The art and science behind effective mental health assessment

Mental health conditions often have overlapping symptoms, which can make it tricky to diagnose people based on a simple conversation. So counselors use mental health assessments to gather relevant information, sort through all the possibilities, and recommend treatments.¹

What is a mental health assessment, and why would someone need one? This article breaks down what these exams involve and why they're part of every counselor's toolkit.

What is a mental health assessment? 

Clinicians use mental health assessments to diagnose patients and offer appropriate support. These exams typically focus on:

• Physical appearance
• Behavior 
• Cognition, including memory and alertness 
• Mood 
• Speech (language, amount spoken, volume) 
• Thought process¹ 

For example, a clinician might notice a female teenage client appearing very thin and speaking about purging in the school bathroom during her assessment. She also gets agitated when the counselor asks about her eating habits. Based on these signs, the clinician may conclude that she's probably experiencing an eating disorder, even if the patient denies it.²

Without a thorough exam, clinicians might miss critical symptoms or even completely misdiagnose someone.

Plus, these assessments can reduce stigma, especially for schoolchildren and other vulnerable groups.³ They turn mental health exams from frightening ordeals into routine check-ups. This helps patients feel less singled out or "crazy," which can encourage them to stick with a treatment plan.

Breaking down the assessment process 

Physical exams are fairly routine: take a blood sample, listen to the heart, and so on. In contrast, mental health intake assessments can be more adaptable, depending on the clinical mental health counselor's experience and the patient's needs.¹

These assessments typically start with an interview to help the counselor and patient get acquainted. Throughout the discussion, the practitioner will ask questions to learn more about the client's mental state. They'll also observe the client for nonverbal signals and clues.¹ For example, someone might insist they feel happy, but their teary eyes and shaky hands tell a different story.

In some circumstances, these evaluations may include different types of testing to make them more accessible. For example, a clinician may use questionnaires for people with hearing impairments or patients who struggle to talk about their concerns out loud. If they suspect that there's a physical issue at play, the counselor may refer the patient for a neurological exam.⁴ Court-ordered assessments could focus on certain charges or situations too.

Examples of mental health assessments in practice 

Assessments for mental health are more of an art form than an exact formula. Counselors need to know when to ask more questions and how to read between the lines. If a patient mentions that they haven't got much sleep, for instance, the practitioner may need to probe deeper to understand why.

Mental health assessments typically begin with structured interviews. Clinicians will work through a list of standard questions, such as:

• How are you feeling today? 
• How would you describe your relationship with your family? 
• How is your job going? 
• Can you tell me about the symptoms you're experiencing? Are they new, or have you had them before? 
• Do you drink alcohol? How often? 
• Do you feel safe at home? 
• Do you ever hear voices or see things that aren't there? 
• What do you want to accomplish this year?⁵ 

This may look like an interrogation or quiz, but it should be more of a friendly conversation. The counselor can use the answers to get a sense of the patient's mental state and make a diagnosis.
The counselor should also give the client time to ask questions and mull over treatment options. That way, the patient feels empowered to participate in their own care.⁵

Other mental health assessments include self-report questionnaires and behavioral observations.¹ These methods can help clinicians gather information that patients may not feel comfortable sharing directly.

For example, someone who's thinking about self harm may prefer to write down their response instead of voicing it. Or the counselor may notice that they subconsciously tug down their sleeves and make conclusions based on that cue along with other observations.

How long does a mental health assessment take? 

A basic diagnostic assessment for mental health may take as little as 30 to 60 minutes, especially if the counselor can pinpoint the cause quickly.

Full psychological evaluations usually last two to four hours and might take place over one or two days.

For neuropsychological testing, patients may need to return for multiple sessions, totaling 6 to 10 hours.⁶

However, many factors can lengthen or shorten the process, including:

• The counselor's experience level 
• The patient's willingness to cooperate
• Whether the evaluation has been court-ordered⁶ 
• The need for specialty testing

The role of empathy and connection 

A mental health assessment can be stressful, even for people who actively seek help. Patients may feel worried that the counselor is judging them or that they'll give the "wrong" answer. Or they might be embarrassed about needing counseling in the first place.

Strong communication and rapport-building skills can help counselors break through this initial awkwardness and form genuine connections.⁷ When patients feel a bond with their providers, they are more likely to answer questions truthfully, which can lead to more accurate diagnoses.

Cultural competence and sensitivity matter too. People from marginalized communities may feel more vulnerable or stigmatized during mental health assessments. They may also be coping with past traumas from experiences with other healthcare providers. Approaching all patients with empathy and curiosity will help counselors provide the best support.¹

Learn the art and science of mental health evaluation at OCU 

A mental health assessment isn't just another box to check; it's the foundation for productive counselor-patient relationships and effective treatment plans. After all, a counselor can't help someone unless they understand the person's symptoms and concerns.

Gain the skills you need to assess and treat patients with Oklahoma City University's online Master of Education in Clinical Mental Health Counseling. The curriculum covers essential topics like assessment, behavior pathology, and evidence-based counseling theories.

You'll also practice applying your new knowledge during practicums and supervised clinical work and will prepare for state licensure so you can start treating patients as soon as possible.

Check out the admissions requirements, or schedule an appointment with an admissions outreach advisor to learn more about how OCU can support your counseling career.