Cases/Patient < 19 years old

Fifteen Year Old Whose Mother Found Cuts On Her Thighs — Free SCA Practice Case

Fifteen year old whose mother found cuts on her thighs

Station Timer

12:00

Golden Minute

Initial Introduction

•Introduce yourself

•Ask an open question — "How can I help you today?"

•Listen — don't interrupt

•Catch early cues

Data Gathering

History, ICE & Diagnosis

Clinical Management

Diagnosis, Plan & Decisions

Safety Net

Follow-up & Close

12:00

Golden Minute

Try 5 free cases

Five cases are free: a live 12-minute consultation with an AI patient each, marked, and no card.

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Tegan Rutherford

Age

15 years

Consultation Type

Video

Age

Situation

Video Consultation. Booked by her mother, who is with her at the start of the call.

Reason for Encounter

Mother, at booking: "I found cuts on Tegan's thighs last night. She says it's nothing but she's not herself. Please can someone see her."

Medical Records

●PMH: Eczema in childhood, resolved. Immunisations up to date, including the school teenage booster.
●Medications: None.
●Allergies: NKDA.
●Social: Year 11 at secondary school. Lives with her mother.

Patient Script

For the friend playing the patient role

Character Overview: You are Tegan Rutherford, 15, in Year 11 and sitting GCSEs this year. You live with your mum, Denise, a dental receptionist. Your dad, Gareth, lives in Swindon and has you every other weekend. You play wing attack for the school netball team. Your nan, Margo, lives five minutes away and looks after your dog, Pickle, on school days. About seven weeks ago you sent a private photo of yourself to a boy you liked, Jayden, who is 16 and in Year 12. Three weeks ago he shared it in a group chat and it spread across the sixth form and your year. People have sent you horrible messages and some say things in the corridor. About four weeks ago you started cutting your thighs when the feelings get too much. Last night your mum came into your room as you were changing and saw the marks. She was upset, and you told her it was nothing. She booked this appointment and is sitting next to you at the start of the call. You are ashamed, exhausted and frightened, and very guarded while your mum can hear. Once she has stepped out you talk quietly and quickly, as if you have been holding it in, and you cry a little when you talk about the photo. Only your friend Amani knows about the photo.

Opening Sentence: "Hi. Mum made me come. She found some marks on my legs and she's gone mental about it, but it's honestly nothing. I'm fine."

History if Asked (Data Gathering Phase)

Gating note: While your mum is on the call, give only short answers such as "It's just stuff", "I'm okay" and "School's just annoying". If the doctor suggests some time on your own, you agree: "Yeah, okay. Mum, can you wait in the kitchen? ... She's gone." After that, answer fully. If no one asks to speak to you alone, keep to the short answers.

●How it started: "About four weeks ago. Something happened online and I couldn't switch my head off. I did it once and it felt like the noise stopped for a bit. So I did it again."
●How often and where: "Maybe six or seven times. Only my thighs, where clothes cover it. It's a bit more often now. Last night was the last time, just before Mum came in."
●What it feels like: "Like the horrible feeling drains out for a few minutes. Then I feel stupid and ashamed and hide it. I wear leggings even for PE."
●The marks: "Scratches and a few cuts, nothing deep. The newest ones sting. One looked a bit red yesterday but there's no pus. I clean them with a wipe. They don't need stitches or anything."
●Whether she has taken anything: "No tablets, nothing like that. I've never swallowed anything."
●Thoughts of not wanting to be here: "Sometimes, late at night, I wish I could just disappear so everyone would stop looking at me. But I'd never do anything. I haven't got a plan and I've never tried to badly hurt myself. I don't want to die."
●What she keeps for it: "Something sharp, in my room. I could give it to Mum if I had to. I don't really want to say more about it."
●Medicines at home: "Mum's tablets and the paracetamol are in the bathroom cupboard. I've never touched them."
●What happened online: "I sent Jayden a photo. I shouldn't have. It was private, without my top on. He said he'd delete it. Three weeks ago it was in all the group chats. People call me names, and some of the boys say things in the corridor."
●Pressure and who was involved: "He kept asking for about three weeks. I said no a couple of times, then I said yes. It was only Jayden. Nobody older has been involved."
●Messages and threats: "Loads of people I know, and some accounts I don't, with rude comments. I blocked the ones I could. Nobody has asked me for money or more pictures, and nobody has said they'd send it to Mum. I shut my Instagram and then opened a new one because I was scared of missing something."
●Mood and sleep: "Low most days. I cry in the shower so Mum can't hear. I lie awake checking my phone until very late. I've missed two weeks of netball, and I skip school a day or two a week, saying I've got a stomach ache. My appetite is okay."
●Alcohol and drugs: "I tried a vape once. No alcohol or drugs."
●Who knows: "Amani knows about the photo. Mum knows about the cuts now, but not the photo. She thinks it's some nasty group chat. Mrs Prentice, my head of year, asked if I was okay last week and I said yes."
●Feeling safe at home: "Home's fine. Mum's lovely. Nobody makes me feel in danger."

Ideas, Concerns, Expectations

Gating note: Tegan does not raise any of the following herself. Each part comes out only when the doctor asks what she thinks, what worries her, or what she hoped for from the appointment.

●Ideas: She thinks the cutting is her fault because she sent the photo, and that it is the only thing that works. "It's my own fault, I shouldn't have sent it. It's the only thing that makes it stop."
●Concerns: Her biggest fear is that her mum will find out about the photo and be ashamed of her. She also fears the school hearing, in case Jayden and his friends are told, and that she will be in trouble for sending it. "If Mum sees what I did she'll never look at me the same. And am I going to get in trouble, because I sent it?"
●Expectations: She expects to be told off. If the doctor is kind, she says what she hopes for: "I just want it to stop and I want the photo gone. I don't know if anyone can do that."

If Asked: Medical History and Medications

Gating note: Tegan answers plainly when asked.

●Other health problems: "Nothing now. I had eczema as a kid."
●Medicines and allergies: "None, and no allergies."
●Sexual contact: "No. I've never done anything with anyone. It was just the photo."
●Eating: "I eat normally. I'm not trying to lose weight."
●Family history: "Nobody hurts themselves. Nan was low for a long time after Grandad died."

Social History and Lifestyle Impact

●Home: Two bedroom house with Mum. Dad rings on Sundays and she has told him nothing. Nan is the person she trusts most: "Nan would just give me a cuddle and not make a fuss."
●School: She wants to do sports science at sixth form. She is dreading going in. She does not know who the school safeguarding lead is.
●Activities: Netball is her thing.
●Phone: She checks it constantly, afraid of what has been posted. "If you take my phone I won't know what they're saying."
●Availability: Mum works until 5, so Tegan is home alone after school. She can attend the surgery any weekday after 4.

If Asked: Associated Symptoms

Gating note: Tegan answers only when asked.

●If asked about panic or a racing heart: "My chest goes tight when my phone buzzes, but it passes."
●If asked about hearing voices, odd beliefs or hurting anyone else: "No."
●If asked about injuries elsewhere: "No, only my thighs. It's not deeper, just more often."
●If asked how she feels about tonight: "I'll be okay tonight. I just don't want Mum to see everything."

Responses to Management (The Negotiation Phase)

●
If the doctor explains confidentiality and its limits:
- ●Reaction: Wary but listening. "So you won't tell Mum? Or the school?" If told what stays private, and that safety and protecting young people may mean sharing some things, ideally with her knowing first: "So it's not a total secret. Can you tell me before anyone gets told?" If the doctor promises total secrecy, she says, "Good, thank you," and relaxes.
●
If the doctor wants her mum told about the photo:
- ●Reaction: Panics. "No, please, she'll hate me." If offered a choice (the doctor tells her, they tell her together, or Tegan tells her with the doctor there) and told Mum has been worried and wants to help: "Could you be there? Maybe you say it and I just sit there." If the doctor simply announces it: "You said you'd tell me first," and she goes quiet.
●
If the doctor says the school's safeguarding lead needs to know:
- ●Reaction: Scared. "Will Jayden find out it was me? Will they tell everyone?" If told it goes to a trained lead and the aim is to get help and stop the sharing: "Okay. But not the whole staff room." Then: "And the police? Am I in trouble for sending it?" If reassured she is being treated as the person who was harmed, and told what happens next: "Okay."
●
If the doctor offers a referral to the children and young people's mental health service:
- ●Reaction: Anxious. "Will they put me on tablets? Will I get put in hospital?" If told what a first appointment involves and roughly how soon: "Okay." If told to wait weeks with no support in between: "I can't wait that long."
●
If the doctor discusses a safety plan:
- ●Reaction: Engages. "What do I do when it's the middle of the night and I want to?" She names Nan and Amani as people to text. She would give the sharp thing to Mum once Mum knows. She would try a text helpline. "Do I have to give my phone up? I won't." If the doctor says nothing about means, she does not volunteer more.
●
If the doctor gives safety netting and arranges a review:
- ●Reaction: Wants specifics. "How will I know if it's bad enough to ring someone?" If the advice is vague ("come back if you feel worse"): "That's what everyone says. What exactly do I do?" She repeats back clearly when given specific warning signs, who to ring and a review in two days. "Can I come on my own, or does Mum have to come?"

Mark Scheme

Domain 1: Data Gathering and Diagnosis

0 / 16 indicators checked+0−0

Positive (0/8)

Negative (0/8)

Domain 2: Clinical Management and Medical Complexity

0 / 24 indicators checked+0−0

Positive (0/12)

Negative (0/12)

Domain 3: Relating to Others

0 / 14 indicators checked+0−0

Positive (0/7)

Negative (0/7)

Clinical Learning Points

The Core Dilemma and the Model Plan

●Tegan is 15 and has cut her thighs six or seven times in four weeks after a private photo she sent to a boy was shared across her school. Her mother found the cuts and sits beside her at the start. The station tests a private, non scored risk assessment, safeguarding of a shared image of a child, involving her mother with Tegan's agreement, and specialist referral.
●The model plan has eight parts. Ask for time alone, with her mother's agreement. Agree the limits of confidentiality before the sensitive history. Assess the self harm, any suicidal thinking, injuries, means and protective factors without a risk scale. Establish what happened online without seeing or describing the image. Judge that she can be managed in the community with prompt follow up. Refer to children and young people's mental health services (CAMHS) for psychosocial assessment. Act on the image through the school safeguarding lead or another local safeguarding route, with Tegan told first. Agree a safety plan and specific safety netting, and review within about 48 hours.
●Acceptable alternatives: telling her mother about the cuts first and the photo later, once Tegan agrees; the doctor telling her mother, or telling her together; making the safeguarding contact through the practice safeguarding lead or children's social care rather than the school first; urgent same day CAMHS or crisis team advice if the candidate judges risk higher, with reasons.

Assessing Self Harm in a Young Person

●Self harm is any intentional self injury or self poisoning, whatever the apparent intent. NICE Clinical Knowledge Summaries (CKS) on self harm (revised February 2025) advise assessing physical injury, emotional state, safeguarding and the person's wishes.
●The history should cover when it began, how often, whether it is escalating, what triggers it and what it does for her. Ask directly about thoughts of suicide, plans and previous attempts, and about tablets taken. Tegan has passing wishes to disappear but no plan, intent or attempt, and clear protective factors (nan, dog, netball, future plans).
●NICE NG225 (self harm: assessment, management and preventing recurrence, 2022) says not to use risk assessment tools and scales to predict suicide or repetition, nor to decide who is offered treatment. Form the judgement from the conversation and record it.

Confidentiality and Consent in a 15 Year Old

●A young person under 16 can consent to her own care if she understands the decision (Gillick competence). Confidentiality still applies to her. Offer it early and state the limits plainly: information may be shared where needed to protect her or another young person from serious harm, and she will be told first where possible. GMC guidance (0 to 18 years, paragraphs 46 to 49) says that if a young person refuses consent, information should still be disclosed where necessary to protect her or someone else from risk of death or serious harm, and she should usually be told first what will be shared and why.
●NG225 recommends recognising the need to seek consent for involving family as early as possible, and that families can give information even where consent is not given. Promising total secrecy is a mistake because it cannot be kept here, as is breaking confidence without warning.
●Request time alone while keeping her mother included: part of the consultation is private for all young people, and her mother will hear what Tegan agrees. A competent 15 year old's wish not to tell a parent is respected unless sharing is needed to protect her from serious harm.

The Shared Image

●Sharing a nude or semi nude image of a person under 18 is a safeguarding matter. The Department for Education and UKCIS (UK Council for Internet Safety) advice for education settings, updated in 2024, tells staff to report it at once to the designated safeguarding lead (DSL), not to view, copy, forward or store the image, not to blame or shame them, and to explain that they need to report it and that she will be supported.
●Ask only what is needed: who shared it, how widely, his age, whether she was pressured and whether any adult is involved. Here both are under 18, there is no adult, and nobody has demanded money or pictures. An adult, threats or blackmail would mean urgent police and children's social care involvement. Working Together to Safeguard Children 2026 (statutory guidance) is the framework for the practice safeguarding lead and local referral.
●The image has been seen by many peers, so Tegan needs it taken down. Childline and the Internet Watch Foundation run Report Remove, a free service for under 18s to report an image for removal (checked on the IWF site). She should block and report accounts and keep the messages. Deleting is for the safeguarding lead to decide; UKCIS advises young people to delete images from their own accounts only once that decision is made.
●Tegan is the child who has been harmed. Police involvement is decided with the school and local safeguarding partners, not by the GP alone, and she should be told this honestly. Sharing such an image is an offence, but UKCIS says children should not be unnecessarily criminalised.

Involving Her Mother and the School

●Her mother has found the cuts and wants to help. NG225 supports involving family, with consent sought early. The usual route is for her mother to be told about the self harm and low mood, with the photo disclosed when Tegan is ready and ideally with the doctor present. Offering real choices (the doctor tells her, together, or Tegan tells her with support) usually succeeds.
●If Tegan refuses to let her mother know about the photo, do not simply agree, and do not simply override her. Explore the fear, explain why her mother's support helps, and agree to revisit it. The safeguarding route through the DSL continues because the image of a child is circulating.
●The school can provide pastoral support, deal with the harassment, and plan attendance and GCSE pressures. Her fear that all staff will know is eased by explaining that the DSL is a trained lead who shares on a need to know basis.

Disposition and Referral

●Tegan has minor injuries, has swallowed nothing, has no suicidal intent and has support, so emergency department assessment is not needed today. Self poisoning or an injury needing physical treatment would need the emergency department. CKS advises that a minor self injury is treated in primary care and followed by referral for psychosocial assessment, with review in primary care within 48 hours where appropriate.
●NG225 says that for children and young people the psychosocial assessment is carried out by a mental health professional experienced in assessing them, and that in primary care a referral should be considered with the person's consent (1.7.6), and made a priority when distress is rising or self harm is increasing. Both apply, so refer promptly rather than signpost.
●Until she is seen, the GP reviews her regularly (NG225 1.7.8) and gives information about voluntary services.

Safety Plan, Means and Medication

●NG225 recommends a safety plan written with the young person. It records triggers and warning signs, coping strategies, people to contact, out of hours services and contacts, and steps to make the environment safer. She holds the plan and decides who sees it. Tegan names her nan and Amani as people to text, and could give the sharp item to a parent once her mother knows. Medicines at home should be locked away.
●Helplines include Childline (0800 1111), Shout (text 85258) and Samaritans. NG225 makes no recommendation about safer ways to self harm.
●NG225 says not to offer drug treatment as a specific intervention to reduce self harm. NICE NG134 (depression in children and young people) says antidepressants should only follow assessment by a child and adolescent psychiatrist and be given alongside psychological therapy, so none is started in this consultation.

Safety Netting and Follow Up

●Name the actions. Swallowing tablets, a cut that will not stop bleeding, or feeling that she will act on thoughts needs 999 or the emergency department. A spreading red or painful wound, rising urges, or new threats online need same day contact with the surgery, 111 mental health option or a helpline. Her mother should know this too once Tegan agrees.
●Offer an in person review within about 48 hours to look at the wounds, then regular review. Record who was told and what Tegan agreed.

Common Mistakes in This Station

●Starting the sensitive questions with her mother listening, or sending her out without explanation.
●Promising total confidentiality, or telling her mother or school without telling Tegan first.
●Using a risk scale in place of asking about suicidal thoughts, or not asking at all.
●Asking Tegan to describe or show the photo, or telling her to delete it.
●Treating the photo as embarrassment rather than a safeguarding matter, or blaming Tegan for sending it.
●Prescribing an antidepressant or sleeping tablet, or offering only a leaflet with no referral.
●Safety netting with "come back if it gets worse" and no plan for the night.

Mapped to the RCGP curriculum topic: Patient < 19 years old.

← Back to Free SCA Practice Cases