Youth justice and detained young people — OSCE

Station brief (candidate)

You are the on-call paediatric doctor called to the youth justice reception health screen. A 16-year-old boy has just been remanded in custody. He is quiet, avoids eye contact, and has told the nurse that he has been thinking about ending his life. You have eight minutes to assess him and agree a plan. [5] [11]

Candidate tasks

1. Establish rapport in a trauma-informed way and explain your role, what you will do with the information, and the limits of confidentiality. [16]
2. Perform a suicide and self-harm risk assessment appropriate to the first night in custody. [5] [11]
3. Identify acute risks requiring immediate action (intoxication, withdrawal, undisclosed injury). [1]
4. Agree an immediate safety plan with the young person and the custodial team, and outline the pathway to comprehensive assessment. [16]

Examiner guidance — expected behaviours

The candidate opens with the equivalence-of-care mindset and a trauma-informed introduction, naming their role, explaining confidentiality and its limits, and asking permission. [1] [16]

The candidate asks directly about suicidal ideation, intent, plan, means access, prior attempts and protective factors. [5] [11]

The candidate screens for intoxication and withdrawal, and asks about undisclosed injury and recent trauma. [1]

The candidate sets an observation level, removes means, arranges urgent mental-health assessment, and documents a safety plan, framing the encounter as the entry point to a comprehensive assessment rather than the endpoint. [16]

The candidate avoids interrogating about the offence and avoids a punitive or security-driven framing, recognising the clinician's role is to treat and advocate, not to investigate. [1]

Why this station works

The first night in custody is the highest-risk window for suicide and self-harm. [5] [11]

This station tests whether the candidate can hold equivalence of care, perform a trauma-informed risk assessment, communicate confidentiality and its limits honestly, and convert the assessment into an actionable safety plan — the core skills of detention medicine. [16]