Education and care-planning support only — does not replace clinical judgment or local protocols.

🩺 CP-MIND — Mood & Mind Screen

Low mood, anxiety, confusion and self-harm risk. · Group P Emotions and mind · Links to: P1–P29

Original tool, not yet validated. Pilot and review with clinicians before clinical decisions. Supports, but does not replace, clinical judgment, validated scales and local policy.

Patient

Date/Time

Nurse

Item	0	1	2
Mood in last 2 weeks	0 · Fine	1 · Low some days	2 · Low most days
Worry / anxiety	0 · Calm	1 · Worried at times	2 · Constant worry or panic
Sleep and appetite	0 · Normal	1 · Changed	2 · Much worse
Interest in things	0 · Normal	1 · Less	2 · None
Orientation (time, place, person)	0 · All correct	1 · 1 wrong	2 · 2–3 wrong or new confusion
Thoughts of self-harm	0 · No	1 · Passive thoughts	2 · Plan or intent — URGENT

⚠ Red flags — escalate at once regardless of score

Any plan or intent to self-harm

Total: 0 — select a score for each item

Score	Level	Action
0–3	Low	Support and listen
4–7	Medium	Inform doctor, consider mental-health referral
≥8 or self-harm item = 2	High	Do not leave alone, escalate now

Nursing notes / action taken

⬇ Blank form (PDF)