Mental Health and Mental Illnesses

Tell me about your mental health.

This question broadly focuses on health and invites a dialogue. The statement should not be asked in isolation or as a one-off question, as societally and culturally there are different meanings of what constitutes mental health and a client may not identify themselves as having mental health issues. If a client responds “Good,” consider probing a bit further with “Tell me about how so,” or “What do you mean by good?” which allows them to respond in more depth.

Tell me about the stress in your life.

Stress, by and large, is a relatable term that many clients have experienced and that is something they are likely more comfortable talking about than more difficult health issues because it is so ubiquitous. It’s important to be attentive to the client’s language and consider terms they may use, such as “extreme stress,” “severe stress,” “unmanaged stressed,” or “debilitating stress,” as these may indicate an underlying mental health issue or stress that requires intervention.

How does stress affect you?

Understanding how stress affects the client provides insight into the mental, physical, and social impact on them. You may need to probe about how stress affects the client physically, mentally, and socially.

How do you cope with this stress? (may include positive or negative coping strategies.)

This question invites discussion about coping strategies. It is important to be attentive to any self-harm coping strategies such as substance abuse, isolation/disengagement, food restriction, purging, cutting, compulsions, and phobias as these could indicate a mental health issue. Additionally, you want to use a strength-based approach to your assessment and facilitate the client’s capacity to identify and use positive coping strategies.

Have you experienced a loss in your life or a death that is meaningful to you?

Inviting discussions about loss and grief could be helpful for clients who have not had an outlet to speak openly about their emotions and the impact. Allowing for loss and grief to be talked about and understanding to what degree grief is affecting health is an important aspect of a mental health assessment.

Have you had a recent breakup or divorce?

Estrangement, emancipation, disruption, or severance of a relationship are not necessarily an indication of a mental illness. However, a pattern in relational disruption may indicate underlying issues such as, but not limited to, ineffective relationship skills, poor coping, or low self-esteem. Assess further if the client reports a breakup or divorce.

Have you recently lost your job or been off work?

Many clients define themselves through their work, and job loss can be disruptive to everyday life. Understanding the meaning of loss of employment is an important dimension of mental health.

Have you recently had any legal issues?

Asking about legal issues should be purposeful, not invasive. For example, a pattern of driving under the influence or possession of illicit drugs could indicate an underlying addiction. Use your clinical judgment when asking questions about legal issues, and be sure to convey an unconditionally accepting way of being with the client.

Have you purchased any weapons?

The purchase of weapons by itself is not an indication of mental illness. In Canada, some people enjoy hunting and other recreational activities that involve weapons. However, the purchase of weapons in response to threats to personal safety or to feelings of self-harm could indicate an underlying mental illness.