Candidate Instructions 🐼
You are working in a community mental health clinic. Captain Dan Hughes, a 38-year-old Royal Navy officer, has been referred by his GP with ongoing psychological difficulties since returning from service in the Middle East.
Please take a history from Captain Hughes.
Actor Instructions
You are Captain Dan Hughes, aged 38, a senior Royal Navy officer. Throughout the consultation, you seem tightly wound-alert, tense, and you keep scanning the room, sometimes fidgeting with your watch or the tissues on the table. You apologise for being “on edge” and describe struggling to feel settled or safe, even outside work.
If the doctor asks how things started, say that about 4 months ago, while deployed to support allied forces overseas, your patrol was caught in an unexpected attack. You were unharmed, but three close colleagues were badly injured-one lost a leg. You were responsible for calling in medical help and managing the initial chaos until reinforcements arrived. You remember it all in fragments-loud noises, shouting, and a flash of blood and dust. For the first few days after, you pushed on with work, throwing yourself into duty and not really thinking about it. Once back home, though, things began to unravel.
You say that almost every night, you are woken by a replay of the attack. “It feels like I’m there again-the same sounds, even the smell of smoke. Sometimes I wake up shouting or drenched in sweat.” Daytime is also hard: loud noises (a backfiring motorbike, a dropped pan) make your heart race, and you have, on a few occasions, thrown yourself to the ground before you realise you are not in danger. Any films or news about armed conflict bring back a flood of images-you avoid them, as well as anything remotely military, which makes socialising with former colleagues difficult.
You actively avoid certain places, especially those that remind you of the deployment (crowds, busy streets, even family barbecues when fireworks might go off or there may be loud noises). You admit that you have deliberately missed out on some family events, even your nephew’s birthday, because you “just couldn’t face” the possibility of a trigger. You describe feeling emotionally blunted: “It’s like there’s a wall between me and everyone else…” You say you try to reassure your wife and two boys but struggle to show them affection. You used to love running and sailing, but lately, you’ve lost interest and often just sit watching TV for hours. You have been discharged from the military and are not currently working.
If asked directly, you confide that your sleep has been poor (“broken, restless-sometimes I just wander the house”), and while your appetite is fair, you don’t get much pleasure from food or drink. You mention drinking “a few whiskys” most evenings to help get to sleep, more than you used to, but deny using any drugs.
You’re not tearful, but say you feel “numb or cut off” rather than sad. You find it hard to concentrate and sometimes worry if you could have done more to prevent what happened.
If asked about risk, you state explicitly that you don’t wish to harm yourself or others and have never thought about suicide. You own firearms for sporting purposes (verified on your firearms license), which you have locked securely away and have never considered using in anger or distress.
You have no history of previous mental health issues or criminal problems and no significant medical concerns beyond some sports injuries. If asked directly about coping or support, you say that your wife and close friends know a little about what happened-but you don’t like to talk about it, preferring to “keep busy or just drink until I feel quiet.”
If the doctor is gentle, checks your understanding often, and allows silences, you gradually share more detail and may ask if it’s really possible for things to get better.