Educational purposes only. These scenarios are designed to support learning and reflection. In real clinical situations, nurses must always follow their organisation's local policies, trust protocols, and current national guidance including NICE guidelines, the NMC Code (2018), and relevant legislation. Clinical judgement and senior support should always be sought when managing complex situations.
Section 136: Person in Mental Health Crisis in a Public Place
A police officer has brought a 34-year-old man to the Section 136 suite. He was found in a park, distressed and shouting, and appeared to be responding to voices. He has no known psychiatric history. You are the receiving nurse.
Capacity Assessment: Refusing Medication
Margaret, 67, is an informal patient on an acute mental health ward with a diagnosis of severe depression. She is refusing her antidepressant medication, saying she does not believe it will help. You need to assess her capacity to make this decision.
Rapid Tranquilisation: Managing Acute Agitation
David, 28, is detained under Section 3 MHA. He has a diagnosis of schizophrenia and is acutely agitated, threatening staff, and has already damaged property on the ward. De-escalation has been attempted for 20 minutes without success. The team is considering rapid tranquilisation.
Clozapine Monitoring: Recognising Serious Side Effects
Sarah, 42, has been on clozapine 400mg daily for 3 years for treatment-resistant schizophrenia. She attends the clozapine clinic and reports feeling unwell for the past week — sore throat, fever, and fatigue. Her last FBC was 3 weeks ago.
Section 5(4): Nurse's Holding Power
You are a registered mental health nurse (RMN) on an acute inpatient ward. Michael, 29, an informal patient admitted yesterday with a first episode of psychosis, tells you he is leaving the ward immediately. He is highly agitated and you believe he is at immediate risk of serious harm to himself if he leaves.
Safeguarding Adults: Disclosure of Suspected Abuse
During a ward review, a 68-year-old female patient with a history of depression discloses that her son has been taking money from her bank account without her consent. She asks you not to tell anyone.
Lithium Toxicity: Recognition and Immediate Management
You are a nurse on an acute psychiatric ward. A 45-year-old man with bipolar disorder on lithium carbonate 800mg twice daily presents with coarse tremor, confusion, and vomiting. His last lithium level was 0.8 mmol/L three weeks ago.
Mental Capacity Act: Assessing Capacity to Refuse Treatment
A 52-year-old woman with schizophrenia is refusing her depot antipsychotic injection. She has been stable for two years on this medication. She says she wants to stop because she has gained weight. You need to assess her capacity to make this decision.
Risk Assessment: Acute Suicidal Ideation in the Community
You are a community mental health nurse visiting a 38-year-old man with recurrent depression. During the visit he discloses active suicidal ideation with a specific plan to overdose on his antidepressants tonight. He lives alone.
De-escalation: Managing Acute Agitation on the Ward
A 28-year-old man with a first episode of psychosis is becoming increasingly agitated on the ward. He is pacing, shouting, and has knocked over a chair. Other patients are distressed. You are the nurse in charge.
Clozapine Monitoring: Neutropenia Alert
A 35-year-old man with treatment-resistant schizophrenia has been on clozapine for 18 months. His weekly blood result shows a neutrophil count of 1.4 × 10⁹/L (amber alert). He is currently asymptomatic.
Physical Health Monitoring: Metabolic Side Effects of Antipsychotics
A 42-year-old woman with schizophrenia has been on olanzapine 20mg for three years. At her annual physical health review you note she has gained 18kg since starting the medication, her BMI is 32, her fasting glucose is 7.2 mmol/L, and her blood pressure is 148/92 mmHg.
MDT Communication: Handover and Escalation
You are a newly qualified nurse on an acute psychiatric ward. During handover you are told that a patient, Mr Singh, 55, has been increasingly withdrawn and refusing meals for the past 48 hours. The previous nurse did not escalate this. You are now responsible for his care.
Section 2 MHA: Supporting a Formal Assessment
A 29-year-old woman with no previous psychiatric history has been brought to A&E by her family. She is expressing paranoid beliefs, has not slept for five days, and is refusing all assessment. The AMHP and two doctors are about to conduct a Section 2 assessment. You are the nurse supporting the process.
Eating Disorders: Managing Refusal to Eat and Refeeding Risk
A 19-year-old woman with anorexia nervosa is admitted to an eating disorder unit with a BMI of 13.5. She is refusing all oral nutrition. Her potassium is 2.8 mmol/L and her phosphate is 0.6 mmol/L. She is medically compromised.
Medication Adherence: Exploring Non-Adherence Therapeutically
During a CPA review, a 34-year-old man with bipolar disorder tells you he has stopped taking his mood stabiliser (lithium) because 'it makes me feel like a zombie'. He has been well for 18 months. He does not want to be admitted.
PTSD: Trauma-Informed Care and Avoiding Re-traumatisation
A 31-year-old woman with PTSD following domestic violence is admitted to an acute psychiatric ward following a suicide attempt. She becomes very distressed when a male nurse attempts to conduct a physical health assessment. She asks for a female nurse.
Section 5(2): Nurse's Assessment of Informal Patient at Risk
You are the nurse in charge on an acute psychiatric ward. An informal patient, Mr Obi, 40, with severe depression, tells you he wants to leave the ward immediately. He has expressed suicidal intent earlier today and the duty doctor is unavailable for 30 minutes.
Perinatal Mental Health: Postnatal Psychosis
A community midwife contacts the perinatal mental health team about a 26-year-old woman who gave birth five days ago. Her partner reports she has not slept for four days, is expressing grandiose beliefs (saying she has special powers), and has been behaving erratically. She has no previous psychiatric history.
Dual Diagnosis: Mental Illness and Substance Misuse
A 32-year-old man with schizophrenia is admitted following a relapse. He discloses he has been using cannabis daily and drinking heavily. He says the cannabis helps him sleep and the alcohol calms his voices. He is reluctant to engage with substance misuse services.
Older Adult: Delirium vs Dementia — Differential Assessment
An 82-year-old man with known vascular dementia is admitted to an older adult psychiatric ward. His family report he has become acutely confused over the past 24 hours, is seeing things that are not there, and is very agitated. His usual baseline is mild-to-moderate cognitive impairment.
Carer Support: Recognising and Responding to Carer Needs
During a home visit to a 58-year-old man with treatment-resistant depression, you meet his wife who has been his sole carer for five years. She appears exhausted, tearful, and tells you she 'cannot cope anymore'. She has not had a break in two years.
Rapid Tranquillisation: Safe Administration and Monitoring
A 25-year-old man with acute psychosis is extremely agitated and has attempted to assault a staff member. Oral and IM lorazepam have been offered but refused. The psychiatrist has prescribed IM haloperidol 5mg and IM lorazepam 2mg for rapid tranquillisation (RT). You are the nurse administering the medication.
Learning Disability: Communication and Reasonable Adjustments
A 24-year-old man with a moderate learning disability and anxiety disorder is admitted to an inpatient unit. He is very distressed and unable to communicate verbally. His support worker is not present. He is hitting himself on the head.
Substance Misuse: Opioid Withdrawal and Methadone Safety
A 38-year-old man with opioid dependence is admitted to a detoxification unit. He is prescribed methadone 60mg daily as part of an opioid substitution programme. On day two of admission, he reports severe withdrawal symptoms and requests additional methadone. He says his community prescription was 80mg.
Eating Disorders: MARSIPAN — Medical Emergency in Anorexia
A 19-year-old woman with severe anorexia nervosa is admitted to an inpatient psychiatric unit. Her BMI is 13.2. She is bradycardic (HR 42 bpm), hypotensive (BP 88/54), and hypothermic (35.1°C). She refuses all physical health monitoring and oral nutrition. She has capacity.
Eating Disorders: Bulimia Nervosa — Physical Complications and Risk
A 22-year-old woman with bulimia nervosa presents to the community eating disorder service. She reports purging 10–15 times daily for the past three weeks. She has palpitations, muscle cramps, and dental erosion. Her GP has requested urgent bloods. Her potassium is 2.8 mmol/L.
Perinatal Mental Health: Antenatal Depression and Risk
A community midwife refers a 29-year-old woman who is 28 weeks pregnant. She has been crying daily for six weeks, has stopped attending antenatal appointments, and her partner reports she has said she 'doesn't want to be here anymore'. She has a history of depression treated with sertraline, which she stopped when she found out she was pregnant.
Perinatal Mental Health: Mother and Baby Unit Admission
A 31-year-old woman, three weeks postpartum, is brought to A&E by her husband. She has not slept for five days, believes her baby has been replaced by a demon, is refusing to feed the infant, and has made a statement about harming the baby. She has no previous psychiatric history.
Learning Disabilities: Restrictive Practice and Positive Behaviour Support
A 35-year-old man with a moderate learning disability and autism spectrum condition is an inpatient on a specialist learning disability ward. He has been placed in prolonged prone restraint (face-down) by two staff members for 18 minutes following a behavioural incident. He is now calm. The nurse in charge arrives on the ward.
Learning Disabilities: Capacity Assessment and Communication Adjustments
A 28-year-old woman with a mild learning disability is admitted to a general hospital ward for an elective surgical procedure. She has become very distressed and is refusing consent for the operation. The surgical team asks the psychiatric liaison nurse to assess her capacity. She communicates using Makaton and simple sentences.
Deprivation of Liberty Safeguards: Applying for a Standard Authorisation
An 82-year-old woman with moderate dementia is admitted to your ward from a care home. She lacks capacity to consent to her admission and treatment. The ward manager asks you to initiate the DoLS process.
Absent Without Leave: Managing a Patient Who Has Gone AWOL
You are a nurse on an acute inpatient ward. A detained patient (Section 3) has been found to be absent without leave. You must manage the immediate response, documentation, and return of the patient.
First Episode Psychosis: Assessment and Early Intervention
A 19-year-old student is brought to the emergency department by his parents. He has become increasingly withdrawn over the past 3 months, believes his thoughts are being broadcast on the radio, and has not slept for 4 days. This appears to be his first episode of psychosis.
Community Treatment Order: Recalling a Patient to Hospital
You are a community psychiatric nurse (CPN). Your patient, Sarah, 35, is on a Community Treatment Order (CTO) following a Section 3 detention. She has stopped taking her medication, is becoming increasingly unwell, and is not engaging with the community team.
Alcohol Withdrawal: Recognition and Management on an Inpatient Ward
You are a nurse on an acute mental health inpatient ward. A 45-year-old man admitted yesterday for depression has become increasingly agitated, sweaty, and tremulous. He did not disclose his alcohol use on admission.
Medication Refusal: Treating a Detained Patient Without Consent
A 30-year-old man detained under Section 3 is refusing his prescribed antipsychotic medication. He says the medication makes him feel like a zombie and he does not believe he has a mental illness. You must navigate the legal and ethical framework for treating him without consent.
Serotonin Syndrome: Recognition and Emergency Management
A 28-year-old woman on the ward has been prescribed sertraline 100mg and tramadol for pain. She has developed agitation, muscle rigidity, hyperthermia, and clonus. You suspect serotonin syndrome.
Mental Health Tribunal: Preparing the Nursing Report
Your patient, detained under Section 3, has applied to the First-tier Tribunal (Mental Health). You are asked to prepare the nursing report for the tribunal. This is your first time preparing a tribunal report.
Postpartum Psychosis: Emergency Assessment and Management
A community midwife calls you urgently. A 26-year-old woman, 5 days postpartum, has become acutely confused, is not sleeping, believes her baby has been replaced by a demon, and is refusing to feed the baby. Her husband is very distressed.
Capacity Assessment for Electroconvulsive Therapy (ECT)
A 55-year-old woman with severe treatment-resistant depression is being considered for ECT. She is an informal patient. She says she does not want ECT as she is 'scared of electricity'. You must assess her capacity to make this decision.
Forensic Mental Health: Transfer from Prison to Hospital Under Section 48
You are a nurse on a medium secure unit. A 38-year-old man is being transferred from prison under Section 48/49 MHA 1983. He has been on remand for assault and has developed acute psychosis in prison.
Community Crisis: Home Assessment of a Person in Mental Health Crisis
You are a nurse in a Crisis Resolution and Home Treatment (CRHT) team. You are called to assess a 42-year-old man at home who has called the crisis line saying he is having thoughts of suicide. His wife is present and very distressed.
Discharge Planning: Safe Discharge from Inpatient to Community
You are the named nurse for a 45-year-old man who is ready for discharge after a 6-week inpatient admission for a manic episode. He has no fixed abode and limited social support. The MDT is planning his discharge for next week.
Eating Disorder: Recognising and Preventing Refeeding Syndrome
A 22-year-old woman with severe anorexia nervosa (BMI 13.5) is admitted to an eating disorders unit. She is to commence nutritional rehabilitation. You must monitor for refeeding syndrome.
Borderline Personality Disorder: Managing a Crisis Presentation
A 27-year-old woman with a diagnosis of Borderline Personality Disorder (BPD/EUPD) presents to the crisis team following a superficial self-harm episode. She is distressed and demanding admission. The team is considering whether admission is appropriate.
Alcohol Withdrawal: Recognising and Managing Delirium Tremens
A 45-year-old man admitted to an acute psychiatric ward for depression is found to be trembling, sweating, and confused on day 2 of admission. He had not disclosed his alcohol use on admission.
Community Treatment Order: Managing a Recall to Hospital
A patient on a Community Treatment Order (CTO) has stopped taking his depot antipsychotic and his mental state is deteriorating. The Responsible Clinician is considering recall to hospital.
Postpartum Psychosis: Emergency Assessment and Management
A community midwife calls the mental health crisis team about a 28-year-old woman who gave birth 5 days ago. She has not slept for 3 days, is talking rapidly about a 'special mission', and her husband is frightened.
Electroconvulsive Therapy: Capacity Assessment and Consent
A consultant psychiatrist has recommended ECT for a 62-year-old woman with severe treatment-resistant depression. She is on s.3 detention. The team needs to assess her capacity to consent to ECT.
Mental Health Tribunal: Preparing the Nursing Report
A patient detained under s.3 has applied to the Mental Health Tribunal. You are the named nurse and have been asked to prepare the nursing report for the tribunal.