From bedside to risk board: Harmonizing mental status, neurological findings and risk assessment in contemporary psychiatric practice

Fragmented psychiatric assessments—separating the mental status examination (MSE), neurological screening, and risk formulation—drive diagnostic delay, safety incidents, and inequity, particularly in emergency and primary-care interfaces and low-resource settings. We conducted a narrative review informed by realist synthesis, mapping determinants to CFIR and reach/sustainment to RE-AIM. Evidence and guidance were synthesized into a pragmatic pathway that standardizes the first clinical hour: history/MSE, a brief neurological screen with explicit thresholds (e.g., delirium screen, rapid EEG rules for suspected nonconvulsive status epilepticus), and structured risk (e.g., C-SSRS, BVC/HCR-20) translated into an actioned plan. Handover uses a minimum dataset (working diagnosis, MSE anchors, neuro red flags, risk formulation, named follow-up ≤7 days). Measurement emphasizes run/SPC charts, audit-and-feedback, and equity stratification (e.g., HEAT). This standardized core with locally adaptable periphery is feasible under mhGAP task-sharing, supports safer disposition, reduces restraints/readmissions/self-harm, and strengthens ethical, rights-based care while minimizing costs. Done well, bedside reliability becomes risk-board assurance, linking first cues to system-level learning and sustained improvement.