Mental State Exam (MSE) Template: Free + 3 Real Examples

What is the MSE?

The mental state exam (MSE) is a structured, clinician-administered assessment of a patient's mental functioning at the time of the encounter. It is the psychiatric equivalent of the physical exam — a snapshot of objective findings used to support diagnosis, document risk, and track change over time.

Unlike rating scales (PHQ-9, GAD-7, MoCA), the MSE is a narrative description grounded in direct observation. It is required for initial psychiatric evaluations, expected on most progress notes, and should be at minimum abbreviated whenever a non-psychiatric clinician documents a mental health concern.

The 9 domains, with descriptors

Domain	What to capture	Descriptors
Appearance	Grooming, dress, hygiene, posture, eye contact, signs of self-neglect, age congruence	well-groomed, disheveled, age-appropriate, poor hygiene, casual dress
Behavior	Motor activity, agitation, retardation, mannerisms, cooperation, response to environment	cooperative, restless, psychomotor agitation, slowed, guarded, hostile, withdrawn
Speech	Rate, rhythm, volume, articulation, prosody, latency, pressure	normal rate/rhythm, pressured, soft, loud, slowed latency, slurred, monotone
Mood	Patient's stated emotional state (subjective). Use the patient's own words in quotes.	"depressed," "anxious," "fine," "angry," "numb," "scattered"
Affect	Observed emotional expression (objective). Range, intensity, congruence with content.	euthymic, restricted, blunted, flat, labile, congruent, incongruent
Thought process	Organization and flow of ideas	linear, goal-directed, tangential, circumstantial, loose associations, flight of ideas, blocked
Thought content	What the patient thinks about — delusions, obsessions, suicidal/homicidal ideation, paranoia	no SI/HI, passive SI, paranoid delusions, obsessions, no AH/VH
Cognition	Orientation, attention, memory, abstraction. Bedside testing (MoCA / MMSE) when indicated.	A&O x4, attention intact, registration 3/3, recall 2/3, abstract thinking intact
Insight & judgment	Awareness of illness; ability to make sound decisions	good insight, fair insight, limited insight, poor judgment, intact judgment

Free printable template

mse_template.txt

MENTAL STATE EXAMINATION

Date / Time:
Setting: [Outpatient / ED / Inpatient / Telehealth]
Source: [Patient / Collateral / Chart review]

APPEARANCE
  Grooming / Hygiene:
  Dress / Eye contact / Posture:
  Notable features:

BEHAVIOR
  Motor activity:
  Cooperation / Engagement:
  Response to environment:

SPEECH
  Rate / Rhythm / Volume / Articulation:
  Latency / Pressure / Prosody:

MOOD (subjective, in patient's words):
  "...."

AFFECT (objective):
  Range / Intensity / Reactivity:
  Congruence with mood/content:

THOUGHT PROCESS:
  [Linear / goal-directed / tangential / circumstantial / loose / FOI / blocked]

THOUGHT CONTENT:
  SI: present / absent — plan / intent / means:
  HI: present / absent:
  AH / VH / paranoia / delusions / obsessions:

COGNITION:
  Orientation:
  Attention / Concentration:
  Memory (registration / recall):
  Abstract thinking:
  MoCA / MMSE (if administered):

INSIGHT:
  Good / Fair / Limited / Poor — re: condition, treatment

JUDGMENT:
  Intact / Impaired — clinical reasoning at this time

ADDITIONAL NOTES:

Clinician signature / date:

Example 1 — Stable depression follow-up (outpatient)

Appearance: Casually dressed, well-groomed, age-appropriate, eye contact intact. Behavior: Cooperative, calm, no psychomotor abnormality. Speech: Normal rate/rhythm/volume. Mood: “Better than last month, maybe a 5 out of 10.” Affect: Mildly restricted but reactive, congruent with mood. Thought process: Linear and goal-directed. Thought content: No SI/HI. No AH/VH or delusions. Cognition: A&O x4. Attention intact. Insight: Good. Judgment: Intact.

Example 2 — Acute mania (ED presentation)

Appearance: Disheveled, brightly colored mismatched clothing, intermittent eye contact, no obvious self-care for several days per family. Behavior: Pacing, intrusive into staff conversations, attempting to leave the exam room twice during interview. Speech: Loud, rapid, pressured, difficult to interrupt. Mood: “Best I've ever felt in my life!” Affect: Elevated, expansive, labile (briefly tearful when discussing recent job loss before returning to euphoria). Thought process: Flight of ideas, tangential, occasional clang associations. Thought content:Grandiose delusions (believes she is being recruited by “a major studio”), no current SI/HI, no AH/VH. Cognition:A&O x3 (uncertain about date), attention markedly impaired. Insight: Poor. Judgment: Severely impaired given recent spending of $40,000 in 5 days.

Example 3 — Normal baseline (annual physical)

Appearance: Well-groomed, casually dressed, eye contact normal. Behavior: Cooperative, engaged, calm. Speech: Normal in all parameters. Mood: “Fine.” Affect: Euthymic, full range, congruent. Thought process: Linear and goal-directed. Thought content: No SI/HI. No abnormal content elicited. Cognition:A&O x4, attention and recall intact. Insight: Good. Judgment: Intact.

Risk assessment integration

Whenever the MSE captures suicidal or homicidal ideation, self-harm, or grossly impaired judgment, the note must include an explicit risk assessment with: identified risk factors, identified protective factors, access to means, and the clinical judgment of acute vs chronic risk level. Document the safety plan (collaborative, in patient's words where possible) and any disposition decision (voluntary discharge, involuntary hold, increased follow-up).

Common pitfalls

Interpretive language in descriptive domains

Write "tearful, head down, hesitant" not "sad." Affect is what you see; mood is what the patient says.

Vague terms without descriptors

"Within normal limits" carries little information. State the actual finding.

Implicit risk documentation

"No safety concerns" is insufficient — name SI and HI explicitly, present or absent, with qualifying detail.

Skipping cognition entirely

Even "A&O x4, attention grossly intact" is better than nothing in a brief encounter.

How AI scribes capture the MSE

Most descriptive MSE domains can be auto-populated from the recorded session. PatientNotes captures speech, mood (in the patient's own words), affect (from observable cues you describe aloud), thought process, and thought content automatically. The clinician adds bedside cognitive testing results, finalizes insight/judgment ratings, and signs off. Risk assessment language remains the clinician's responsibility.

Frequently asked questions

Is the MSE part of every psychiatric note?

A complete MSE is required for psychiatric initial evaluations and most progress notes, regardless of setting. For brief medication-management visits, a focused MSE covering mood, affect, thought content (SI/HI), and judgment is typically sufficient.

Do non-psychiatrists need to do an MSE?

Yes — primary care, ER, and hospitalist documentation should include at minimum an abbreviated MSE when the visit involves any mental health concern. A few descriptive sentences covering appearance, mood, affect, thought content (SI/HI), and orientation usually suffice.

What's the difference between MSE and mental status exam?

They are the same thing. "MSE" is the abbreviation for Mental Status Exam (sometimes called Mental State Exam, particularly in UK/AU usage). The format and required domains are identical.

How is mood different from affect?

Mood is what the patient reports feeling (subjective — captured in their own words). Affect is what you observe of their emotional expression (objective — body language, facial expression, prosody). They can be congruent or incongruent.

Should I always document SI/HI?

Yes — every psychiatric MSE must explicitly document the presence or absence of suicidal ideation (SI) and homicidal ideation (HI), including plan, intent, means, and access to means when ideation is endorsed. Implicit absence is not sufficient documentation.

Can an AI scribe write the MSE?

Yes for the descriptive domains (appearance, behavior, speech, mood, thought process, content) where the AI captures observations from the recorded conversation. Cognition testing (MoCA/MMSE) and final judgment ratings still require clinician input and structured tools.

Mental State Exam (MSE) Template

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