An MSE records the present moment, not the history. Write what you saw and heard, with examples, rather than conclusions. Print with your browser's Print command; the site's menus are left off the paper.

Mental state examination

Trainee: ____________________ Placement: ____________________ Date: ____________

Appearance and behaviour

Dress, grooming, apparent age
Eye contact, posture, movements
Rapport and cooperation

Speech

Rate, volume, tone and quantity
Spontaneous or only in reply

Mood and affect

Mood in the client's words
Affect as observed: range, reactivity, fit with content

Thought form

Flow and organisation
Examples of anything unusual, in quotes

Thought content

Preoccupations, worries, obsessions
Beliefs held with unusual conviction
Thoughts of harm to self or others

Perception

Hallucinations: which sense, when, what they say or show
Other perceptual changes

Cognition

Orientation to time, place and person
Attention and concentration
Memory (immediate, recent, remote)
Tests used, if any, and scores

Insight and judgement

How the client understands what is happening
Their view of help and treatment

Risk observed today

What was asked, what was said, what was done

Examined by: ______________________________ Date: ______________

Supervisor: ______________________________ Date: ______________

Template from PsychologyOrbit (https://psychologyorbit.com/templates/mental-state-examination). Free to print and adapt. No client names, phone numbers, CNIC or hospital numbers, or dates of birth.