I faced many challenges while working on this special unit, including difficulties communicating with many of the more severely impaired patients. Obtaining a collateral history took on increased significance when evaluating MR patients, analogous to working with geriatric patients with dementia. For instance, a patient with a very low IQ may provide a history with less clarity or fewer details. In contrast, verbal communication by other patients was clear to attuned evaluators and highlighted the need to assess each person individually. In this way, psychiatry residents modified their interviewing skills to obtain an accurate evaluation. We learned to approach MR patients with a somewhat different interviewing technique, looking at cases from "outside the box."