | 0-4 | Minimal | Monitor | | 5-9 | Mild | Watchful waiting, follow-up | | 10-14 | Moderate | Treatment plan recommended | | 15-19 | Moderately Severe | Active treatment indicated | | 20-27 | Severe | Immediate intervention, consider hospitalization |

Question 9 (Suicidal Ideation): Any positive response (>0) requires follow-up assessment.

GAD-7 (Generalized Anxiety Disorder-7)

Anxiety screening tool with 7 questions scored 0-3.

Scoring: | Score | Severity | Recommended Action | |-------|----------|-------------------| | 0-4 | Minimal | Monitor | | 5-9 | Mild | Consider intervention | | 10-14 | Moderate | Treatment indicated | | 15-21 | Severe | Active treatment, possible referral |

AUDIT (Alcohol Use Disorders Identification Test)

Alcohol use screening with 10 questions.

Scoring: | Score | Risk Level | Recommended Action | |-------|-----------|-------------------| | 0-7 | Low risk | Education | | 8-15 | Hazardous | Brief intervention | | 16-19 | Harmful | Brief intervention + monitoring | | 20-40 | Possible dependence | Referral for evaluation |

PHQ-2 (Quick Screen)

2-question depression screener for initial intake.

Scoring:

• Score ≥3: Administer full PHQ-9
• High sensitivity for major depression

Columbia Suicide Severity Rating Scale (C-SSRS) Screening

Brief suicide risk screening:

1. Wish to be Dead - "Have you wished you were dead or wished you could go to sleep and not wake up?"
2. Suicidal Thoughts - "Have you actually had any thoughts of killing yourself?"

If YES to either, proceed with full assessment and consider escalation.

Mental Status Examination

Document mental status using standard format:

Components

1. Appearance - Grooming, dress, hygiene, apparent age
2. Behavior - Psychomotor activity, eye contact, cooperation
3. Speech - Rate, rhythm, volume, tone
4. Mood - Patient's subjective emotional state
5. Affect - Observed emotional expression, congruence
6. Thought Process - Linear, tangential, circumstantial, loose
7. Thought Content - Suicidal/homicidal ideation, delusions, obsessions
8. Perception - Hallucinations (auditory, visual, tactile)
9. Cognition - Orientation, attention, memory
10. Insight - Understanding of condition
11. Judgment - Decision-making capacity

Example Mental Status Documentation

MENTAL STATUS EXAMINATION

Appearance: Well-groomed, age-appropriate dress, good hygiene
Behavior: Cooperative, fair eye contact, psychomotor retardation noted
Speech: Slow rate, low volume, monotone
Mood: "Depressed" (patient's words)
Affect: Flat, congruent with mood
Thought Process: Linear, goal-directed
Thought Content: Passive suicidal ideation without plan or intent,
                 denies homicidal ideation
Perception: Denies hallucinations
Cognition: Alert and oriented x4, attention fair
Insight: Fair - recognizes need for treatment
Judgment: Intact for basic decisions

Crisis Intervention Protocol

Risk Stratification

| Risk Level | Indicators | Response | |------------|-----------|----------| | LOW | Passive ideation, no plan, protective factors | Safety plan, outpatient care | | MODERATE | Suicidal thoughts, vague plan, some risk factors | Intensive outpatient, daily contact | | HIGH | Active ideation with plan, means access | Immediate escalation, possible hospitalization | | IMMINENT | Intent to act, preparing means | Emergency services, do not leave alone |

Safety Planning Steps

1. Warning Signs - Identify triggers and early warning signs
2. Coping Strategies - Internal coping mechanisms
3. Social Contacts - People who can provide distraction
4. Family/Friends - People who can help during crisis
5. Professionals - Clinicians and crisis lines
6. Means Restriction - Reduce access to lethal means
7. Reasons for Living - Personal motivations

Crisis Resources

Always provide appropriate crisis resources:

• National Suicide Prevention Lifeline (US): 988
• Crisis Text Line (US): Text HOME to 741741
• iCall (India): 9152987821
• Vandrevala Foundation (India): 1860-2662-345
• AASRA (India): 9820466726

Therapy Session Notes

Progress Note Template (SOAP Format)

THERAPY PROGRESS NOTE

Date: [Session Date]
Session #: [Number]
Duration: 50 minutes
Modality: [Individual/Group/Family]

SUBJECTIVE:
Patient reports [mood, symptoms, events since last session].
[Direct quotes when relevant]

OBJECTIVE:
- Appearance: [observations]
- Affect: [observations]
- PHQ-9: [score if administered]
- GAD-7: [score if administered]
- Safety: [suicide/homicide risk assessment]

ASSESSMENT:
[Clinical formulation, progress toward goals, treatment response]
Current diagnosis: [ICD-10 code and description]

PLAN:
1. [Therapeutic intervention focus for next session]
2. [Medication considerations if applicable]
3. [Between-session assignments]
4. [Follow-up schedule]

Next session: [Date and time]

Treatment Goal Documentation

Document therapy goals in SMART format:

Example Goals:

• Reduce PHQ-9 score from 16 to <10 within 8 weeks
• Utilize 3 coping skills when anxiety level reaches 6/10 by week 6
• Attend 90% of scheduled sessions over 12-week treatment course
• Reduce panic attack frequency from 4/week to <1/week by week 10

Usage Instructions

1. Initial Screening

• Start with PHQ-2 for depression screening
• If positive, administer full PHQ-9
• Include GAD-7 for anxiety assessment
• Screen for substance use with AUDIT if indicated

2. Safety Assessment

• Always assess for suicidal ideation
• Use C-SSRS screening questions
• Document protective and risk factors
• Create or update safety plan if indicated

3. Document Findings

• Complete mental status examination
• Score all administered instruments
• Document clinical impression
• Create treatment plan with SMART goals

4. Escalation Handling

• High-risk findings trigger immediate human review
• Provide crisis resources to patient
• Document escalation and handoff
• Follow up to confirm patient safety

Scope Limitations

This skill does NOT:

• Provide definitive psychiatric diagnoses
• Prescribe or adjust psychiatric medications
• Replace clinical judgment for complex cases
• Conduct forensic or disability evaluations
• Provide psychotherapy (facilitates documentation only)

All findings should be reviewed by qualified mental health professionals.

Integration with TherapyPod

This skill integrates with:

• Patient Triage - Routes mental health presentations appropriately
• Escalation Rules Engine - Triggers human handoff for safety concerns
• Medical Safety Engine - Crisis detection and alerting
• ClinEval Benchmark - Mental health domain validation

Compliance Considerations

Documentation Standards

• Follow state/jurisdiction requirements for mental health records
• Maintain confidentiality per HIPAA and applicable mental health privacy laws
• Document informed consent for treatment
• Note mandated reporting considerations (child abuse, elder abuse, Tarasoff duty)

Billing Documentation

• Include time-based documentation for psychotherapy CPT codes
• Document medical necessity for services
• Use appropriate ICD-10 codes for mental health conditions

References

• See references/assessment-instruments.md for complete instrument details
• See references/crisis-protocols.md for emergency procedures
• See references/documentation-standards.md for compliance requirements