SCA practice case · Telephone consultation
“They’re watching him through the telly, he says”
Telephone consultation
Young person patient
Someone else speaking
Hard
Children & young peopleMental health & addictionUrgent & unscheduled care
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Daniel · 17 years · male
Setting
Telephone — mother describing her son’s frightening change.
Past history
- Nil significant
- No previous mental health contact
Medication
- No regular medication
Allergies
NKDA
Recent notes
⚠ Telephone call-back requested by his mother: “He’s changed completely and I’m frightened.” Daniel is at home and will not come to the phone. No previous consultations about mood or behaviour.
Reason for contact
Mother asking for advice about her son’s behaviour. “Is he on drugs? Is he having a breakdown?”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Weeks of progressive withdrawal, insomnia, auditory hallucinations, persecutory and referential delusions (the TV "watching/sending messages"), functional decline and self-protective behaviour in a teenager is probable first-episode psychosis — a serious but treatable condition where early intervention improves outcomes, and must not be dismissed as "just drugs" or "a phase". The tasks: recognise it, assess risk through the collateral history (self-harm/suicide, harm to others, command hallucinations, ability to stay safe, household safety), and arrange URGENT same-day assessment via the Early Intervention in Psychosis/crisis pathway (NICE CG155: urgent referral for a first presentation of sustained psychotic symptoms; no antipsychotic started in primary care without a consultant child and adolescent psychiatrist), with home-based assessment for a young person who won’t engage and 999/police if there is immediate danger. Cannabis is a relevant precipitant but not a blame narrative. The examinable hidden agenda is the mother’s guilt ("I caused it by missing the cannabis") and her unspoken terror that he has inherited his father’s illness and will be "locked away forever" — address both with compassion and honest, hopeful information about community treatment and recovery, and support the family. A concrete, coordinated safety plan, not just information, wins the station.
The guidance behind it
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