Assessment of people with mental, neurological No Yes ⓪ ② and substance use problems No Yes ⓪ ② Moderate-severe Depressive Disorder (DEP) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Psychosis (PSY) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, No Yes ⓪ ② Epilepsy/Seizures (EPI) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Acute Stress (ACU) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Grief (GRI) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Post-traumatic Stress Disorder (PTSD) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Intellectual Disability (ID) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Harmful Use of Alcohol and (SUB) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Suicide (SUI) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Other Significant Mental Health Complaints If yes, please circle: psycho-education, psychological (OTH) interventions, pharmacological interventions, other: Other disorders** No Yes ⓪ ② Bipolar disorder If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Child Behavioral Disorders (ADHD, conduct) If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: No Yes ⓪ ② Dementia If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Other Relevant Training Psychological Interventions (e.g. problem No Yes ⓪ ② solving plus, IPT, thinking healthy) Psychological first aid (PFA) No Yes ⓪ ②
Assessment of people with mental, neurological and substance use problems ⓪ No ② Yes Moderate-severe Depressive Disorder (DEP) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Psychosis (PSY) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, Epilepsy/Seizures (EPI) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Acute Stress (ACU) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Grief (GRI) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Post-traumatic Stress Disorder (PTSD) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Intellectual Disability (ID) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Harmful Use of Alcohol and (SUB) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Suicide (SUI) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Other Significant Mental Health Complaints (OTH) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Other disorders** Bipolar disorder ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Child Behavioral Disorders (ADHD, conduct) ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Dementia ⓪ No ② Yes If yes, please circle: psycho-education, psychological interventions, pharmacological interventions, other: Other Relevant Training Psychological Interventions (e.g. problem solving plus, IPT, thinking healthy) ⓪ No ② Yes Psychological first aid (PFA) ⓪ No ② Yes
IMC%202017%20PHC%20MH%20Integration%20Checklist%20Sample_designed.docx