Mid-Term Report

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Mid-Term Report

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Client Information

General information

Client ID

Client ID number given by the NHS, get this from Simon

Report Date

Today's date

Psychotherapist * Verity Jill Wendy Shabir Matthew Jennifer Sue Hazel Victoria Jacob Other Psychotherapist

Therapist selection

Report For? * NHS England Health Board Insurance Legal Report Other Report For?

Who is the report for? (use other if not listed)

Mental Health Issues

The major mental health condition/issue (the number 1 reason for counselling?

Mental Health Issue * Anger Anxiety Bipolar Borderline Personality Disorder (BPD) Depression Panic Post-Traumatic Stress Disorder (PTSD) Phobias Stress Schizophrenia Trauma Other Mental Health Issue

Number 1 mental health Issue identified after first few sessions (this could of changed from the original assessment)

Initial Assessment * Mild Moderate Moderate/Severe Severe Other Initial Assessment

Counsellors assessment of the mental health of the client. (use other if required)

Current Assessment * Mild Moderate Moderate/Severe Severe

Counsellors assessment of the client on date of report.

Note, if other selected or you feel more information needs to be explained

Mental Health Issues

Co-existing mental health issue

Co-Existing (MHI) Anger Anxiety Bipolar Borderline Personality Disorder (BPD) Depression Panic Post-Traumatic Stress Disorder (PTSD) Phobias Stress Schizophrenia Trauma Insomnia Other Co-Existing (MHI)

Additional mental health issue (only use, if this is in addition to the one above, in my experience clients have multiple issues which we can highlight and help with the funding for additional sessions)

Initial Assessment Mild Moderate Moderate/Severe Severe

As above

Current Assessment Mild Moderate Moderate/Severe Severe

As above

Note, if other selected or you feel more information needs to be explained

Mental Health Issues

Co-existing mental health issue

Co-Existing (MHI) Anger Anxiety Bipolar Borderline Personality Disorder (BPD) Depression Panic Post-Traumatic Stress Disorder (PTSD) Phobias Stress Schizophrenia Trauma Insomnia Other Co-Existing (MHI)

Additional mental health issue if more than 2 listed (only use, if this is in addition to the one above)

Initial Assessment Mild Moderate Moderate/Severe Severe

As above

Current Assessment Mild Moderate Moderate/Severe Severe

As above

Note, if other selected or you feel more information needs to be explained

Contributing factors

Emotional Factors for Mental Health Decline

Emotional Health Worry (something dreadful will happen) Shame (feel inadequate)) Isolated (lonely, no friends) Worry (pending homelessness) Death of a parent Death of a grandparent Terminal Illness (close friend) Terminal Illness (family member) Other Emotional Health

Explains how the patient feels from the counsellors sessions (counsellor assessment)

Initial Assessment Mild Moderate Moderate/Severe Severe

As above

Current Assessment Mild Moderate Moderate/Severe Severe

As above

Note, if other selected or you feel more information needs to be explained

2

Emotional Health (2) Worry (something dreadful will happen) Shame (feel inadequate)) Isolated (lonely, no friends) Worry (pending homelessness) Death of a parent Death of a grandparent Terminal Illness (close friend) Terminal Illness (family member) Other Emotional Health (2)

Only use if multiple issues

Initial Assessment Mild Moderate Moderate/Severe Severe

As above

Current Assessment Mild Moderate Moderate/Severe Severe

As above

Note, if other selected or you feel more information needs to be explained

3

Emotional Health (3) Worry (something dreadful will happen) Shame (feel inadequate)) Isolated (lonely, no friends) Worry (pending homelessness) Death of a parent Death of a grandparent Terminal Illness (close friend) Terminal Illness (family member) Other Emotional Health (3)

Only use if multiple issues

Initial Assessment Mild Moderate Moderate/Severe Severe

As above

Current Assessment Mild Moderate Moderate/Severe Severe

As above

Note, if other selected or you feel more information needs to be explained

Addictions

Does the client have any addictions that contribute to the mental health condition?

Addictions? Cannabis Cocaine Social drugs OCD Food Alcohol Other Addictions?

Does the client have any addictions

Type of User? Daily Light user Social user Daily routine (OCD) Other Type of User?

Frequency of use

Initial Assessment Mild Moderate Moderate/Severe Severe

As above

Current Assessment Mild Moderate Moderate/Severe Severe

As above

Any Additional Addictions Information?

New Request for Sessions

Does this report indicate an request for additional sessions?

Is There a Need for More Sessions? * No Yes

The NHS do not like requests for more sessions, will apply if required

If Yes, How Many Required? 4 6 8 10 12 Other If Yes, How Many Required?

If yes, how many are you requesting?

Reason for Request of Additional Sessions?

Any additional Information?

Section

Any Client Safety Risk? No Yes Low Moderate Other Any Client Safety Risk?

Are there any suicidal or self-harm risks (other can be used for anything different)

What is the Risk? No Risk Self-harm Suicidal thoughts Has attempted suicide Other What is the Risk?

What is the risk? (use other to explain in more depth or another risk reported if required)

Note, if you feel more information needs to be explained

Section

Additional Information

Any additional Information?

Submit