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MSE Reminders

How the Mental Status Alarm and Improvement Detection reminders work, their MSE findings, and configuration options.

7 min
Beginner

Overview

This guide covers two mental status examination (MSE) triggered reminder rules:

  • Mental Status Alarm
  • Improvement Detection

One monitors recurring concerning findings, the other detects improvement — two complementary rules working in opposite directions.

Tip
These reminders trigger when you save mental state findings (MSE). You can record findings from three places: the session detail page, the session card in the client flow, or the context panel in a session-linked note editor. Each time you save, the system compares the findings against the configured lists.

Why Does It Matter?

Mental status examination (MSE) findings are a snapshot of the client at each session. A single finding can be meaningful, but the real clinical value emerges in the pattern across consecutive sessions. A client appearing dysphoric for three sessions in a row is a much stronger signal than a single observation.

MSE reminders perform this trend analysis for you automatically. When concerning findings recur, they signal that it’s time to intervene; when improvement findings appear, they remind you to share and reinforce progress with the client. This makes your clinical decision-making data-driven.

What Are MSE Findings?

MSE (Mental Status Examination) findings are standardized clinical observations that describe a client’s mental state during a session. You can select one or more findings for each session.

Findings fall into two categories:

Primary State

Euthymic (Balanced), Dysphoric (Depressed), Anxious, Irritable, Elevated

Quality of Affect

Restricted (Diminished expression), Labile (Rapid shifts), Incongruent (Mismatch with content)

Session Mode and MSE

Learn in detail how to record MSE findings.

Mental Status Alarm

When concerning MSE findings recur across multiple sessions, creates a reminder to evaluate the client’s condition.

How does it trigger?

1

You record MSE findings

You select and save mental state findings from session detail, client flow, or note editor context panel.

2

Current session is checked

The saved findings are compared against the configured concerning findings list.

3

Previous sessions are checked

If there’s a match, the system counts how many of the last N sessions (trend window) also had these findings.

4

Reminder created if threshold is met

If the number of matching sessions meets the threshold (including current), the reminder triggers.

Default concerning findings

The findings below trigger this reminder by default; you can add or remove them in the rule settings.

😔 Dysphoric (Depressed)😟 Anxious😠 Irritable

Default configuration

This rule triggers with the default thresholds below, which you can adjust to fit your practice.

Trend window

The span of consecutive sessions checked for whether findings are worsening.

Default: 3 sessions

Trigger threshold

How many sessions in this window must show concerning findings before the alarm triggers.

Default: 2 sessions

Default reminder text

When the reminder triggers you see the default text below, which you can edit however you like.

"Recurring mental state findings detected across recent sessions. Evaluate the client condition."

How to configure

1

Tools → Smart Reminders

Navigate to the Smart Reminders page from the top menu.

2

Click the gear icon

Click the gear icon next to the "Mental Status Alarm" rule.

3

Choose the findings to monitor

Decide which MSE findings are tracked.

4

Set the trend window and threshold

Adjust how many sessions to look back and how many matches trigger the alarm.

5

Edit the reminder text

Change the default text shown on the card however you like.

Quick actions on the reminder card

With a single tap, you can do the following:

Go to Client

Navigates to the client profile page.

Tip
Recurring concerning MSE findings may indicate a pattern requiring attention in the client’s clinical condition. Take this signal seriously for early intervention.

Improvement Detection

When a client who previously showed concerning findings no longer exhibits them in recent sessions, creates a positive reminder to evaluate progress.

How does it trigger?

1

No concerning findings in current session

The saved MSE findings contain none of the configured concerning findings.

2

Improvement window is checked

Including the current session, the last N consecutive sessions must also be clean (no concerning findings).

3

Past concern existence is verified

Within the lookback window, at least one older session must have had a concerning finding recorded.

4

Improvement reminder is created

If all conditions are met, a positive reminder is created.

Default configuration

This rule triggers with the default thresholds below, which you can adjust to fit your practice.

Improvement window

The number of consecutive sessions free of concerning findings required for the client to count as improved.

Default: 3 consecutive clean sessions

Lookback window

The total number of past sessions scanned when evaluating improvement.

Default: 6 sessions

Default reminder text

When the reminder triggers you see the default text below, which you can edit however you like.

"Improvement observed in the client mental state findings. Evaluate progress and reinforce therapeutic gains."

The system checks past sessions’ MSE records for the presence of concerning findings (the finding list you configured — default: Dysphoric, Anxious, Irritable). At least one of these must have been recorded in a past session; otherwise there’s nothing to improve from and the rule won’t trigger. A previous Mental Status Alarm reminder is not required.

How to configure

1

Tools → Smart Reminders

Navigate to the Smart Reminders page from the top menu.

2

Click the gear icon

Click the gear icon next to the "Improvement Detection" rule.

3

Choose the findings to monitor

Decide which MSE findings are tracked.

4

Set the improvement and lookback windows

Adjust how many consecutive clean sessions are required and how far back to scan.

5

Edit the reminder text

Change the default text shown on the card however you like.

Quick actions on the reminder card

With a single tap, you can do the following:

Go to Client

Navigates to the client profile page.

Acknowledged

Marks the reminder as completed.

Tip
Improvement detection helps you notice and reinforce positive therapeutic outcomes. Sharing this progress with the client can boost motivation.

Difference Between the Two Rules

The two rules complement each other but work in opposite directions:

Feature Mental Status Alarm Improvement Detection
PurposeDetect concerning patternsCelebrate & reinforce progress
Current sessionMust HAVE concerning findings.Must NOT have concerning findings.
Historical checkLooks for recurrence of findings.Looks for absence of findings + past presence.
Category / TabTherapeutic Core / ImportantClinical Support / Follow Up
Default findingsDysphoric, Anxious, Irritable

Frequently Asked Questions

Can Alarm and Improvement trigger simultaneously for the same client?
No. Alarm requires concerning findings to be PRESENT in the current session, while Improvement requires them to be ABSENT. Both cannot be true at the same time.
What happens if the trend window is set to 1?
Historical checking is disabled and a single session with matching findings will trigger the reminder.
Does the Improvement rule trigger if no concerning findings were ever recorded?
No. Improvement detection requires at least one session with concerning findings in the past. Without prior concerns, there’s nothing to improve from.
Is it a problem if I select different MSE findings across sessions?
No. The system evaluates each session independently. If at least one configured finding matches, that session counts.
Can I add "Euthymic" to the concerning findings list?
Technically yes, but since Euthymic represents a balanced/normal state, monitoring it as concerning doesn’t make clinical sense.
Are reminders visible to clients?
No. Reminders are only visible on the therapist’s Home page.
Can I pause these rules for a specific client?
Yes. Use the ⋯ menu on the reminder card and select "Pause for this client".
What does "consecutive clean sessions" mean for Improvement?
Including the current session, the last N sessions must have zero configured concerning findings. If any session in between has a finding, the streak is broken.
If Alarm triggered and the next session still meets the threshold, does it trigger again?
If the previous reminder is still active, no — no duplicate is created. If you marked it as "Completed" and the threshold is still met, a new reminder will be created.
Can I monitor different findings in Alarm vs Improvement?
Yes, but it’s not recommended. Monitoring the same findings ensures the two rules work together: Alarm catches the concern, Improvement detects when it resolves.
Does a session without MSE data count as a "clean session"?
Yes. A session with no MSE findings recorded is treated as having no concerning findings (clean). This means it can fill the improvement window. For accurate results, recording MSE findings every session is recommended.
If I save MSE on the same session multiple times, will a second reminder be created?
No. The system won’t create a new reminder if an active or snoozed reminder already exists for the same rule and client. Each save is re-evaluated, but duplicates are prevented.
How do I remove a wrongly triggered reminder?
Click the "Completed" button on the reminder card to close it. The reminder isn’t deleted — it’s marked as completed.

Tips

Use both together

When Alarm and Improvement monitor the same findings, they form a complementary tracking system.

Record MSE findings consistently

Recording MSE findings every session is critical for both rules to work accurately.

Share improvement with the client

When you receive an improvement reminder, sharing this positive progress with the client can boost motivation.

Adjust sensitivity

For Alarm, adjust the trend window and threshold to control sensitivity.