FMH1 Assess, diagnose and formulate an individual's mental health disorder

Overview

This standard covers the identification of an individual’s mental health disorder and making recommendations about the most suitable treatment for a pathway to recovery. The process draws on the views and expertise of the multidisciplinary team and the individual using the Care Programme Approach. The findings may have legal implications, under the Mental Health Act (1983) and the Mental Health (Care and Treatment) (Scotland) Act 2003, or in relation to a psychiatric defence or fitness to plead. Assessments are carried out in a similar way for individuals referred not by the courts but by other health services. A formulation provides the basis for agreeing how to treat the problem. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. diagnostic systems
2. information gathering and recording
3. actuarial assessment
4. assessing an individual’s history of offending and offending behaviours
5. assessing concordance with treatment plans and compliance with procedural and physical boundaries
6. interview techniques
7. investigative methods & procedures
8. inquiry reports on forensic mental health settings, including recommendations and analysis of practice in the assessment of individuals
9. mental health disorders
10. working with individuals with complex needs and vulnerabilities
11. offending behaviour (eg arson)
12. substance misuse
13. personality disorders and psychopathy
14. developmental disorders
15. the range of treatments and the range of levels of security available at the establishment
16. working with individuals with a high media profile
17. evidence of the effectiveness of different treatments, singly and in combination
18. clinical risk assessment and the assessment risk of violence and re-offending
19. identifying benefits to individuals from different settings and treatments
20. how to balance therapeutic risk against public safety issues
21. organisational and contextual impacts on risk and its management
22. the requirements of current mental health legislation and other national and local regulations and standards
23. the legal rights of individuals and their families
24. the criminal justice system
25. the religious beliefs of different cultures
26. the effects of culture and religious beliefs on individual communication styles
27. the different features services must have to meet people’s gender, culture, language or other needs
28. effects of different cultures and religions on care management
29. the principle of confidentiality and what information may be given to whom
30. the functions and limitations of other agencies
31. how information obtained from individuals should be recorded and stored.

Performance Criteria

You must be able to do the following:

1. take into account data and information from all relevant sources including past reports and documentation, other professionals’ views and the individual and family/carer views
2. where possible, involve the individual in exploring events, thoughts and feelings that may relate to their condition and the pathway to recovery
3. question and observe the individual in sufficient depth to justify and support your evaluation of their mental disorder
4. identify sufficient characteristics and sustaining of symptoms to form a justifiable diagnosis or formulation of the problem
5. identify and evidence any connection between the individual’s mental disorder and offending behaviour where appropriate
6. identify the individual’s abilities and strengths that may contribute to their recovery (eg for managing violence, self harm, relapse)
7. use a recognised assessment and diagnostic system (eg DSM-IV, ICD-10) with validated psychometric measures where possible
8. provide and record for audit information, evidence and reasoning, about:
1. the nature and severity of the individual’s mental disorder
2. risks posed by the individual to themselves, specific persons and the public, using a recognised measure of risk (eg HCR-20)
3. the individual’s vulnerability to harm from others
4. the individual’s fitness to plead in criminal proceedings
5. a recommendation as to medical and psychological treatment, environment, support and the individual’s likely contribution to their recovery
6. a recommendation for the mix of relational, procedural and physical security needed
7. whether the individual is detainable under relevant mental health legislation
8. the influence of co-morbidities (eg substance misuse, personality or developmental disorders)
9. a contextualised formulation of the biological, psychological and social factors influencing the clinical presentation
9. help the individual, carers and family understand your analysis and recommendations.

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning