In addition to discussing confidentiality and its limits, it is helpful to normalise the process of a mental health assessment and explain the process. This may include seeking permission to ask questions, and letting young people know that they don’t have to answer questions.
A mental health assessment takes time, and it may be appropriate to encourage young people to book a longer appointment (once safety is established), in order to complete the assessment.
It is important to spend some time alone with young people who present with family or friends after explaining the limits of confidentiality.
The HEADSS approach provides a valuable framework to obtaining a psychosocial assessment with young people:
- Education and employment
- Drugs and alcohol
- Suicide Risk/depression
The headspace psychosocial assessment is an adaptation of the HEADSS to suit the Australian context, with an extension to 10 domains as well as a subsection on strengths, difficulties, and goals. It involves screening and probing questions as required. The assessment has been positively evaluated (RACGP article on headspace assessment tool).
See the buttons in this toolkit on specific disorders (anxiety, depression, borderline personality disorder and psychosis) for further information about assessing these disorders.
A formulation framework can also assist in understanding the broader context for the young person. These can be summarised by the following factors:
Presenting problem(s): Initial signs, symptoms or other difficulties that are clinically important for the young person. (e.g. low mood)
Predisposing factors: Aspects of the young person’s background that make him/her susceptible to presenting with the given problems (e.g. history of mental illness in family)
Precipitating factors: Immediate issues or events that have caused the young person to present with or experience these problems or symptoms at this time (e.g. recent life experiences/stressors, bullying etc.)
Perpetuating factors: Factors that cause the young person’s symptoms/problems to continue or to progressively get worse (e.g. conflict in home, low social support, poor coping strategies)
Protective factors: Factors that help to improve the young person’s situation or symptoms (e.g. supportive relationships, friendships and strengths)