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. For an assessment to be helpful, the young person needs to be engaged, so it is important to take some time to support them to feel comfortable and safe with you. You may need to provide the assessment over more than one appointment.

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. It intentionally starts with asking about less sensitive issues to assist with developing rapport with the young person and easing them into the assessment:

• Home
• Education and employment
• Activities
• Drugs and alcohol
• Sexuality
• 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. In any assessment, it is important to be strengths based, don’t forget to explore a young person’s strengths, supports and interests, and talk to them about periods in their life when things were going better. This is important in building rapport, delivering person-centred care, and building optimism from the outset.