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Practice case P2-03 · Face-to-face · simulated patient
“I’m not coping” — low mood and suicidal thoughts
A 30-year-old man has booked an urgent appointment because he feels “down”. He will not mention suicide unless you ask.
Reviewed and kept current
Station family: Mental health assessment and safety planning · 8-minute station · 1 min 30 s reading · Last editorial review: 19 September 2026.
Candidate instructions
Read this as you would outside the room
You have 1 minute 30 seconds to read, then 8 minutes. Candidates: everything below this section is folded away — leave it closed until you have finished the station.
| Information | |
|---|---|
| Your role | Foundation Year 2 doctor in a general practice |
| Patient | Mr Daniel Ibrahim, 30, software engineer |
| Reason for appointment | Booked an urgent same-day appointment. The receptionist’s note says: “feeling down, wants to see someone today”. |
| Records | No significant past medical history. No regular medication. No allergies. |
Your task
•
Assess his mental state.
•
Assess his safety.
•
Agree an immediate management plan with him.
•
You are not required to perform a physical examination.
Folded away
For the actor and the examiner
1 · Actor script — role player only
Candidates: do not open until you have consulted.
Persona and manner
- Daniel Ibrahim, 30. Flat voice, slow answers, little eye contact, shoulders down. Not tearful — emptied out. You answer what you are asked, briefly.
Opening line — say this verbatim
- “I’m not coping. I don’t really see the point any more.”
Volunteer freely if given the space
- About two months of feeling low most of the day, every day. Nothing is enjoyable — you have stopped going to five-a-side and stopped coding for fun.
- Waking at 4 am and lying there. Little appetite; you have lost some weight. You cannot concentrate at work and have had a warning about missed deadlines.
Only if asked
- Your partner of four years, Leila, left ten weeks ago. You live alone now.
- You feel like “a burden” to your family, and guilty that you “drove her away”.
- Only if asked directly about suicide or ending your life: yes — most days for the past two weeks. You have thought about taking the zopiclone you have at home (a box of 28 left over from a locum prescription last year) with whisky. Three nights ago you took the box out and counted the tablets, then put them back. You have not written a note or made other preparations. You have never attempted suicide or harmed yourself before.
- What stopped you: your sister Amira — “she’d be the one to find me” — and your faith; you are a practising Muslim and believe it is forbidden.
- Alcohol: nothing in the week, but most of a bottle of whisky across Friday and Saturday nights. It makes the thoughts worse. No drugs.
- No voices, no unusual beliefs, no periods of high mood or needing little sleep. No thoughts of harming anyone else.
- Your mother had depression. No family suicide.
- Tonight you would be at home on your own. Amira lives 15 minutes away and you speak most days; she knows you are low, not about these thoughts.
Ideas, concerns and expectations
- Idea: “I think I’m depressed.”
- Concern: being “locked up”, and work finding out.
- Expectation: you do not really know — “something to make it stop”. Perhaps tablets.
Cues to deliver, timed
- Minute 2: “Everyone would honestly be better off.” — then look at the floor.
- Minute 4, if suicide has not been asked about: “I’ve got those sleeping tablets at home… they don’t even work.”
- If the doctor asks about suicide using a euphemism only (“dark thoughts”, “doing anything silly”): “What do you mean?”
How to respond to the doctor
- If asked about suicide plainly and kindly: a long pause, then you answer honestly. You look relieved afterwards: “I’ve not said that out loud before.”
- If the doctor makes a plan with you — being seen by the mental health crisis team today, Amira staying tonight and taking the tablets away, no whisky, numbers to ring, a follow-up appointment: you agree. You will let the doctor ring Amira with you in the room.
- If the doctor says “you need to be sectioned” or threatens admission: alarmed — “I came here for help, not to be locked up.”
- If the doctor just gives antidepressants and “come back in two weeks”: say “OK” flatly and get up to leave.
- If asked whether you can keep yourself safe tonight: “If Amira’s there, yes. On my own… I don’t know.”
Do not
- Mention suicide, the tablets being counted, or the whisky unless the doctor asks (apart from the timed cue).
- Become agitated or psychotic. You are low, slowed and honest.
2 · Examiner mark sheet — generic scheme, identical at every station
Domain marks
| Domain (GMC wording) | 1 | 2 | 3 | 4 | Score |
|---|---|---|---|---|---|
| 1 · Data gathering, technical and assessment skills | ☐ | ☐ | ☐ | ☐ | /4 |
| 2 · Clinical management skills | ☐ | ☐ | ☐ | ☐ | /4 |
| 3 · Interpersonal skills | ☐ | ☐ | ☐ | ☐ | /4 |
| Station total | /12 |
Examiner's overall judgement (standard-setting only — it does not decide your result): ☐ Unsatisfactory ☐ Borderline ☐ Satisfactory ☐ Good
What each mark means
| Mark | Acumen training descriptor — applies to each domain | Typical picture |
|---|---|---|
| 4 | Complete, prioritised and fluent. Every key task for the domain achieved; nothing unsafe; the patient's agenda visibly shapes the consultation. | A confident F2 you would be happy to have on your team. |
| 3 | Competent. Most key tasks achieved; omissions are minor and do not affect safety or the patient's understanding. | Safe and sound, with small gaps. |
| 2 | Borderline. Some key tasks achieved but important gaps, poor prioritisation or a disorganised approach. Nothing dangerous. | Would be safe with supervision; the station could go either way. |
| 1 | Poor or unsafe. Few key tasks achieved; major omissions or incorrect reasoning; communication that damages rapport — or a safety-critical action missed, harmful advice given, or disrespectful behaviour, whatever else was done well. | Below the standard expected of an F2; patient safety or trust compromised. |
GMC feedback statements — where underperformance was identified
A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. Tick every statement that applied; leave all blank if none did.
| Tick | GMC feedback statement | Underperformance it signals |
|---|---|---|
| ☐ | 1 · Consultation | Disorganised or unstructured consultation |
| ☐ | 2 · Issues | Key issues or priorities not recognised |
| ☐ | 3 · Time | Poor time management |
| ☐ | 4 · Findings | Abnormal findings or results, or their implications, not identified |
| ☐ | 5 · Examination | Physical examination or use of instruments not competent |
| ☐ | 6 · Diagnosis | Working diagnosis or differential diagnoses not correct |
| ☐ | 7 · Management | Management plan not reflecting current best practice |
| ☐ | 8 · Rapport | Rapport and sensitivity to the patient’s feelings and concerns not shown |
| ☐ | 9 · Listening | Verbal and non-verbal cues not used; poor active listening |
| ☐ | 10 · Language | Language or explanations not understandable; understanding not checked |
Timing checkpoints (observer)
| Timing checkpoint (8-minute station) | Done | Minute |
|---|---|---|
| Name and GMC number confirmed; patient greeted and identified; patient opens without interruption | ☐ | |
| Presenting problem characterised and red flags screened by 3:30 | ☐ | |
| Ideas, concerns and expectations elicited by 4:30 | ☐ | |
| Examination requested / findings obtained and a summary offered by 5:30 | ☐ | |
| In management — explanation started — by 6:00, with two minutes left (no warning bell is guaranteed in the real examination) | ☐ | |
| Specific safety-net, follow-up and understanding check before 8:00 | ☐ |
Full explanation: the mark scheme and how PLAB 2 is passed · anatomy of the 8-minute station.
3 · Station-specific marking standard — what earns 4, 3, 2 and 1 here
Use with the generic sheet. The top row lists what a competent F2 would do at this station; lower rows describe how performance falls away. Acumen training standard — the GMC does not publish station mark sheets.
| Mark | Domain 1 · Data gathering, technical and assessment skills | Domain 2 · Clinical management skills | Domain 3 · Interpersonal skills |
|---|---|---|---|
| 4 |
|
|
|
| 3 | Suicide asked about directly, plan and means identified; one area thin (alcohol, psychosis screen, or protective factors). | Same-day specialist assessment and a safety plan arranged; one of means removal, senior involvement or early follow-up missing. | Warm and non-judgemental; one cue missed or plan more told than agreed. |
| 2 | Depression history adequate but suicide enquiry late, euphemistic or superficial (asks about thoughts, not plan or means). | Recognises seriousness but plan is loose: “I’ll refer you to the mental health team” without urgency, or crisis numbers only. | Checklist tone; rapid-fire screening questions; moves on quickly after the disclosure. |
| 1 | Generic low-mood history; safety not meaningfully assessed. Or unsafe: does not ask about suicide. | Routine plan: antidepressant and review in two weeks; means not addressed. Or unsafe: lets him leave alone with no safety plan; or threatens compulsory admission as the first step with a consenting patient who has capacity. | Visible discomfort, platitudes (“you’ve got so much to live for”), or lecture about alcohol. Or unsafe: judgemental, dismissive, or breaches trust (rings the sister without asking). |
4 · Examiner points of fact and guidelines
Points of fact the examiner should have to hand
- Asking about suicide does not plant the idea. Ask plainly: “Have you had thoughts of ending your life?”
- NICE NG225 (2022): do not use risk assessment tools or scales to predict suicide, and do not use “low / medium / high” risk labels to decide who gets care. Base the plan on a psychosocial assessment of needs, safety and vulnerabilities.
- Features here that demand same-day specialist assessment: a specific plan, means at home, a preparatory act (counting tablets), alcohol, recent loss, living alone.
- A safety plan is written with the patient: warning signs, coping strategies, people and places for distraction, people to ask for help, professional and crisis contacts, making the environment safe.
- Crisis routes in England: NHS 111 and select the mental health option; Samaritans 116 123 (free, 24 hours); 999 or the emergency department if life is at immediate risk. Local crisis team access varies across the four nations.
- He has capacity and accepts help, so the Mental Health Act is not the starting point. Confidentiality: seek consent to involve his sister; disclosure without consent is justified only to protect from serious harm (GMC Confidentiality guidance).
- Antidepressants are not the emergency treatment. If started after assessment, NICE NG222 advises review within one week for people aged 18–25 or where there is concern about suicide risk, and consideration of toxicity in overdose and limited quantities.
- Examination of mental state counts as clinical examination in PLAB 2 (GMC). Comment on appearance, behaviour, speech, mood and affect, thought content, perception, cognition and insight.
Where candidates lose marks at this station
- “Any dark thoughts?” — and moving on.
- Labelling him “medium risk” instead of making a plan.
- Sertraline and a fortnight.
- Ringing the sister without asking him.
Guidelines for this station
5 · MLA content map tags for this case
| MLA content map | This station |
|---|---|
| Domain 1 · Areas of clinical practice | Mental health · General practice and primary healthcare |
| Domain 3 · Clinical and professional capabilities | History, examination and differential diagnosis · Safeguarding vulnerable patients · Managing risk · Capacity, consent and confidentiality |
| Domain 5 · Patient presentations | Altered mood · Suicidal thoughts · Self-harm · Sleep problems · Substance misuse |
| Domain 6 · Conditions | Depression · Self-harm |
| Station family | History, diagnosis and management — Mental health assessment and safety planning |
6 · My marks and reflection — practice log form
Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.
Record my marks and reflection for P2-03
Revision link for this case: acumenprimarycare.com/plab-2-osce/case-03-low-mood-suicide-risk
Independence & scope. Independent, formative training material from MD Acumen Ltd. Not affiliated with, endorsed by, or delivered on behalf of the General Medical Council. The GMC does not publish its station mark sheets: every mark scheme and descriptor on these pages is an Acumen training tool calibrated to the GMC's published marking domains, feedback statements and the MLA content map. Practice scores are not a prediction of examination performance. Clinical content reflects UK guidance at the date of editorial review — always check the current guideline. All patients are fictional.
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