OET letter for a mental health patient: risk, wording and an example for nurses
In an OET letter about a patient with a mental health condition, state the purpose first, then give the reader what keeps the patient safe: current mental state, any risk to self or others and what has been done about it, medications and adherence, supports at home, and the follow-up you are asking for. Describe behaviour factually and respectfully ('reported hearing voices', 'has not taken her medication for a week') instead of using labels such as 'psycho' or 'non-compliant', and keep sensitive history that does not affect the next step of care out of the letter.
Why mental health letters feel harder
Mental health case notes often contain more sensitive information than a physical health case: family conflict, substance use, past self-harm, police contact, a patient's own words. Nurses often worry about two opposite mistakes, either leaving out risk because it feels uncomfortable to write, or copying every detail because it all seems important.
The test is the same as for any OET letter: what does this reader need in order to take over safely, and act on your request? Use the case-notes selection test for every note, then apply the extra checks below.
What to include (and what usually stays out)
| Usually include | Usually leave out or shorten |
|---|---|
| Diagnosis and why the patient was seen or admitted | Childhood history with no bearing on current care |
| Current mental state in plain, factual terms | Every daily observation of mood |
| Risk to self or others, and the plan to manage it | Gossip-like detail about family members |
| Medications: current, changed, stopped, and adherence | Long lists of past medications that were stopped years ago |
| Substance use, if it affects risk or treatment | Exact quotes, unless one shows risk the reader must know |
| Supports: who the patient lives with, carer, community team | Former jobs and hobbies unrelated to care |
| Follow-up booked and what you are asking the reader to do | Normal physical observations needing no action |
If a note is sensitive and the reader needs it to keep the patient safe, it goes in. If it is sensitive and changes nothing the reader will do, leave it out.
Wording: factual, respectful, person-first
The Genre & Style criterion rewards writing that suits a professional reader; in mental health that also means writing that would be acceptable if the patient read it. Compare:
| Avoid | Write instead |
|---|---|
| "He is a schizophrenic." | "He has schizophrenia." |
| "She is non-compliant with meds." | "She has not taken her sertraline since early May." |
| "Patient was crazy and aggressive." | "He was agitated and shouted at staff; no one was harmed." |
| "Attention-seeking self-harm." | "She has superficially cut her forearm twice this month." |
| "Alcoholic." | "He drinks about six cans of beer a day." |
Keep clinical terms where the reader is clinical (a community mental health nurse or psychiatrist), and explain them if the reader is not (see writing to a non-clinical reader). Write abbreviations in full; "SI" or "CMHT" may not be clear to every reader (see abbreviations).
Where risk goes in the letter
If there is current risk, the reader should not have to reach paragraph four to find it. A plan that works for most mental health referrals and discharges:
- Purpose: who, why you are writing, and what you want ("I am writing to refer… for urgent review by your team").
- Current presentation and risk: mental state, any risk, and what has been put in place.
- Background: diagnosis, relevant history, previous response to treatment.
- Medications and adherence.
- Social situation and supports.
- Request and follow-up: what you ask the reader to do, and by when.
If the notes describe no current risk, paragraph 2 can simply be the current presentation. For signalling urgency, see urgent letter language.
Worked example (invented case)
Case summary (invented): Ms Priya Nair, 34, seen in a hospital emergency department after taking extra paracetamol tablets. Medically cleared. Diagnosis: depression, two years. Stopped fluoxetine three weeks ago "because it wasn't helping". Lives with her sister. Says she regrets the overdose; no current plan. Safety plan agreed. Sister aware. Works as an accountant, on leave. Enjoys painting. Previous ED visit 2024 for anxiety. Discharge home today. Task: write to Ms Kate Ellison, Community Mental Health Nurse, requesting follow-up within 48 hours.
Notes chosen: the overdose and medical clearance, the current risk and safety plan, the stopped fluoxetine and reason, the sister as support, the discharge date and the 48-hour request. Left out: painting, her job title, the 2024 anxiety visit (no effect on the next step).
Sample letter body (excerpt):
Dear Ms Ellison,
Re: Ms Priya Nair, aged 34
I am writing to refer Ms Nair, who is being discharged home today after an intentional paracetamol overdose, for follow-up by your team within the next 48 hours.
Ms Nair presented to the emergency department last night and has been medically cleared. She reports regretting the overdose and denies any current plan to harm herself. A safety plan has been agreed with her, and her sister, with whom she lives, is aware of it and will stay with her.
Ms Nair has a two-year history of depression. She stopped taking fluoxetine three weeks ago because she felt it was not helping, and she would like to discuss alternative treatment.
I would be grateful if you could contact her within 48 hours to review her mental state and her medication. Please do not hesitate to contact me if you require further information.
Yours sincerely,
Notice that the risk appears in the second paragraph, the medication problem is described without blame, and the request in the closing matches the request in the opening. For more closing sentences, see closing paragraph examples.
Common mistakes in mental health letters
- Burying or omitting risk. The reader must not discover it from someone else.
- Copying the patient's words at length. Report them unless a short quote is essential.
- Judgemental labels. "Difficult", "manipulative", "non-compliant" add opinion, not information.
- Too much history. Every past admission and medication change rarely helps the next step.
- A vague request. "Please see her" is weaker than "Please contact her within 48 hours to review her medication."
Practise and check
Try a timed letter on the practice cases, or paste a letter and its case notes into the letter checker. medEmu marks each of the six criteria, shows which case notes you included or missed, and marks problems on your own sentences. Its grade is an estimate for practice, not an official OET result; medEmu covers OET Writing for Nursing only and is not affiliated with OET.
Sources
This guide is medEmu's writing advice, not official OET guidance; the patient and case notes are invented. The network used for this run could not reach oet.com, so no OET test facts are stated here beyond the criterion names. For the official Writing test format and assessment criteria, see oet.com.