# Langcare Langcare MCP Fhir Mental Health Screening > Mental Health Screening - Skill: `tomevault-io/langcare-langcare-mcp-fhir-mental-health-screening` (Agent Skill, multi-file: 2 files) - Install (CLI): `npx skillmds@latest add tomevault-io/langcare-langcare-mcp-fhir-mental-health-screening` - Raw SKILL.md: https://api.skillmd.com/api/skills/tomevault-io/langcare-langcare-mcp-fhir-mental-health-screening/raw - Safety review: pending (external: skill-scanner PASS, skillspector PASS) - Works with: Claude Code, Claude.ai, OpenAI Codex - Category: AI & ML - Author: tomevault-io (https://skillmd.com/u/tomevault-io) - Updated: 2026-09-17 - Page: https://skillmd.com/skills/tomevault-io/langcare-langcare-mcp-fhir-mental-health-screening --- # Mental Health Screening ## Overview Administer, score, and document validated mental health screening instruments using FHIR QuestionnaireResponse and Observation resources. Supported tools: PHQ-2 (brief depression), PHQ-9 (depression severity), GAD-7 (generalized anxiety), AUDIT-C (alcohol use), Columbia Suicide Severity Rating Scale (C-SSRS), Mood Disorder Questionnaire (MDQ, bipolar), and PC-PTSD-5 (PTSD). Calculate scores, classify severity, generate clinical recommendations by score range, and trigger safety assessment workflows for positive suicidality screens. Record results as FHIR Observations with standardized LOINC codes. ## FHIR Resources Used | Resource | Purpose | Key Fields | |----------|---------|------------| | Patient | Demographics, age | birthDate, gender | | QuestionnaireResponse | Screening instrument responses | questionnaire, item, answer, authored | | Observation | Screening scores and interpretations | code, valueQuantity, interpretation, effectiveDateTime | | Condition | Existing mental health diagnoses | code, clinicalStatus, onsetDateTime | | MedicationRequest | Current psychotropic medications | medicationCodeableConcept, status, dosageInstruction | | RiskAssessment | Suicide risk documentation | prediction, method, mitigation | ## Instructions ### Step 1: Retrieve Patient Demographics and History ``` Tool: fhir_read resourceType: "Patient" id: "[patient-id]" ``` Extract age (screening tools may have age-specific versions) and gender. Pull existing mental health conditions: ``` Tool: fhir_search resourceType: "Condition" queryParams: "patient=[patient-id]&category=encounter-diagnosis&code=35489007,197480006,724689000,66590003,47505003,313182004&clinical-status=active" ``` SNOMED codes: - 35489007 = Depressive disorder - 197480006 = Anxiety disorder - 724689000 = Alcohol use disorder - 66590003 = Bipolar disorder - 47505003 = PTSD - 313182004 = Suicidal ideation ### Step 2: Pull Prior Screening Results ``` Tool: fhir_search resourceType: "Observation" queryParams: "patient=[patient-id]&code=44249-1,69737-5,75626-2,77564-3,89206-7&_sort=-date&_count=10" ``` LOINC codes for screening scores: - 44249-1 = PHQ-9 total score - 69737-5 = PHQ-2 total score - 75626-2 = GAD-7 total score - 77564-3 = AUDIT-C total score - 89206-7 = C-SSRS (Columbia suicide severity) Extract prior scores and dates for trend analysis. ### Step 3: Pull Current Psychotropic Medications ``` Tool: fhir_search resourceType: "MedicationRequest" queryParams: "patient=[patient-id]&status=active" ``` Identify psychotropic medications: - SSRIs: sertraline, fluoxetine, escitalopram, citalopram, paroxetine - SNRIs: venlafaxine, duloxetine, desvenlafaxine - Benzodiazepines: alprazolam, lorazepam, clonazepam, diazepam - Mood stabilizers: lithium, valproate, lamotrigine, carbamazepine - Antipsychotics: quetiapine, aripiprazole, olanzapine, risperidone - Stimulants: methylphenidate, amphetamine salts - Bupropion, mirtazapine, trazodone, buspirone Note current medications to inform treatment recommendations. ### Step 4: Determine Which Screening Tool to Administer Selection logic: - **Universal screening**: PHQ-2 first; if score >=3, proceed to PHQ-9 - **Depression concern**: PHQ-9 directly - **Anxiety concern**: GAD-7 - **Alcohol use concern**: AUDIT-C - **Suicidal ideation**: C-SSRS (always if PHQ-9 item 9 > 0) - **Bipolar concern**: MDQ (before starting antidepressant, if mood cycling history) - **Trauma history**: PC-PTSD-5 If user does not specify, default to PHQ-2 + GAD-7 as standard primary care screening. ### Step 5: Score the Screening Instrument See references/screening-tools.md for complete item-level scoring. Summary scoring: **PHQ-2** (items 1-2 of PHQ-9, range 0-6): - Score >=3: positive screen, proceed to full PHQ-9 **PHQ-9** (9 items, range 0-27): - 0-4: minimal/none - 5-9: mild - 10-14: moderate - 15-19: moderately severe - 20-27: severe - Item 9 (suicidal ideation) > 0: trigger C-SSRS safety assessment **GAD-7** (7 items, range 0-21): - 0-4: minimal - 5-9: mild - 10-14: moderate - 15-21: severe **AUDIT-C** (3 items, range 0-12): - Men: score >=4 positive - Women: score >=3 positive **C-SSRS** (severity scale 1-5): - 1: Wish to be dead - 2: Non-specific active suicidal thoughts - 3: Suicidal ideation with method (no plan or intent) - 4: Suicidal ideation with intent (no specific plan) - 5: Suicidal ideation with specific plan and intent **MDQ** (13 yes/no items + 2 supplemental): - Positive screen: >=7 "yes" items AND items occurred at same time AND caused moderate/serious problems **PC-PTSD-5** (5 yes/no items, range 0-5): - Score >=3: positive screen, proceed to full PTSD evaluation ### Step 6: Record Screening Score as Observation ``` Tool: fhir_create resourceType: "Observation" resource: { "resourceType": "Observation", "status": "final", "category": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/observation-category", "code": "survey", "display": "Survey"}]}], "code": {"coding": [{"system": "http://loinc.org", "code": "[LOINC-code]", "display": "[instrument-name] total score"}]}, "subject": {"reference": "Patient/[patient-id]"}, "effectiveDateTime": "[current-datetime]", "valueQuantity": {"value": [score], "unit": "{score}"}, "interpretation": [{"coding": [{"system": "http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation", "code": "[N/A/H]", "display": "[severity]"}]}] } ``` ### Step 7: Record QuestionnaireResponse (if item-level data available) ``` Tool: fhir_create resourceType: "QuestionnaireResponse" resource: { "resourceType": "QuestionnaireResponse", "status": "completed", "subject": {"reference": "Patient/[patient-id]"}, "authored": "[current-datetime]", "item": [ {"linkId": "1", "text": "[question text]", "answer": [{"valueInteger": [score]}]}, ... ] } ``` ### Step 8: Safety Assessment for Positive Suicidality Screen If PHQ-9 item 9 > 0 or C-SSRS positive: 1. Determine imminent risk level: - **Imminent risk** (C-SSRS 4-5, or active plan/intent): immediate psychiatric evaluation, do not leave patient unattended, contact crisis team - **Elevated risk** (C-SSRS 2-3, PHQ-9 item 9 = 2-3): same-day mental health evaluation, safety plan - **Low risk** (C-SSRS 1, PHQ-9 item 9 = 1): outpatient mental health referral within 1 week, safety plan 2. Document safety assessment: ``` Tool: fhir_create resourceType: "Observation" resource: { "resourceType": "Observation", "status": "final", "code": {"coding": [{"system": "http://loinc.org", "code": "89206-7", "display": "Columbia suicide severity rating scale"}]}, "subject": {"reference": "Patient/[patient-id]"}, "effectiveDateTime": "[current-datetime]", "valueQuantity": {"value": [severity-level], "unit": "{score}"}, "note": [{"text": "Safety assessment completed. [Plan details]."}] } ``` See references/mental-health-management.md for safety planning template and crisis resources. ### Step 9: Generate Recommendations by Score Present structured output: ``` MENTAL HEALTH SCREENING RESULTS -- [Patient Name] -- [Date] ============================================================= SCREENING INSTRUMENT: [Name] Score: [value] / [max] -- Severity: [classification] Prior score: [value] on [date] -- Trend: [improved/stable/worsened] CURRENT PSYCHOTROPIC MEDICATIONS [list or "None"] INTERPRETATION [Clinical interpretation based on score and context] RECOMMENDATIONS [Specific actions per severity level -- see references/screening-tools.md] SAFETY STATUS Suicidal ideation screen: [Negative / Positive -- details] [If positive: safety plan status, risk level, disposition] ``` ## Examples ### Example 1: Routine Depression and Anxiety Screening **User says:** "Run depression and anxiety screening for patient MH-1120" **Actions:** 1. `fhir_read` Patient/MH-1120 -- 34-year-old female 2. `fhir_search` Condition?patient=MH-1120&category=encounter-diagnosis&code=35489007,197480006&clinical-status=active -- generalized anxiety disorder (active since 2024) 3. `fhir_search` Observation?patient=MH-1120&code=44249-1,75626-2&_sort=-date&_count=10 -- prior PHQ-9: 12 (moderate, 3 months ago), prior GAD-7: 14 (moderate, 3 months ago) 4. `fhir_search` MedicationRequest?patient=MH-1120&status=active -- sertraline 100mg daily 5. Score current PHQ-9 = 8 (mild), GAD-7 = 10 (moderate). PHQ-9 item 9 = 0 (no suicidal ideation). 6. `fhir_create` Observation for PHQ-9 score (LOINC 44249-1, value 8) 7. `fhir_create` Observation for GAD-7 score (LOINC 75626-2, value 10) **Result:** ``` MENTAL HEALTH SCREENING RESULTS -- Sarah Mitchell -- 2026-02-07 ================================================================ PHQ-9: 8/27 -- Mild depression Prior: 12 (moderate) on 2025-11-07 -- IMPROVED Item 9 (suicidal ideation): 0 -- NEGATIVE GAD-7: 10/21 -- Moderate anxiety Prior: 14 (moderate) on 2025-11-07 -- IMPROVED (borderline) CURRENT MEDICATIONS: sertraline 100mg daily (started 2024) INTERPRETATION Depression improving from moderate to mild on current SSRI. Anxiety remains moderate but trending downward. No safety concerns. RECOMMENDATIONS - Continue sertraline 100mg. Consider dose optimization for residual anxiety. - Rescreen in 4-6 weeks. - Consider CBT referral for anxiety management. - Discuss sleep hygiene, exercise, stress management. ``` ### Example 2: Positive Suicidality Screen with Safety Assessment **User says:** "PHQ-9 screening for patient MH-4450, he endorsed suicidal thoughts" **Actions:** 1. `fhir_read` Patient/MH-4450 -- 52-year-old male 2. `fhir_search` Condition?patient=MH-4450&clinical-status=active -- major depressive disorder, alcohol use disorder 3. `fhir_search` MedicationRequest?patient=MH-4450&status=active -- bupropion 300mg daily 4. Score PHQ-9 = 22 (severe). Item 9 = 2 (more than half the days). 5. Administer C-SSRS: severity level 3 (suicidal ideation with method, no plan or intent). 6. `fhir_create` Observation for PHQ-9 score (value 22, interpretation HH) 7. `fhir_create` Observation for C-SSRS (value 3) **Result:** ``` MENTAL HEALTH SCREENING RESULTS -- Robert Johnson -- 2026-02-07 ================================================================ [SAFETY ALERT] POSITIVE SUICIDALITY SCREEN PHQ-9: 22/27 -- SEVERE depression Item 9 (suicidal ideation): 2 -- endorsed "more than half the days" C-SSRS: Severity Level 3 -- Suicidal ideation WITH METHOD (no plan or intent) Patient reports thinking about overdose but denies specific plan or intent. RISK FACTORS IDENTIFIED - Severe depression (PHQ-9 = 22) - Active alcohol use disorder - Male sex, age >45 - Has identified method PROTECTIVE FACTORS - Denies specific plan or intent - Currently engaged in treatment - On antidepressant (bupropion) IMMEDIATE ACTIONS REQUIRED 1. Do not leave patient unattended until safety plan completed 2. Same-day psychiatric evaluation recommended 3. Lethal means counseling -- assess access to medications, firearms 4. Complete safety plan (see references/mental-health-management.md) 5. Provide crisis resources: 988 Suicide and Crisis Lifeline TREATMENT RECOMMENDATIONS - Current bupropion may be insufficient -- psychiatric consultation for medication adjustment - Screen for alcohol use severity (AUDIT-C recommended) - Intensive outpatient or partial hospitalization may be appropriate - Follow-up within 48-72 hours if discharged ``` ## Troubleshooting ### QuestionnaireResponse Resource Not Supported by Server - Fall back to creating Observation resources only with the total score and LOINC code. - Document individual item responses in `Observation.note[].text` as structured text. - Some servers accept QuestionnaireResponse but require a canonical Questionnaire URL. Use standard URLs: `http://loinc.org/vs/LL3342-0` for PHQ-9, `http://loinc.org/vs/LL3318-0` for GAD-7. ### Prior Screening Scores Not Found - Scores may be stored in different Observation categories. Try searching without category filter: `patient=[id]&code=44249-1&_sort=-date`. - Some systems store screening results as part of encounter notes (DocumentReference) rather than discrete Observations. Note that trend analysis is unavailable. - Check if DiagnosticReport contains embedded screening results. ### RiskAssessment Resource Not Supported - Document suicide risk assessment entirely within Observation resources using LOINC 89206-7 (C-SSRS). - Add clinical detail in `Observation.note[]` including risk level, protective factors, and disposition plan. - If no structured resource is available, clearly present the safety assessment in the output for clinical documentation. ## Related Skills - `medication-reconciliation` -- for reviewing psychotropic medication lists - `clinical-summary-generator` -- for comprehensive summary including behavioral health - `follow-up-task-generator` -- for scheduling follow-up screening and safety check-ins - `referral-generator` -- for generating psychiatry or therapy referrals --- > Converted and distributed by [TomeVault](https://tomevault.io/claim/langcare) — claim your Tome and manage your conversions.