What to expect from a mental health assessment
A simple guide to what may happen, what you may be asked, and what support may be offered in Scotland.
A mental health assessment is not a test you pass or fail.
It is a conversation to understand what is happening, how safe you are, and what support may be needed.
You can bring notes. You can ask questions. You can ask for things to be explained clearly.
If this is urgent
If you or someone else is in immediate danger, call 999.
If you need urgent mental health support but it is not immediately life-threatening, call NHS 24 on 111 and ask for mental health support.
NHS 24 says the 111 Mental Health Hub is for people of all ages, is free, and is available 24 hours a day, 7 days a week.
You do not need to explain everything perfectly. This sentence is enough to start. You can say:
“I need urgent mental health support and I’m not sure what to do.”
What is a mental health assessment?
A mental health assessment is a structured conversation to understand what is happening and what support may be needed.
It may look at:
How you are feeling
What has changed recently
Whether you feel safe
Whether there is risk of harm
What support you already have
What treatment or follow-up may help
Whether urgent or specialist care is needed
It is not a test
You do not need to give perfect answers.
Where it might happen
A mental health assessment can happen in different places depending on how urgent things are and who is involved.
Community
This may be through:
GP
NHS 24
Community Mental Health Team
Crisis team
Psychological therapies service
Police custody or prison
This may involve:
Custody healthcare
Prison healthcare
Mental health nurses or doctors
Risk assessment
Referral to specialist mental health services
Court or justice setting
This may happen when:
Mental health is relevant to bail
The court needs more information
A solicitor asks for assessment
A report is needed
Hospital-based assessment or treatment is being considered
Hospital
This may be in:
A&E
A hospital ward
Psychiatric liaison
Mental health assessment unit
Psychiatrist appointment
What they may ask
The questions can feel personal or frightening, especially if they ask about suicide, self-harm, alcohol, drugs, trauma, or risk.
They usually ask because they need to understand what support is needed and how urgent the situation is.
What is happening now
They may ask:
What brought you here?
What has changed?
How long has this been happening?
Are things getting worse?
What help do you feel you need?
Thoughts and experiences
They may ask about:
Confusion
Racing thoughts
Paranoia
Hearing or seeing things
Feeling detached from reality
Intrusive thoughts
Thoughts of harming yourself or someone else
Safety and risk
They may ask directly about:
Suicidal thoughts
Self-harm
Plans or intent
Previous attempts
Access to medication, weapons, ligatures, or other means
Risk from other people
Risk to children or dependants
Alcohol or drug use
Whether you can stay safe
How you are feeling
They may ask about:
Depression
Anxiety or panic
Anger or irritability
Hopelessness
Feeling numb or overwhelmed
Mood swings
Feeling unusually high, energetic, or impulsive
Being honest about risk is important. It helps services understand what support is needed. You can say:
“I feel scared answering this, but I want to be honest so I can get the right help.”
What may happen during the assessment
Not every assessment is the same, but most try to understand your symptoms, risk, history, and support needs.
They may look at your mental state
This means how you seem during the conversation, including mood, speech, behaviour, memory, concentration, confusion, distress, agitation, or whether you seem detached from reality.
They may check immediate safety
They may ask whether you are safe right now, whether you have a plan to harm yourself, whether someone is with you, and whether you need urgent medical help.
They may ask about your wider situation
This may include medication, previous treatment, physical health, trauma, alcohol or drug use, housing, money, work, relationships, children, support network, or recent police/court involvement.
What may happen afterwards
A good assessment should leave you knowing what the next step is, who is responsible, and what to do if things get worse.
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Advice and self-help resources
Safety plan
Follow-up with GP
Referral to a Community Mental Health Team
Crisis team involvement
Therapy referral
Medication review
Psychiatric review
Social work or housing support
Substance use support
Voluntary hospital admission
Detention under mental health law in serious cases
Before you leave, ask:
What happens next?
Who is responsible for follow-up?
When will I be contacted?
What should I do if things get worse?
Can I have the plan in writing?
Are assessments different in hospital, custody, prison, or court?
The basic aim is similar: to understand mental health, risk, support needs, and what should happen next.
But the setting can change the focus.
Hospital or A&E
The focus is usually immediate health, safety, crisis risk, and whether you need urgent treatment, follow-up, crisis support, or hospital admission.
They may consider voluntary admission or, in serious cases, detention under mental health law.
Prison
The focus may include mental health screening, suicide/self-harm risk, medication, withdrawal, crisis support, referral to prison mental health services, and whether specialist hospital transfer is needed.
NHS Scotland is responsible for healthcare, including mental healthcare, in Scotland’s prisons, but support can involve multiple partners including SPS, social work and third-sector services
Court-related assessment
The focus may include whether mental health is relevant to bail, sentencing, fitness to take part in proceedings, risk, treatment needs, or whether reports are needed.
Police custody
The focus may include whether you are safe in custody, need healthcare, need medication, understand what is happening, can be interviewed, or need an Appropriate Adult.
In Scotland, Appropriate Adults provide communication support to vulnerable people aged 16+ during police investigations, and police must request this support for vulnerable people in custody.
If hospital detention is being considered
Most mental health assessments do not lead to detention.
But in serious situations, services may consider whether someone needs to be kept in hospital under the Mental Health Act.
In Scotland, an emergency detention certificate can allow someone to be detained in hospital for up to 72 hours while their condition is assessed. This must be recommended by a doctor, and a Mental Health Officer should agree.
Detention should only be used when legal criteria are met
This may include serious concern about:
Mental disorder
Significant risk
Urgent need for assessment or treatment
Impaired decision-making about treatment
Whether detention is necessary and proportionate
Your rights and support
You can ask questions. You can ask for things to be explained. You can ask for support to help your views be heard.
You can ask
What is happening?
Who is assessing me?
What decision has been made?
What happens next?
Can I have the plan in writing?
Can someone I trust be involved?
Independent advocacy
An independent advocate can help you understand your rights, ask questions, prepare for meetings, challenge decisions, and make sure your views are heard.
The Mental Welfare Commission says people with mental illness, personality disorder or learning disability have a right to independent advocacy, and you do not have to be in hospital or detained to access this right.
Advance statements
An advance statement is a written statement about how you would or would not want to be treated if you became unwell in the future.
The Mental Welfare Commission says an advance statement is not a guarantee that your wishes will be followed, but it does guarantee they will be taken into account.
Before the assessment: quick checklist
You do not need to have everything prepared. But if you can, write down the things you are worried you might forget.
Tell them
What is happening now
When it started
Whether things are getting worse
Whether you feel safe
Whether you have thoughts of suicide or self-harm
Whether you have a plan or access to means
Whether you are sleeping and eating
Whether you are taking medication
Whether alcohol or drugs are involved
Whether you are hearing, seeing, or believing things others do not
Whether you have somewhere safe to stay
What support you already have
What help you think you need
If you are supporting someone else
Families and loved ones can provide important information, especially if the person is too distressed, confused, frightened, ashamed, or unwell to explain clearly.
Focus on clear examples.
Be specific
Instead of saying:
“They’re not themselves.”
Say:
“They have not slept for three nights, they are saying people are watching them, they tried to leave the house at 3am, and they said they don’t want to be alive.”
What to write down
What you have noticed
Changes in behaviour
Changes in sleep or eating
Changes in speech or thinking
Any suicidal comments
Any previous attempts
Any recent losses or stress
Any medication concerns
Alcohol or drug use
Whether they have support at home
Whether you believe they are safe to leave alone
If you feel you were not properly assessed
One assessment does not mean the situation is definitely resolved.
If you still feel unsafe, or you are worried someone remains at risk, ask for help again.
You can ask
Was a risk assessment completed?
Was suicide risk considered?
Was family information included?
Was a safety plan made?
Who is responsible for follow-up?
What should happen if symptoms get worse?
What to do next
Call 111 again if urgent support is needed
Call 999 if there is immediate danger
Contact your GP or mental health team
Ask who is responsible for follow-up
Ask for the plan in writing
Keep a record of who you speak to and what they say
What matters most right now
You do not need to explain everything perfectly.
Be honest about risk.
Ask what happens next.
Get the plan in writing if you can.
If something still feels unsafe, keep asking for help.