Original set · Worked example

Meet Taylor

One group, eleven dice, and the risks they found along the way.

This is an example of how one group worked through the original set in a teaching session. After each roll they described what the new information looked like for their patient, then noted the risks it raised. Watch how the picture builds: early rolls suggest isolation and excess alcohol use, and by the final die the group has moved to suicide risk.

Each box below is one die, in the order the group rolled them.

The patient is fictional, students used their own knowledge and practice learning to respond to the dice categories.

Please note: contains mentions of child sexual abuse, self-harm and suicide risk.

Demographic

Roll Result: Young adult (18–25)

Taylor Walker, age 22. He is a university student.

Mental health history

Roll Result: PTSD

Diagnosed at 19, following sexual abuse when he was a child and teenager.

Current symptoms

Roll Result: Social withdrawal

Has stopped spending time with his friends, and if he does go out it is only to the pub, where he drinks heavily and prefers to sit on his own. He has also stopped replying to texts, and has been missing a lot of university lectures.

Emerging risks

  • Alcohol intake, and the physical and mental complications that can come with it.
  • Isolating himself from his friends, so potential loss of his support network.
  • He is missing university, so he may be falling behind on his modules, which could mean he fails. This is a risk to his future.
  • We know he has PTSD, so this could indicate a deterioration in his condition.

Physical indicators

Roll Result: Bruises / injuries

We can see bruises on his knuckles and a black eye, so it looks as though he has been fighting. He also has a limp and is clearly uncomfortable when he sits down.

Risks

  • This could indicate physical harm: perhaps Taylor has been assaulted and has tried to defend himself.
  • We know he is drinking heavily, so he may be getting into fights because of his alcohol use.
  • We would need to consider whether he is self-harming. He has PTSD and we think his condition is deteriorating, so he might be self-harming to manage his symptoms, for example by punching walls.
  • He could be getting into fights deliberately because he feels he ‘deserves’ to be hurt, which is common in people who have experienced sexual abuse. He may not be suicidal, but it might mean he doesn’t care what happens to him, which is definitely a risk.
  • His limp: he is clearly in pain, so chronic pain could be a risk.

Living situation

Roll Result: Living with flatmates / shared housing

Taylor lives in university accommodation with flatmates. They are all on different courses from him and he doesn’t really know them. He keeps his food in his room so he doesn’t need to use the shared kitchen. He hates it when they are all home because it can get noisy, so he goes out, sometimes all night.

Risks

  • Again this highlights his isolation. Even though he isn’t friends with his flatmates, he doesn’t want to, or can’t, interact with them, even casually.
  • Leaving when it gets noisy also suggests his mental health is deteriorating. Avoidance of loud noise is common in PTSD.
  • If he is staying out all night to avoid his flatmates, he will be missing sleep, which will make his mental health worse.
  • If he is out all night, he could be more likely to get into fights when people are coming home from clubs.
  • If he is keeping food in his room it might go off, so he is at risk of becoming physically unwell.
  • There is also a risk of Taylor being stigmatised as ‘weird’ by flatmates who don’t know he is struggling, which will make him feel even more isolated.

Recent life events

Roll Result: Pending court case

Taylor has a court case coming up next month, where he will testify against the family member who abused him when he was younger.

Risks

  • Stress and emotional distress. This will be bringing everything back for him, and helps explain why his mental health seems to be deteriorating.
  • We already suspect self-harm and some risky behaviour, with the fighting and drinking. These could get worse as the trial gets closer.
  • He might feel overwhelmed by the case and run off. We know he already stays out all night sometimes when he can’t cope.
  • We have already seen that Taylor is fighting. He might try to confront his abuser, putting them both at risk.
  • It also intensifies the risk of failing university and isolating from friends.

Risk history

Roll Result: History of impulsive, risky behaviours

This fits with what we have already seen in Taylor: drinking, fighting and leaving his flat in the middle of the night. With this die, though, we have also found out that Taylor sometimes takes risks with transport, for example running in front of trains, or deliberately not looking when crossing busy roads.

Risks

  • The new information about transport could lead to serious injury or death, not just for Taylor but for drivers and passengers too.
  • We already know he is drinking heavily, so he is likely to do this more when drunk, as he will have even fewer inhibitions.
  • Again, it builds on the sense that he doesn’t care what happens to him, so we need to look at suicidal intent more closely.

Protective factor

Roll Result: Spiritual or religious beliefs

Taylor is a member of a local church and prays daily. He feels his religion is a comfort and helps guide him onto a better path. He has a good relationship with his minister.

How this might help

  • Taylor has a good relationship with his minister and respects him. He might be able to support Taylor emotionally, even while Taylor is avoiding his friends.
  • There is a moral aspect too: some of Taylor’s behaviours could hurt other people, which is against his religion, so this might make him rethink.
  • Praying can be used as a form of mindful stress reduction.
  • We have looked up ‘spiritual coping with trauma’, which can offer a framework for coping with his past and give him hope. These resources could be shared with Taylor.

Behavioural indicators

Roll Result: Repeated questions

When Taylor has been speaking with us, he asks the same question in lots of different ways.

Risks

  • It is likely to indicate he is anxious or experiencing obsessive thoughts, which are both common in PTSD, but he also has the court case coming up.
  • Stress and burnout, which fits with falling behind at university too. He just can’t cope with everything that is going on, so he is not taking anything in.
  • It could reflect hypervigilance or a need for control, often seen in people who have experienced trauma, as they seek to ensure their safety.
  • Risk of communication difficulties.
  • He may be misinterpreting what is said to him, potentially because of previous experiences of being misled or confused.

Cultural background

Roll Result: Grew up in foster care

Taylor was placed in foster care when he was three, because of his mum’s addiction. He lived in nine different homes in total: some were nice, some were awful. His uncle worked away so couldn’t have Taylor live with him, but he used to take him out at weekends when he was home, and sexually abused Taylor from the age of 3 to 14.

Risks

  • This fits with the lack of care he has for his own safety. He feels shame and guilt for not disclosing what was happening earlier, and blames himself for ‘letting’ it happen. This is common in survivors of child sexual abuse.
  • With a background this complex, it again makes us think he could be a suicide risk.
  • Attachment could be an issue in his relationships, because he has not had any steady relationships growing up except the harmful one with his uncle.

Ethical considerations

Roll Result: Online activity suggests risk, patient denies it

He is posting song lyrics with no explanation, and not replying to anyone who responds. The lines are from a song by The Smiths about wanting to sleep and not wake up.

Risks

  • We now definitely think Taylor is suicidal: the lyrics talk about dying, and he is not responding to anyone.
  • There is also a risk that people might think he is attention-seeking, which could lead to further isolation and no offers of support.

Suggested interventions, and why

At this point, the team who created Taylor stops. Their completed documentation is handed to another team, who did not watch the case develop.

The receiving team's response for Taylor

Trauma-informed care, to acknowledge the impact of his abuse history and help create a safe, non-judgemental environment in which Taylor can feel supported.

Crisis intervention and safety planning. Taylor’s risky behaviours suggest possible suicidal ideation, requiring urgent action to ensure his safety.

Social reconnection. He is isolating more and more, which is a real risk. Encourage him to reconnect with friends and attend church groups.

Alcohol support and harm reduction. Alcohol use may worsen Taylor’s impulsivity and emotional instability.

Court case preparation. The court case has the potential to retraumatise Taylor. He should get support from victim support charities.

Build on protective factors. Taylor’s faith and his relationship with his minister are significant sources of strength and guidance.

Regular follow-up appointments to check in with him.

Using this example

This is one group’s reasoning, not a model answer. It is useful for showing how risk judgements should shift as each die lands, which mirrors the unpredictability of clinical practice. Roll your own patient on the original set, and see running it with a group for briefing and debrief guidance.