If a patient denies illness but MSE indicates significant impairment, what steps should you take regarding safety and next steps?

• A. Discharge after confirming denial.
• B. Assess capacity for decision-making; consider safety plan and collateral information; address immediate safety risks; escalate to appropriate care if risk present.
• C. Immediately involuntarily commit.
• D. Repeat the MSE until the patient agrees.

Answer: (B)

Decision-making capacity and safety planning are the priorities when a patient denies illness but the mental status exam shows significant impairment. Denial alone does not rule out a dangerous or disabling condition, so you shouldn’t discharge simply because the patient says they’re fine. The first step is to assess whether the patient has the capacity to make informed decisions about their own care. This means checking if they can understand information about their condition, appreciate how it affects them, reason about treatment options, and consistently express a choice. If capacity is lacking, you need to address immediate safety risks, involve collateral information from family or other sources to get a fuller picture, and implement a safety plan. Depending on the level of risk, escalate to appropriate care so the patient can be evaluated and treated in a setting equipped to manage safety concerns, which could include inpatient or crisis services. If capacity is intact, you can pursue voluntary treatment while continuing to monitor safety and arrange supports, but remain ready to escalate if risk changes.