18 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER C. The client described his/her own pattern of decreased mental illness symptoms as he/she has aged. D. The client denied that he/she has experienced a pattern of decreased mental illness symptoms as he/she has aged. 8. Referral for a Physical Evaluation (8) A. The client was referred for a complete physical evaluation by a medical professional who is knowledgeable i n both geriatric and mental illness concerns. B. The client has completed his/her physical evaluation, and the results of this evaluation were processed. C. The client has not submitted to a physical evaluation and was redirected to do so. 9. Support an d Monitor Physical Evaluation Recommendations (9) A. The client was supported in following up on the recommendations from the medical evaluation. B. The client's follow-up on the recommendations from the medical evaluation have been monitored. C. The cl ient was reinforced for following up on the recommendations from the medical evaluation. D. The client has not regularly followed up on his/her medical evaluation recommendations and was redirected to do so. 10. Assist in Physical Health Needs Expression (10) A. The client was taught how to express his/her physical health needs to the medical staff. B. The client's bizarre descriptions of his/her physical health problems were “translated” to the medical staff to assist in providing more clear communicat ion. C. Role playing was used to practice asking questions of or reporting concerns to the medical staff. D. The client has provided more information to the medical staff as a result of more assertive and clear expression of needs. E. The client continu es to fail to express his/her physical health needs to the medical staff and was given additional direction. 11. Interpret and Investigate Decompensation (11) A. The client's psychiatric decompensation was interpreted as a possible reaction to medical instability and the stress that is associated with it. B. As the client has decompensated psychiatrically, inquiries have been made about his/her medical needs. C. The client accepted the interpretation that he/she is struggling with medical concerns, feel s more stressed, and has been decompensating psychiatrically due to these problems. D. The client denied any medical difficulties that have led to his/her psychiatric decompensation, and he/she was given further education in this area. 12. Obtain and Rev iew Physical Health Information (12) A. Having procured the necessary authorization from the client to release confidential material, information was obtained about the physical health concerns that he/she experiences. 