Module guide · Clinical

Psychiatry

Mental health care recorded the way it is practised: an assessment with a mental state examination and a risk formulation, a course of therapy, medication that has to be monitored, and scores that show whether any of it is working.

Overview Dashboard Assessments Risk & safety plan Therapy sessions Medication monitoring Rating scales Patient record Analytics & export Good practices

What this module is for

Assessment, therapy, medication and outcomes for one service, with the queues that stop a patient quietly dropping out of it.

Who uses it

Psychiatrists, psychologists, psychotherapists and mental health nurses, plus administrators and directors for the analytics.

Where to find it

Open Mental health from the sidebar. Seven screens: a dashboard, Assessments, Therapy sessions, Today's diary, Medication monitoring, Rating scales and a per-patient record, plus Analytics and Import & export.

1
Assess
Patient, date, contact type and clinician open a draft assessment; the mental state examination and risk block are filled in on the record page.
2
Rate the risk and write the safety plan
Rate each domain deliberately, and write the plan the out-of-hours team will read.
3
Treat
Book therapy sessions, and open one medication review per drug the patient is on.
4
Measure
Score a standardised instrument at baseline and again during the course.
5
Watch the queues
High risk with no contact, monitoring overdue, depot due and did-not-attend all surface on the dashboard.

A few terms you'll see throughout

The MSE (mental state examination) is the structured description of how a patient presented. A depot is a long-acting injectable antipsychotic. A safety plan is what the patient and the service agreed to do if things get worse.

Dashboard

The service at a glance, and the four lists it should never let grow.

Queues

Field	What it means
High risk, no recent contact	The gap allowed depends on the level: a day at imminent, a week at high, four weeks at moderate.
Monitoring overdue	Lithium levels and clozapine counts get missed because the date lives in somebody's memory.
Depot due	A depot that slips by three weeks is a relapse waiting to happen.
Did not attend	In mental health a missed appointment is a clinical event, not an absence of one.
No safety plan	Assessments rated high or imminent with nothing written. The one number a service should want at zero.
Detained patients	Patients who are not here by choice.
Drafts	Assessments opened and never finalised.

Unrated is never shown as no risk

An unrated risk domain means nobody asked. The dashboard, the record and the analytics all keep that apart from a domain that was asked about and found to be low — they are different facts and the difference matters.

Assessments

Every psychiatric assessment on file, searchable and filterable.

Only the patient, date, contact type and clinician are needed to start. The assessment opens as a draft and the substance of it — the mental state examination, the risk block, the formulation — is entered on the record page.

The mental state examination

Field	What it means
Ten headings	Recorded under the ten standard headings, in the order the examination is taught: appearance and behaviour, speech, mood, affect, thought form, thought content, perception, cognition, insight and judgement.
Formulation	The clinician's account of what is going on and why.
Amendment	A finalised assessment can be amended; the reason is kept with the record.

Risk and the safety plan

A domain-by-domain rating, and the plan somebody will read at two in the morning.

Each risk domain is rated separately, and leaving one unrated is a legitimate and meaningful entry: it says nobody asked. The safety plan is written for the out-of-hours team, and the dashboard counts assessments rated high or imminent that have none.

Not assessed — nobody asked — never read as an absence of risk

Low — asked about and found low

Moderate — contact expected within four weeks

High — contact expected within a week; safety plan required

Imminent — contact expected within a day; safety plan required

Therapy sessions and the diary

Booked, attended, missed — and one day at a time in clock order.

A session needs a therapist, a time and a modality. Today's diary shows one day's sessions in clock order; a session flagged as escalated had something that went to somebody else the same day.

A session nobody attended is not billable

Closing a session as not attended stops it being billable, whatever the booking said. That is deliberate: the booking is an intention and the closure is the fact.

Medication monitoring

Is it working, is it being taken, and is it safe.

One review per drug

Field	What it means
Effectiveness	Whether the drug is doing what it was started for.
Adherence	Including Unknown, which is a real answer — a review recording good adherence when nobody asked is worse than one that admits it does not know.
Side effects and movement disorder screening	Tardive dyskinesia is the side effect a patient will not report and a clinician will not see unless they set out to look.
Next monitoring date	Left blank, a date is supplied for the drug classes that carry one, so the patient appears on a list at all.

One row per drug, because a patient on three drugs has three monitoring schedules and three decisions.

Rating scales

The only rows in the module that support a trend line.

The instrument decides the score range and which direction counts as better; the screen states both when you record a result. The first score on an instrument becomes the baseline, and a later one can be marked as a new baseline when a course restarts.

Change is signed so that positive always means better

Some instruments run high-is-worse and some the other way. The recorded change is normalised, so a positive number always means the patient improved — no reader has to remember which way a given scale points.

Patient record

One patient, the whole course.

Search by name or medical record number to open a patient's record: their assessments, therapy sessions, medication reviews and scale results together, with the trends across them.

Analytics, import and export

What the service did, and how well it did it.

What is measured

Field	What it means
Cancellation rate	Over every session that was on the books.
Safety plan completion	Of the assessments rated high or imminent.
Scale improvement	Of the patients scored twice or more on the same instrument.
Average session duration	Attended sessions only.
Risk distribution	Assessments where risk was never rated appear as not assessed, not as none.
Unassessed domains	A completeness measure rather than an activity one, counted per domain.

Rating scale results can be imported in bulk. Exports come as CSV, Excel or PDF; the PDF is the document you sign and file and stops at 500 rows.

What the exports deliberately leave out

The list exports carry numbers, dates and categories. They do not carry the mental state examination, the formulation or the session notes — a spreadsheet is a file that gets emailed.

Good practices

Leave a risk domain unrated when nobody asked

It is tempting to rate everything low to clear the form. That records an assessment nobody made, and the analytics will later count it as evidence of a safe caseload.

Write the safety plan for the person who has never met the patient

It is read out of hours, by somebody with no context and no time. Names, numbers and concrete steps beat a paragraph of formulation.

Record a missed session as missed

Deleting a did-not-attend tidies the diary and erases a clinical signal. The dashboard queue exists precisely because those are the patients most worth chasing.

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