What the interview establishes #
A psychiatric interview explores the person's difficulties, their development over time, the effects on everyday life and the help the person wants. It also provides observations for the mental status examination. History describes events across time; the MSE describes the current encounter. Neither replaces physical assessment, records or carefully obtained collateral information. Begin with a working structure, then adapt its sequence to the person's priorities, distress and ability to participate.
- Identify the presenting concern and why help is sought now.
- Establish baseline functioning, chronology, associated symptoms and relevant exclusions.
- Explore health concerns, support, treatment experience and immediate needs.
- Finish with a shared summary, remaining uncertainties and next assessment steps.
Open the encounter #
Introduce your name and role, check the person's preferred form of address and explain the purpose of the meeting. Ask what language they prefer and whether hearing, vision, literacy or communication support is needed. Offer privacy for sensitive discussion. Explain confidentiality and its practical limits in understandable language; do not promise absolute secrecy. Establish who is present and whether the person wishes them to remain. An interpreter should support accurate communication rather than answer for the patient.
- What would you most like me to understand about what has been happening?
- What brought you here today, and what would make this meeting useful?
- Would you prefer to discuss any part of this on your own?
- If I misunderstand something, please correct me.
Move from narrative to precise questions #
Allow an initial account without repeatedly interrupting it. Then identify unclear experiences, missing chronology and contradictions. Use one question at a time. Start with ordinary language; technical terms are conclusions reached after clarification. A pause may allow thought or emotion, while excessive silence can feel abandoning. Summaries demonstrate understanding and allow correction. Explain a change of subject rather than abruptly introducing intimate questions.
| Style | Original prompt | Purpose or limitation |
|---|---|---|
| Open | Tell me about the first change you noticed. | Obtains the person's account. |
| Focused | When did that begin, and how often does it happen? | Clarifies timing and frequency. |
| Clarifying | What does 'my mind stopped' mean to you? | Prevents premature labels. |
| Leading | You were hearing voices, weren't you? | Invites agreement; rephrase neutrally. |
| Summary | Have I understood that sleep changed before work became difficult? | Checks sequence and shared understanding. |
Use collateral information carefully #
Ask how each informant knows the person, how frequently they meet and which events they witnessed. Separate direct observation from inference or information obtained from someone else. Seek permission for appropriate involvement and explain information-sharing boundaries. A family member may report night-time activity while knowing little about private thoughts; this limits a particular observation, not the value of the whole account. Record disagreement explicitly instead of choosing the most confident speaker.
- Patient reports three hours' sleep; partner reports pacing but cannot confirm total sleep.
- The account of last month is limited because the informant was away.
- Medication details require records; neither interviewee recalls the name.
Sensitive topics and difficult engagement #
Explain why you ask about substances, trauma, sexuality and thoughts of self-harm without implying that everyone has the same experience. Ask directly and calmly when relevant. Give choice over pace and avoid pressing for graphic trauma details unnecessary for the present assessment. Limited speech, refusal or irritability may reflect fear, pain, confusion, communication barriers or previous experiences of care. Explore these possibilities before describing someone as uncooperative.
Synthetic example: clarify rather than label #
A trainee hears, 'My neighbours keep talking about me.' Instead of immediately recording a delusion, they ask what was heard, where it occurred, whether anyone else heard it, how certain the person is and whether another explanation is possible. The person describes a real corridor disagreement and remains uncertain about its meaning. The history supports an interpersonal concern requiring further assessment; it does not by itself establish psychosis. The interviewer also explores effects on sleep, leaving home and relationships.
Close and document #
Summarize the main concerns and ask what has been missed. Distinguish the person's words, observed behaviour, collateral reports and interpretation. Record uncertainties and reasons for incomplete assessment. Explain next steps in an achievable sequence and check understanding. Avoid a diagnostic label that conceals missing history, and avoid reproducing every conversational detail when it adds no clinical meaning.