The task
Assume that today's date is 22 October 2026. Ms Gledhill is being discharged home this afternoon.
You are a registered nurse on the medical ward of the local hospital. Using the information in the case notes, write a letter to Ms Eleanor Holroyd, Community Mental Health Nurse, referring Ms Gledhill for follow-up in the community. Address the letter to Ms Eleanor Holroyd, Community Mental Health Nurse, Community Mental Health Service, 14 Park Street. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
Case notes
Patient details
- Name: Ms Caroline Gledhill
- DOB: 14/03/2004 (22 yrs)
- Address: Flat 4, 61 Mill Street (shared flat)
- Admitted: 19/10/26; discharge: 22/10/26
Social background
- Final-year law student; exams in 5/52; part-time café job, hours recently ↓ → money worries
- Shares flat with 2 flatmates (both students)
- Relationship with boyfriend (2 yrs) ended 3/52 ago
- Mother lives 1 hr away; will stay with pt at flat for 1/52 after discharge
- Close to older sister, who phones daily
- Parents divorced 10 yrs ago; father remarried, minimal contact
- Plays netball weekly; owns a cat
- Mother told staff ex-boyfriend 'was always a waste of space'
Medical history
- Low mood, poor sleep, ↓ appetite approx 4/12; not previously treated; no GP contact
- Self-harm (cutting) age 15–16, saw school counsellor at the time; nil since
- Alcohol: binge drinking most weekends (approx 8–10 standard drinks/night); nil illicit drugs
- Tonsillectomy age 8
- Allergies: nil known
Admission
- Intentional OD: approx 30 × paracetamol 500 mg tabs, taken alone at flat after phone argument with ex-partner; alcohol taken same evening
- Texted friend 2 hrs later → ambulance called; presented approx 4 hrs post-ingestion
- IV acetylcysteine full course completed; LFTs and INR normal on completion; medically fit for discharge
- Complained about hospital food and being woken for overnight obs
Psychiatric assessment (20/10/26)
- Dx: moderate depressive episode; OD described as impulsive; pt regrets OD — 'I just wanted everything to stop'
- Denies current suicidal intent or plan; ongoing intermittent passive thoughts ('better if I wasn't here')
- Protective factors: close to sister and mother, wants to finish degree, responsibility for cat
- Sertraline 50 mg mane commenced 21/10; monitor for ↑ agitation / suicidal thoughts early in treatment (age < 25)
Safety plan
- Written safety plan completed with pt: warning signs (isolating, not sleeping, drinking alone), coping strategies, contacts (sister, mother), crisis line & ED
- Means restriction: no paracetamol/other OTC medicines kept at flat; mother to hold & give sertraline; 1/52 supply only dispensed
- Pt agreed to avoid alcohol; effect of alcohol on mood discussed
- Consent given for referral & for information sharing with mother
Plan
- Community MH nurse: home visit within 48 hrs of discharge (by 24/10); ongoing support, risk review, monitor mood & response to sertraline
- GP review 1/52 (29/10) — sertraline review & repeat prescription
- Referred to university counselling service; pt considering request for exam deferral
Who is reading, and what do they need?
Ms Holroyd is a community mental health nurse who will visit within 48 hours and review risk and mood. She has not met the patient, so she needs the overdose, current risk, protective factors, safety plan, medication and consent, but not the physical treatment in detail.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Approx 30 × paracetamol 500 mg with alcohol; acetylcysteine completed; LFTs and INR normal | States the event and confirms medical fitness for discharge, so the nurse knows the physical risk has been treated and focuses on mental health. |
| Ex-partner ended 3/52 ago; exams 5/52; money worries; binge drinking; self-harm at 15–16 | These recent stressors, drinking and past self-harm are relevant to the nurse's risk review. |
| Moderate depressive episode; impulsive OD; denies current intent or plan; intermittent passive thoughts | The nurse needs the assessed diagnosis and the current risk position, including the ongoing passive thoughts, stated accurately. |
| Protective factors: sister, mother, finish degree, responsibility for cat | All four recorded protective factors help the nurse judge risk and know what to support; none should be dropped. |
| Sertraline 50 mg mane from 21/10; monitor agitation/suicidal thoughts early (age under 25) | A new antidepressant in a patient under 25 needs early monitoring, and the nurse is asked to monitor response. |
| Warning signs: isolating, not sleeping, drinking alone; coping strategies; contacts; crisis line and ED | The nurse is to review risk, so she needs the warning signs and plan contents. Itemise the warning signs. |
| No paracetamol/other OTC medicines at flat; mother holds sertraline; 1/52 supply; avoid alcohol | Means restriction and the agreement to avoid alcohol are the key practical safety measures and should be stated in full. |
| Visit by 24/10; consent for referral and sharing with mother; GP review 29/10 | Defines the request, its deadline, who may be contacted and what other follow-up exists. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Mother said ex-boyfriend 'was always a waste of space' | A third party's opinion that is not clinical information and could be unhelpful in a referral. |
| Complained about hospital food and overnight obs | Minor ward complaint with no bearing on community follow-up. |
| Tonsillectomy at age 8 | Unrelated past history; allergies (nil known) need only the briefest mention if at all. |
| Father remarried, minimal contact; two student flatmates | Background social detail that is not in the protective factors or the safety plan. |
| Plays netball weekly | Looks like a protective activity but is not recorded among the protective factors, so it should not be presented as one. |
A paragraph plan for this case
Start with the purpose of the referral and the request for a visit by 24/10. Then summarise the overdose, assessment, stressors and protective factors, followed by medication and monitoring. Finish with the safety plan, means restriction, consent and other follow-up.
Where candidates slip on this task
- Say the visit is needed within 48 hours of discharge, by 24/10, and state the actual date. Do not make the timing vague or leave it implied.
- Report risk exactly as recorded: she denies current intent or plan, but still has intermittent passive thoughts. Do not call the risk resolved, and do not describe it as higher than the notes show.
- Do not shorten the means restriction to paracetamol alone. The notes cover other OTC medicines and a one-week sertraline supply, with the mother holding the sertraline.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Nursing letter tasks
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- Referral to a falls prevention program after a fall at home referral letter
- Referral to hospital-in-the-home for intravenous antibiotics referral letter
Your profession's guide: OET Nursing. Layout and structure: OET letter format.
Questions about this task
Should I name the sharing consent?
Yes, briefly. The notes record consent for the referral and for information sharing with the mother, which matters because the mother holds the sertraline and will stay with the patient for a week.
How much detail on the overdose treatment?
Keep it short: the substance and approximate amount, alcohol the same evening, completed acetylcysteine and normal LFTs and INR. The mental health nurse needs the outcome, not the hospital course.
Sources
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