OSCE APIE Scenario: Anxiety and Depression

The mental health scenario is the station candidates fear for the wrong reason. They worry about saying something harmful; the actual fail mode is not saying the necessary thing: the direct question about suicide. Everything else in the station rewards ordinary human warmth done deliberately.

Assessment. Setting first: privacy, sitting at their level, unhurried. Then the mood history through open questions: sleep, appetite, energy, concentration, enjoyment, how long it’s been like this, what’s changed. The station may reference screening scores (PHQ-9, GAD-7) in the notes; know they measure severity, not risk. Risk is its own conversation, built stepwise and asked directly: how low does it get; thoughts of self-harm; thoughts of ending your life; and if yes: plan, means, timing, previous attempts, what’s kept them here. Asking does not plant the idea. Evidence and every UK guideline agree, and the checklist marks the question being asked, kindly and plainly.

Planning. Match the response to the risk. Low: support, follow-up, signposting. Moderate: a collaborative safety plan: coping steps, means made safer, named contacts and crisis numbers, arranged follow-up. High (thoughts with plan and means, preparations, hopelessness): the person isn’t left alone, and escalation to the responsible clinician and mental health team happens now. Anxiety threads its own goals: panic understood and manageable, avoided activities gradually reclaimed.

Implementation. The listening is the intervention: open questions, silences allowed to work, reflections (“it sounds like the nights are worst”), no minimising, no premature fixing. For acute panic: stay calm, name what’s happening (“this is your body’s alarm system; it peaks and passes”), slow-breathing coaching, grounding. Practical care continues: physical symptoms assessed rather than dismissed, sleep and eating supported, medication questions answered honestly, and the raising concerns pathway used without hesitation when risk climbs.

Evaluation. Re-ask the mood and risk questions rather than assuming yesterday’s answers; risk moves. Is the safety plan real to them: can they say what they’d do at 3am? Are follow-ups actually booked, contacts actually in their phone? Documentation carries the exact words where they matter (“said he’d thought about taking all his tablets”), the risk formulation, actions and who was informed. Precision here is clinical, not clerical.

Five questions below, then a hard clinical turn: the ectopic pregnancy scenario, the emergency hiding in Part B.