Role Play 2 Scenario: Elaine and Jane

Elaine and John (Jane if female actor) Role Play- actors’ notes

Brief for role player - “Elaine”

Elaine has been asked by her parents to go with her father to see her local GP because she’s been having mental health problems. She does not particularly want to be there and she feels slightly overwhelmed and “switched off” from her accompanying father who, at times, tries to talk for her.

If the medical student asks John to leave, he agrees to leave with Ealine’s agreement

More background info for “Elaine”

 Elaine is a 21 and in her 3rd year studying at Leeds University for a History degree

 She was living with her parents up until she went to university and had no problems during her early or later school years. She left school with 9 GCSE’s and 3 A Levels. She has a brother and a sister who are older than her and employed.

 For the past three months there have been difficulties keeping up with work (failed two modules) and missing lectures. It is out of character and there are concerns from her tutor and friends at university. She has noticed problems in sleep and concentration and is generally anxious about mingling with friends. This anxiety increased to the point where she remained confined to her room.

 Sleep Instead Elaine moved back in with her parents ‘to rest’ (“I just want to get some sleep”) and has been home for 2 weeks. Her sleep has not improved in this time

 Paranoia Elaine feels that people are looking at her and talking about her. Though initially this was a fleeting thought, over a period of time she began to believe that this was actually happening. At times, she also feels that she may be at risk of being harmed by her friends. More recently, she started believing this firmly. For this reason she stays in her room where she feels safe

 Voices She started hearing voices six weeks ago. Initially, it appeared as if her name was being called out, and she would turn around if to see if anyone was there. Over a period of time, she heard voices while she was sitting alone in her room. She thinks these voices are originating across the corridor but does not exactly know where they are coming from. The voices appear to be clear and give her instructions such as “You’re going to get up now, you’re going to start walking, you’re going to sit down”. She feels compelled to respond to these voices. Sometimes she also hears voices, which say “Elaine is useless” “Elaine can’t finish her studies”. She is clearly distressed by all this and does not feel able to talk about it to any of her friends. She has tried to distract herself from these voices by putting her headphones on, but this has only helped partially. Of late, she has heard two voices arguing about her, as in one voice saying “Elaine is alright, she’ll pull through” and another voice saying “No she won’t she’s doomed to fail”. The voices appear to her as real voices of real people, but she doesn’t know who they are. At no stage have the voices asked her to hurt herself or other people. She has not seen things nor had any visions. She sometimes perceives a rotten smell like a decaying body and doesn’t know where this is coming from. She does not have any odd tastes in her mouth, nor any sensations of some one touching her.

 Headaches Elaine is having frequent bad headaches which come on at different times of the day

 Attitude to her illness She says that her parents are overreacting and if probed, she says “I am depressed”. She does not belive she has a mental health problem, this is a frightening concept to her, she cannot explain the voices and when mental health is bought up she gets scared and asks ‘am I mad?’

 Appetite Elaine has not been eating because she doesn’t feel hungry. If asked she guesses she may have lost weight but she has not noticed this

 Drugs and alcohol She has not used illicit drugs apart from smoking cannabis on and off during her teens and at college. This was infrequent- ‘at parties’. Elaine used to drink socially with friends, but has not been out with them for a couple of months.

Notes for role-player “Elaine”

1. You are dressed in casual clothing, slightly dishevelled, and a little on edge. You can appear quite perplexed at times and occasionally find it difficult to understand what is being asked. Very guarded and quite frightened. You do not make eye contact and say very little until John leaves the room

2. When John is out of the room, you begin to open up, particularly if the medical student appears to show empathy, (e.g. if he/she asks, “these experiences you talk about, they must be very frightening, is that right?”)

3. Say that you sometimes forget to eat – you just don’t feel hungry any more.

4. You do not give up that you are hearing voices too early, you just begin to hint at this after john leaves the room, saying that you don’t go out anymore because you know your friends are not your friends, that you want to stay in your room where you are safe. The medical student should ask you probing questions to get this out of you and you open up more the more skilled at this they are and the more caring they seem

5. The medical student should not be trying to convince you that the voices are not real. If the medical student refers to them as ‘voices’ you get annoyed and tell him they are people. Brownie points for medical students who explore the content of the voices, e.g., “What do they say?”, etc.

6. Ask at some point in an impassioned way “Am I mad?”

7. Mention how very frightened you are about the prospect of going for specialist assessment. Say you feel that you can’t possibly have a severe mental illness as that would mean that your life is over, you’ve seen how people with mental health difficulties are treated and you believe that you’ll be dismissed as a waste of space, that you’ll be a zombie and on medication for life – you’ve just been finding it difficult at university, that’s all. Student should be able to reassure you that, if that is the diagnosis, it is possible to recover from mental illness, that you might have to be on some medication either short or long term, but that this doesn’t mean that you won’t go on to achieve many of the things you’ve set out to do.

8. Please be sure to mention the really bad headaches you have been getting.

9. Say that you sometimes forget to eat – you just don’t feel hungry any more.

Brief for role player “John” (or Jane Elaine’s mother)

John is feeling extremely anxious and does not understand what is going on. He suspected things were not quite right some time ago. When Elaine was home last, she “did not seem her normal self”. (If followed up, you explain by saying that she did not mix with her friends, isolated herself more and more and stayed for longer periods in her room.) He thought she was unhappy at Uni but, as she kept saying, she passed her first year with flying colours.

Notes for role player – “John”

 You should be putting pressure on the medical student, but not physically threatening or too aggressive. You are distressed and want answers.

 When the medical student is trying to talk to Elaine you will try to constantly interrupt and speak over Elaine, answering for her. This is to do with your extreme anxiety and worry about your daughter and the frustration you feel that Elaine doesn’t seem to think there’s anything wrong with her.

 You keep reiterating how Elaine ‘used to be’ social, outgoing, and mention that she has lost weight and is not sleeping

 We hope the medical student will be able to calm you down and if they ask you to leave, you do so with Elaine’s agreement . You will be called back in at the end to give your feedback. Questions for John to ask

“How long it will be before Elaine gets better. Is it true if caught early the prognosis is better? “

“What can I do to help her?”

“What is going to happen now? She won’t be able to go back to college will she?

“What about job applications, they won’t like it will they?”

“If she is diagnosed with schizophrenia, Elaine might become violent, maybe even hurt someone?”

“Where can I get some information about this?”

“It must be my fault, - is it somehow to do with how I’ve brought Elaine up?”

“Will I be able to get help to cope with this?”