Pic 0: The title card appears before transitioning to a scene of Austin and Judith in an exam room.
Coach: Your goal is to determine if Judith is at risk for a mental health disorder and work towards a treatment plan. Ideally you should be able to complete these steps in about seven minutes. Afterwards we’ll discuss your approach and how long it took.
Austin: Hi, Judith. It’s been six weeks since you were last in for a visit. How have you been doing?
Judith: Oh, not so good.
Austin: What’s going on?
Judith: Well, my wrist has really been hurting lately from the arthritis and I’ve been having some headaches.
Austin: Okay. Last time you were here Dr. Singh prescribed ibuprofen and trying some physical therapy. Has that helped at all?
Judith: No, not really. My wrist is still bothering me.
Austin: And what about physical therapy?
Judith: No, that didn’t help. I went a couple of times but. I don’t know.
Austin: Tell me more about your pain. How are your arthritis and headaches affecting your ability to get around and do things?
Judith: It's not easy. I don't move around much.
Austin: How often are you getting out of the house?
Judith: Not often. This is the first time in a while, actually.
Austin: What about work, or seeing family or friends?
Judith: I retired last year and, I don't, I don't have any immediate family. I had a lot of friends at work, but I haven't really seen them since I retired. It's just really hard with my pain.
Judith’s thought: It's just me now, me and Rosie.
Austin: So the pain and headaches are keeping you a bit isolated.
Judith: Yeah, I have a cat to keep me company, but besides her I never see anybody anymore. My friends from work, they still invite me places, they just don't understand how hard it is.
Coach: Austin did a good job summarizing how he thought Judith is feeling. It’s okay if he doesn’t get the summary perfectly right, he needs to just try to imagine how her situation might make her feel. She’ll correct him if he’s wrong. And, either way, it encourages her to open up.
Austin: Is there anyone around who can help you with things when you're in pain?
Judith: No, it's just me and Rosie, my cat. My, my daughter and my husband are both gone.
Austin: Gone?
Judith: They died a while back.
Austin: Oh. I didn't know. I'm so sorry to hear that.
Judith: Thank you.
Coach: Death or illness of a loved one is a significant risk factor for developing a mental health disorder. Even if Judith had not already screened positive for depression, hearing this would clue Austin in that she might be suffering from emotional distress.
Austin: Judith, would it be alright to talk about the forms you filled out in the waiting room?
Judith: Sure.
Austin: You indicated that you've been feeling kind of down lately and that you've been having trouble sleeping, feeling tired, and there are some changes in your appetite. What's your mood been like?
Judith: Not great, I guess. I just wake up, feed my cat, Rosie, watch a little TV, take a nap. Just kind of go through the motions.
Judith: I really don't feel good. And my arthritis and headaches just make me feel even worse.
Coach: This was a great approach. By asking Judith's permission to discuss the forms, Austin made her more of an equal in this conversation, which encouraged her to open up.
Austin: How long have you felt this way?
Judith: (thinking) On and off. Worse since I retired.
Austin: So it sounds like it's been going on for a while now.
Judith: Well, since I retired and not working, not having something to occupy my mind, it's easier for me to think about things I don't want to think about.
Austin: Do you mind if I ask what kind of things do you think about?
Judith: I just miss my family, I guess.
Austin: Sometimes when people lose loved ones, it's natural to feel extra tired, have trouble sleeping, eat far less or more than they normally do, in general, to feel down, maybe even for a long time, some of the things you indicated you were feeling on the forms you filled out in the waiting room.
When did you lose your husband and daughter?
Judith: It's been a while now. My husband died of cancer and then about a year later Lori, she died.
Austin: Since you're still coping with these losses in your life and with your wrist pain and your headaches and retiring recently, having less to keep you busy, it's understandable you're feeling down.
Judith: Yeah. Yeah, it's been difficult.
Coach: Empathizing with Judith and summarizing her situation made her comfortable opening up to Austin. Sounds like she does have some motivation to make a positive change.
Austin: Judith, I want to talk about something else you wrote on your form. You said that you sometimes think about how you'd be better off dead or about hurting yourself. Can you tell me more about those thoughts?
Judith: Oh. Well, I've thought about it here or there. I'm not working, I don't have a family to take care of, I’m not much use to anybody anymore. And I'd get to be with my daughter and my husband again. But, honestly, I'd never actually do anything.
Coach: Austin did a good job asking Judith about suicide. She seems to be low-risk for suicide, but he needs to ask a few more questions to better assess her risk level.
Austin: It sounds like you've had thoughts of hurting yourself in the past. At the same time, you don't think you'd actually do anything like that.
Judith: Right. It's more like a fantasy maybe.
Austin: What are some things that keep you from ending your life?
Judith: Well, you know, there's Rosie. If I were gone, there'd be nobody to take care of her. She'd probably die, too, and she doesn't deserve that.
Austin: Sounds like Rosie's really important to you.