Cases/Mental Health

Woman Who Was Raped 6 Months Ago and Has Told No One — Free SCA Practice Case

Woman who was raped 6 months ago and has told no one

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

Materials for Candidate

Please review before starting the consultation

Patient Profile

Full Name

Louise Harper

Age

34 years

Consultation Type

Video

Age

Situation

Video Consultation.

Reason for Encounter

"I've been struggling for months — low, anxious, and I can't cope with being close to my husband. I don't really know how to explain it."

Medical Records

●PMH: Nil significant. No prior mental-health diagnosis.
●Medications: None.
●Allergies: NKDA.
●Recent contact: No recent consultations.

Patient Script

For the friend playing the patient role

Character Overview: You are Louise, 34. Six months ago you were raped by someone who was not your partner (you will not go into the details, and you should not be pressed to). You have told no one — not even your husband. Since then you have been low, anxious, having nightmares and flashbacks, and you cannot bear physical closeness with your husband, which is straining your marriage and adding to your distress and shame. You have come ostensibly about your low mood and the intimacy problem. You are tearful, hesitant, and ashamed, and it takes gentleness and safety for you to disclose what happened. If the doctor is warm, unhurried, and does not push for details, you will tell them. You feel enormous relief at finally being believed.

Opening Sentence: "Hi Doctor. [hesitant] I've been in a really bad way for months — low, anxious, not sleeping. And… I can't cope with my husband being close to me, physically, and it's causing problems between us. I don't really know where to start, or how to say it."

History if Asked (Data Gathering Phase)

●How she's been: "Low, tearful, on edge all the time. I'm not sleeping — I have nightmares. I get these moments where it all comes flooding back. I've been avoiding people."
●The intimacy problem: "I can't bear my husband touching me. I freeze, I panic. He doesn't understand, and I can't tell him why. It's pushing us apart and I feel so guilty."
●The disclosure (only emerges with gentle, safe questioning): "[long pause, tearful] Something happened. Six months ago… I was raped. It wasn't my husband. I haven't told a single soul — not him, not anyone. You're the first person I've ever said it to."
●If the doctor is gentle and does not press for detail: "I don't want to go into what happened. I just… I needed to tell someone. I've been carrying it on my own."
●Why now: "I can't keep going like this. It's destroying me and my marriage. I don't know what to do."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate creates a safe space and explores gently.

●Ideas: Louise partly blames herself and has convinced herself she should be able to cope alone; she is unsure what help even exists. "Part of me feels it was somehow my fault, and that I should just be able to deal with it on my own. I don't know what help there is."
●Concerns: Her dominant fears are her husband finding out, being judged or not believed, and that she is broken/that her marriage is ending; there is deep shame. "I'm terrified of my husband finding out, of not being believed, and that I'm broken and losing my marriage."
●Expectations: She is not sure what she wants — mostly to finally tell someone and to stop feeling like this; she is not ready to think about the police. "Honestly, I just needed to tell someone. I don't want to go to the police — please don't make me. I just want to feel okay again."

If Asked — Wellbeing, Risk, and Safety (approached sensitively)

The patient answers these only when directly and sensitively asked.

●If asked about mood, anhedonia, tearfulness: "Low all the time, no joy in anything, crying a lot."
●If asked about PTSD-type symptoms (nightmares, flashbacks, avoidance, feeling on edge): "Yes — nightmares, moments where it comes back like it's happening again, avoiding anything that reminds me, jumpy and on edge constantly."
●If asked, sensitively, about thoughts of self-harm or that life isn't worth living: "There have been times I've felt I can't go on… but I wouldn't act on it. I don't have a plan or anything." (Passive thoughts, no intent or plan. Assess sensitively; no method detail sought or given.)
●If asked about her current safety / whether she is safe now: "I'm safe now — it's not someone in my life, and I'm not in any danger currently."
●If asked whether the person is a risk to anyone else / there are children involved: "There are no children involved, and I don't believe anyone else is at risk." (Proportionate safeguarding screen — negative.)
●If asked about support: "No one knows. My husband's the only person close to me, and I can't tell him."
●If asked about alcohol or other coping: "I've been drinking a bit more in the evenings to numb it, if I'm honest."

Responses to Management (The Negotiation Phase)

●If the Doctor responds to the disclosure with belief and compassion: "You believe me? [tearful] I've been so scared no one would." (The tested point is a calm, believing, non-judgemental response that makes clear it was not her fault.)
●If the Doctor reassures her she is in control and won't be forced to report: "So I don't have to go to the police? It's my choice?" (The tested point is being explicitly non-directive about reporting and giving control back to her.)
●If the Doctor offers specialist support (SARC/ISVA/counselling): "There are people who specialise in helping with this? I had no idea." (The tested point is signposting sexual-violence support and trauma-focused therapy.)
●If the Doctor explains the intimacy difficulty as a trauma response: "So the way I freeze with my husband — that's because of what happened, not because something's wrong with me?"
●If the Doctor raises telling her husband: "I don't know if I can ever tell him. Do I have to?"

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 / 20 indicators checked+0−0

Positive (0/10)

Negative (0/10)

Domain 3: Relating to Others

0 / 12 indicators checked+0−0

Positive (0/6)

Negative (0/6)

Clinical Learning Points

Trauma-Informed Response to Disclosure

●The response to a first disclosure of sexual assault is itself a clinical intervention. The essentials: believe her, make clear it was not her fault, respond with warmth and without judgement, do not press for detail, and go at her pace.
●A poor response can re-traumatise and deter future help-seeking; a good one is powerfully therapeutic.

Autonomy and Reporting

●Whether to report to the police is entirely the survivor's choice — never pressure or expect it. Reporting can be done at any time. Giving control back to someone from whom control was taken is central.

Sexual Assault Referral Centres (SARCs)

●SARCs provide specialist support and health care for people who have experienced sexual violence and can be self-referred. Forensic examination has a time-limited window (so is not the priority 6 months on), but support and health care remain available regardless of how long ago the assault occurred.

ISVAs and Specialist Support

●An Independent Sexual Violence Advisor (ISVA) provides independent, practical, and emotional support through whatever the survivor chooses. Signpost specialist charities (e.g. Rape Crisis, The Survivors Trust).

Recognising and Treating Trauma/PTSD

●Screen for PTSD (re-experiencing, avoidance, hyperarousal, negative alterations in mood/cognition) and associated depression and anxiety. Offer trauma-focused psychological therapy (trauma-focused CBT or EMDR) per NICE NG116, and manage associated conditions.
●Difficulties with physical intimacy are a recognised trauma response — normalise them and offer hope of recovery.

Sexual Health and Safety

●Offer sexual-health screening (STIs and blood-borne viruses) sensitively via GUM/sexual-health services. Assess current safety and conduct a proportionate safeguarding screen (others/children at risk) without interrogation.

Confidentiality, Autonomy, and Pace

●Reassure about confidentiality, respect her autonomy about telling her husband (offering support/couple work if she later wishes), assess risk sensitively (no method detail), and arrange follow-up — nothing need be decided in one consultation.

Common Candidate Mistakes in This Case

●A poor disclosure response: disbelief, awkwardness, minimising, or anything heard as blame.
●Pressing for detail: interrogating her about the assault, re-traumatising her.
●Pressuring her to report: removing her control over reporting to the police.
●Not signposting specialist support: omitting SARC, ISVA, and trauma-focused therapy.
●Ignoring what she presented with: failing to address the intimacy difficulty as a trauma response, or missing risk/sexual-health needs.

Free MRCGP SCA practice case for GP registrars covering Woman Who Was Raped 6 Months Ago and Has Told No One — Mental Health. Includes candidate brief, patient script, marking scheme mapped to the RCGP SCA marking domains, and learning points. Built directly from the RCGP curriculum topic stations listed under "How this might be tested in the MRCGP SCA," part of a free library of 79 SCA practice cases for simulated consultation assessment preparation.

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