Barry Martins

Age: 52 year old male

Full Case

Station List
Doctor
Patient
Examiner

Patient’s Data​

Patient’s name: Barry Martins

Name: Barry Martins

Age: 52-year-old male 

Past medical history 

  • Eczema
  • Hypertension
  • Holds an active fire-arm license

Medications/Repeat template

  • Amlodipine 5mg OD
  • Dermol lotion

Notes

  • No recent consultation

Booked routine consultation to discuss issues

Patient's Story (Role player’s brief)

Patient’s Story – Siobhan (Mother of Connor)

You are Barry, a 52-year-old man. Over the past 2 to 3 months, you’ve noticed that your mood has been consistently low. This started shortly after going through a very difficult and emotionally draining divorce. You were married for 15 years, and the separation has left you feeling isolated and overwhelmed.

You and your ex-wife used to run a restaurant together, but since the divorce, she has withdrawn from the business, leaving you to handle things alone. The financial strain is intense, and you’re now facing the possibility of bankruptcy, which adds to your stress.

You live alone and feel quite cut off — your two sons live in Australia and only visit about twice a year. You hardly see your friends anymore, and this sense of loneliness has been hard to cope with.

You’ve also noticed changes in your basic routines — you’re not sleeping well, and your appetite has really dropped. At times, you’ve had thoughts about not wanting to wake up in the morning. However, you’ve never had any plans to end your life because your sons mean everything to you, and thinking about them helps you keep going.

Socially, you do not smoke, drink alcohol, or use any drugs. You work as a police officer and currently hold a firearm license. If asked about it, you’re not concerned about having access to your weapon and feel in control.

Say NO to any other questions asked. 

Ideas: You believe you may be going through depression. 

Concerns: You are worried that his situation is getting worse — emotionally and financially. You are worried if things are not controlled, it may affect your job as a polic officer 

Expectations: You are hoping the GP will take your concerns seriously and offer a solution — ideally medication to help improve your mood. 

Marking Scheme

Data Gathering and Diagnosis

  • Start by exploring how long Barry has been feeling low and how often the feelings occur.
  • Ask if he has noticed a loss of interest or enjoyment in activities, he used to find pleasurable, particularly in the last one month
  • Explore any known or suspected triggers — such as recent life events, relationship breakdown, or stressors like work or finances.
  • Ask about changes in appetite — whether he’s eating more or less than usual.
  • Explore his sleep pattern — trouble falling asleep, staying asleep, or waking too early.
  • Ask about fatigue — if he feels tired even after resting or during the day.
  • Enquire about any noticeable weight changes, either gain or loss.
  • Gently screen for suicidal thoughts with sensitivity:

“Barry, sometimes when people feel this low, they may start having dark thoughts, like not wanting to wake up or even thinking about harming themselves. Have you experienced anything like this?”

  • Ask about lifestyle — smoking, alcohol use, recreational drugs, and general daily activity levels.
  • Enquire if there’s any family history of depression, anxiety, or mental illness.
  • Ask how his symptoms are affecting his work, social life, and daily functioning.
  • Explore his current support system — whether he lives with anyone, speaks to friends or family, and how he feels emotionally supported.
  • If not already discussed, sensitively ask about his firearm license:

“Barry, given your role, I want to ask if you’re feeling okay having access to your firearm right now? Would you feel safer without it, just while you’re going through this?”

  • Based on the findings, provide a working diagnosis of depression (likely moderate, if impacting daily life without psychosis or active suicidal plans).

Example of explanation To Patient​

Barry, thank you for sharing all of that with me — it sounds like you’ve been going through an incredibly tough time, and I really appreciate how openly you’ve spoken about it.

From what you’ve described — the low mood, poor sleep, loss of appetite, and feelings of hopelessness, this sounds like you’re experiencing depression. And while it’s understandable given everything that’s happened; your divorce, the isolation, financial worries, it’s still something we can and should help you with.

The good news is that there are several things we can do. First, I’d like to ask you to complete a short questionnaire called the PHQ-9. It helps us measure the severity of your symptoms and guide your treatment.

In terms of treatment, we often combine approaches. One option is talking therapy, where you can speak with a trained professional who helps you understand your thoughts and emotions, and find new ways to manage stress. Many people find this extremely helpful.

We can also consider starting you on an antidepressant, such as an SSRI — this type of medication helps rebalance the chemicals in your brain that affect mood. It usually takes 2 to 4 weeks to start working, and you’ll need to stay on it for at least 6 months after you start to feel better, to prevent a relapse. I’ll go through all the possible side effects with you before starting.

I understand you’re a police officer and that you hold a firearm licence. Given how you’ve been feeling, it would be important and responsible to let your occupational health team, and the firearms licensing unit know about what you’re going through. This isn’t about taking anything away permanently , but about keeping you and others safe during a vulnerable time. Many officers go through difficult periods, and there is good support available within the force.

Also, please know you’re not alone. You mentioned you have no plans to end your life, but if things ever feel overwhelming, I want you to know there is urgent support available 24/7. I can give you the number for the local crisis team and you can always call 111 or 999 in an emergency.

I’d like us to review things in about 1–2 weeks to see how you’re doing. In the meantime, even small things like gentle exercise and reconnecting with someone, a neighbour, a colleague, can make a real difference. Would it be okay if we worked through this together

Management

Management

  • Offer PHQ-9 questionnaire, which helps us understand the severity of his symptoms and guides us on the best way to support him. I’d explain that this is a simple tool used widely in primary care to track mood over time.
  • Offer self-help strategies, including encouraging regular physical activity, which is known to improve mood. Recommend gentle exercise like walking daily, and signpost useful mental health apps (for example- Headspace App) or online tools to help manage his mood 
  • Offer talking therapy through NHS Talking Therapies (CBT), as this can help with identifying unhelpful thoughts and developing coping strategies. Reassure him that it’s a confidential and supportive space to work through what he’s going through.
  • Discuss medication. If there are no contraindications, offer to start him on an SSRI like sertraline. Explain that it can take about 2 to 4 weeks to begin noticing improvement, and that if effective, we usually recommend continuing it for at least six months after symptoms improve to reduce the risk of relapse.
  • As Barry is a serving police officer and holds a firearm license, advise him to speak with the occupational health team. They can support him with adjustments at work, such as temporary leave, lighter duties, or access to workplace counselling. Also, explain the importance of informing the firearm licensing unit about his mental health—for safety and compliance reasons, and to ensure the right support is in place. If needed, we can assist with that process sensitively.
  • Arrange a follow-up in 1–2 weeks to see how he is coping, check in on any side effects if medication is started, and continue monitoring his mood.
  • Safety-net regarding thoughts of self-harm or suicide. Provide him with the local crisis team contact and advise that if at any point he feels unsafe or overwhelmed, he should call 111 or attend A&E for immediate help.

Learning point from this station:

This station highlights the importance of a holistic and risk-aware approach when managing low mood in patients who hold a firearm licence, such as police officers, farmers, or members of the armed forces.

Always explore access to firearms in any patient with low mood, suicidal thoughts, or emotional instability.

Advise the patient to inform their occupational health team and licensing authority and explain that temporary removal of firearms may be necessary for safety.

The key lesson is balancing compassionate mental health care with public and personal safety, especially when firearms are involved.