The medical assistant’s role regarding behavioral health

Medical assistants working in behavioral health facilities may perform administrative duties, such as scheduling appointments, working with patients’ health records, and handling telephone calls. Medical assistants may also perform clinical duties for the psychiatrist, which are described in the following sections.

Assisting with the examination

Prior to the patient seeing the provider, the medical assistant rooms the patient. The provider may require the medical assistant to obtain and document the patient’s vital signs, weight, and medical history. The medical assistant may need to prepare prescription refills for the provider to complete and sign.

Weighing patients

When treating patients who have been diagnosed with eating disorders, many times, the psychiatrist will want the patient to be weighed. When the medical assistant obtains the weight, it is important to have patients empty their pockets and remove shoes and extra clothing. This will help ensure the accuracy of the patient’s weight because the weight is an important sign in the treatment plan. Many healthcare facilities have patients with eating disorders get on the scale backward, so they cannot see their weight. They are not told what their weight is. If people gain weight, they may feel “fat,” and it may not be helpful for their treatment. Providers will share the weight with the patient if they feel it is appropriate for the patient’s treatment

The medical assistant’s role regarding behavioral health diagnostic procedures

Some behavioral health facilities may have the medical assistant help with specimen collection and testing (e.g., venipuncture, urine drug test). Most of the diagnostic testing is done by psychologists who perform psychological testing. The medical assistant should have a basic understanding of mental status testing and other psychological testing.

Mental status testing

Mental status testing (also called neurocognitive testing) assesses a person’s ability to think. Providers can identify cognitive impairments. The testing involves the provider asking the patient a series of questions. Common tests include the Mini-Mental State Examination (MMSE), Folstein test, and the Montreal Cognitive Assessment.

The provider assesses cognitive functioning by examining the following aspects:

• Short- and long-term memory: Questions relate to recent and past events. The person may be asked to remember something and, in 5 minutes, will need to recall what was remembered.
• Attention span and concentration: Can the person complete a thought and solve problems? The provider may ask the patient to count by fives or sevens.
• Orientation: Does the person know their name, age, and job? Does the person know the day, time, date, and season?
• Language and communication skills: Questions will examine the person’s ability to form clear ideas. The patient may be asked to read or write a sentence.
• Judgment and intelligence: The person is given a scenario and asked to solve it.

The provider’s general observations are formed by assessing the physical appearance, behavior, motor activity, mood, and affect. For the physical appearance, behavior, and motor activity, the provider checks the appropriateness of clothing, grooming, posture, facial expression, and eye contact. Does the stated age match the apparent physical appearance? Is the person friendly, withdrawn, shy, hostile, irritable, relaxed, or cooperative? For the mood and affect, the provider asks the patient to give information on their emotional state or mood. The provider observes the patient’s emotional state through body movements and facial expressions. The provider observes the person’s affect or external expression of emotion. The provider uses body language and facial features to detect expressions of emotion. The following are types of effects:

• Restricted or constricted affect: A small reduction in the intensity of the affect.
• Blunted affect: A severe reduction in the intensity of the affect; much less emotion is shown compared to the restricted affect.
• Flat affect: A lack of emotional expression in both the face and the body language.
• Labile affect: Rapidly changing emotions that are unrelated to external events.
• Inappropriate affect: The emotional expressions are incongruent with the situation or the person’s verbal message.

Psychological testing

Many psychological tests are used to help diagnose behavioral health diseases and disorders. Tests are available to examine the following:

• Intellectual functioning: There are a variety of tests available, including the Wechsler Adult Intelligence Scale (WAIS), which measures the verbal intelligent quotient (IQ), performance IQ, and full-scale IQ. It is used for people 16 years of age or older. Other versions of the Wechsler can be used for younger children.
• Academic achievement: General tests along with specific tests for math, oral and written language, and reading are available. The Boehm Test of Basic Concepts is an example of a test in this category. It tests a child’s understanding of basic positional concepts. Using pictures, the child must select the correct one when given cues such as “over,” “least,” and “left.”
• Psychological process: A variety of tests are available based on the person’s age. For instance, the Bender Visual Motor Gestalt Test is used to evaluate a person’s visual-motor maturity. It is used to screen for developmental delays and can be used to assess for neurologic issues and brain damage. This test is used for people 5 years or older.
• Adaptive behavior: These tests are used to evaluate a person’s learning difficulties, ADHD, or other impairments related to speech, language, hearing, and motor skills. This is an example.
• Personality and attitudes: A variety of tests are available:
• Draw-a-Person (DAP) Test: An analysis to measure nonverbal intelligence and screen for behavioral or emotional disorders in children.
• Minnesota Multiphasic Personality Inventory (MMPI): A widely used and researched personality assessment. It is used to diagnose behavioral health disorders, to screen for certain high-risk jobs, and as part of criminal defense and custody issues in legal cases.
• Thematic Apperception Test (TAT): A test in which patients are asked to make up stories about the pictures on cards they are shown. This may provide information about a patient’s thoughts, attitudes, and emotional responses.

The medical assistant’s role regarding behavioral health treatments

Medical assistants working in behavioral health must know the medication classifications typically used for conditions and the common types of psychotherapies used. The following sections discuss these treatments.

Medications

Patients with behavioral health diseases and disorders are prescribed a variety of medications. The following are some of the more common classifications of medications for behavioral health disorders:

• Antianxiety: Used to reduce anxiety, produce calmness, and release muscle tension
• Anticonvulsant and mood stabilizer: Used to treat mania and mixed episodes (mania and depression) with bipolar disorder
• Antidepressant: Used to treat depression, anxiety, and other behavioral health disorders
• Antipsychotic: Used to treat schizophrenia and bipolar disorder
• Sedative-hypnotic: Used to treat insomnia
• Stimulant: Used to treat ADHD

Medical assistants should be familiar with medications that are prescribed to patients.

Psychotherapy

Many behavioral health diseases and disorders are treated with psychotherapy. Psychotherapy is commonly referred to as “talk therapy.” It is a general term used for a variety of treatment techniques that help a person identify and change troubling behaviors, thoughts, or emotions. Behavioral health therapists are trained in several types of psychotherapy. Based on the person and the disorder being treated, the therapist may use one or more types of psychotherapy:

• Cognitive behavioral therapy (CBT): A scientifically proven treatment that produces changes in behavior by helping the person face fears, role-play situations, and learn problem-solving skills to cope with difficult issues. It is used for many behavioral health disorders, including depression, anxiety disorders, substance use disorders, and eating disorders.
• Dialectical behavioral therapy (DBT): This evidence-based CBT approach is used for individuals who are diagnosed with personality disorders, are suicidal, or engage in self-harm behaviors. DBT focuses on behavioral change, problem solving, and the regulation of emotions in a manner that is socially acceptable.

Patient coaching

In the behavioral health environment, the medical assistant has an important role in coaching patients on their medications. Patients should be aware of the following details:

• When and how to take the medication
• What to do if the medication is forgotten
• What side effects may occur
• When to contact the provider

Compliance can be an issue with medications in behavioral health. Patients who are experiencing issues may stop the medication. This may increase the signs and symptoms of the disorder. For some disorders, this can be a life-threatening complication. Sometimes hospitalization is required until medications can stabilize the situation.

Legal and ethical issues

Under the Health Insurance Portability and Accountability Act (HIPAA), psychotherapy notes are treated with higher levels of confidentiality than other health records. Psychotherapy notes need to be stored separately from the patient’s health record. They are not released with other health records and must be specifically indicated by the patient to be released.

If an electronic health record system is used, access to the psychotherapy notes must be limited to the behavioral health staff who require the notes for their job. Additional information from the visit is not held at a higher level of confidentiality and includes prescriptions, session times, types and frequency of treatments, and results of clinical tests.

Like HIPAA, many federal and state laws address the confidentiality of drug and substance abuse information. These laws require these patient health records to be held at a higher level of confidentiality.

Patient-centered care

In behavioral health, patient-centered care not only includes the patient but may also include the family. Behavioral health professionals need to develop a strong professional, therapeutic relationship with patients. This relationship provides the emotional support that helps patients feel accepted so that they are willing to share their concerns, thoughts, and feelings with behavioral health professionals.

Often, families play an important part in the management and treatment of behavioral health disorders. Some of these disorders may come from issues related to family relationships. Other times, the family needs to provide emotional support to assist the patient through treatment. Depending on the situation and the patient, family members may be brought into the therapy to ultimately help the patient through the situation or effectively manage the disorder.