Station 55
Lisa Walters (previously known as Andy Walters)
Age: 28 years old female
Examiner
Marking Scheme
Data Gathering and Diagnosis
- Begin by expressing empathy and acknowledging how difficult and upsetting it must be to feel unsupported and singled out at work.
- Ask how long her mood has been low and whether she feels low all the time
- Ask if she has lost interest or enjoyment in activities she would usually do
- Ask about changes in appetite and any associated weight loss or gain
- Ask about sleep disturbances and feelings of tiredness or low energy
- Ask about any thoughts of suicide or self-harm
- Ask about lifestyle factors, including smoking, alcohol consumption, and illicit drug use
- Ask about physical activity levels
- Ask how her symptoms have affected daily life and functioning
- Ask about her support system, including family, friends, or anyone at home
- Make a working diagnosis of work-related anxiety and depression.
Example of explanation to patient
Lisa, thank you for opening up today, I really appreciate how difficult this must be for you. It’s completely understandable that you’re feeling overwhelmed and anxious, especially after such a major and personal journey like your recent surgery. It’s also not acceptable that you’re experiencing discrimination at work, and I’m really sorry you’ve had to go through that.
Based on everything you’ve shared; it sounds like you’re experiencing symptoms of work-related anxiety and low mood. For now, I can provide a sick note so you can take some time off work to focus on your wellbeing. But we should also make sure you’re properly supported during this time.
I’d recommend we refer you for counselling or talking therapy. It can be really helpful to have a safe, confidential space where you can explore how you’re feeling and work through the challenges you’ve been facing with the support of a trained professional.
In terms of the situation at work, it’s important that you escalate your concerns to your line manager or a senior member of staff. No one should feel uncomfortable at work, and your employer has a responsibility to put measures in place to support you. While working from home may be an option, it doesn’t address the core issue of feeling excluded or unable to socialise safely.
If your concerns aren’t addressed appropriately, you can escalate them further to your trade union or seek guidance from Citizens Advice.
Regarding toilet facilities, workplaces should ideally provide gender-neutral toilets that anyone can use comfortably. Under the current Equality and Human Rights Commission (EHRC) guidance, some organisations may restrict access to gendered spaces based on biological sex, but you should never be left without access to a safe and suitable toilet. If you’re unsure, it’s entirely appropriate to discuss this with your workplace and seek a supportive resolution.
Management
Management
- Offer the PHQ-9 questionnaire to assess the severity of depressive symptoms.
- Offer a referral for talking therapy (e.g. counselling or CBT) as a first-line treatment.
- Offer antidepressant medication as an option
- Provide a sick note to support time off work, but explain that this is a temporary solution. Encourage her to speak with her line manager about the discrimination, and if it remains unresolved, to escalate the matter to occupational health (if available) or to her union representative
- Advise that her workplace should ideally provide gender-neutral toilets. Explain that, according to the most recent Supreme court ruling and Equality and Human Rights Commission (EHRC) guidance, access to male or female toilets may be restricted based on biological sex, even for individuals who have transitioned However, reassure her that the law still protects her from discrimination, and she must never be left without access to a toilet. The workplace has a duty to ensure she has a safe, appropriate facility she can use comfortably.
- Signpost to supportive organisations such as Stonewall, TransUnite, and MindOut for additional mental health and LGBTQ+ support.
- Arrange follow up in 2-3 weeks to see how things are going
- Safety net and advise her to seek urgent help if she gets thoughts of suicide or self-harm, including contacting 111, crisis services, or 999 if at immediate risk.
Learning point from this station:
This case highlights the importance of providing empathetic, inclusive, and patient-centred care to transgender individuals, particularly following gender-affirming procedures.
The UK Supreme Court has clarified that under the Equality Act 2010, the term ‘sex’ refers to biological sex.
This means that:
- A ‘woman’ is defined as a biological female (assigned female at birth)
- A ‘man’ is defined as a biological male (assigned male at birth)
- A person who identifies as transgender does not legally change their sex under the Act, even if they hold a Gender Recognition Certificate (GRC)
- Therefore, a trans woman is legally considered a biological man, and a trans man is considered a biological woman
This means that transgender women, who are biologically male but identify as women, can be lawfully excluded from women-only spaces under certain circumstances. However, the EHRC guidance also emphasises that trans individuals must not be left without access to suitable facilities, in settings where single-sex spaces exist, there should also be provisions available to ensure everyone has a safe and appropriate option to use.
Also remember that transgender individuals may be taking hormone replacement therapy (HRT). It is important to ask where this medication is being obtained. If the hormones are being sourced online or are not prescribed and monitored by a recognised gender identity clinic or specialist, the individual should be referred for appropriate care. Regular monitoring is essential to ensure both safety and effectiveness of treatment.