Psychiatric assessment: A word to the WISE
Most clinicians can easily identify the biological and psychological aspects of mental illness, but the social components often are overlooked.1 These include a negative life event, familial or interpersonal stressor, environmental difficulty or deficiency, or inadequate social support.2
We have found that these significant psychosocial factors listed in DSM-IV-TR2 can be easily assessed using the mnemonic, “Family and friends with a WISE HALO.”
Family and friends. Stressful events include family disruption by divorce or separation; illness or death of family members; neglect; emotional, physical or sexual abuse; remarriage of a parent; or birth or adoption of a new sibling.
Work. Stressors associated with work include actual or perceived job loss, difficult working conditions, irregular schedules, difficulty getting along with superiors or coworkers, and job dissatisfaction.
Income. Poverty and inadequate finances can influence the patient’s mental health.
Social environment. Problems with living alone, poor support, difficulty with acculturation, and discrimination are some possible difficulties.
Education. Learning problems, conflicts with teachers and classmates, bullying, and illiteracy could harm your patient’s mental health.
Housing. Stressors include homelessness, unsafe neighborhoods, and problems with a landlord.
Access to health care services. Inadequate access to health care, lack of medical insurance, and absence of transportation can influence your patient’s care.
Legal. Arrest, incarceration, ongoing lawsuits, and being the perpetrator or victim of a crime are included here.
Others. This catchall category includes exposure to disasters or wars and unavailability of social services.
After identifying the psychosocial issues affecting your patient, assimilate this information into a biopsychosocial formulation and treatment plan. Interventions could include referrals for individual and family therapy, bereavement and support groups, recreational therapy, or to subsidized housing programs or job training.
1. Campbell WH, Rohrbaugh RM. The biopsychosocial formulation manual. A guide for mental health professionals. New York: Routledge; 2006:63-70.
2. Diagnostic and statistical manual of mental disorders, 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.
Dr. Madaan is a fellow in child and adolescent psychiatry at Creighton University, Omaha, NE.
Dr. Kohli is a practicing family physician in Amherst, VA.
Dr. Khurana is a clinical observer and visiting researcher at Children’s Hospital, Omaha, NE.