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You are the Acident and Emergency (A&E) Senior House Officer (SHO) on twilight shift at St George's Hospital. You are about half way through your shift and about to sit down with a coffee when one of the nurses comes up to you.

'I just wanted to let you know about a couple of patients,' he says. 'Mr Hill is the 35 year old with an arm laceration secondary to punching a glass window. He's been waiting nearly 4 hours for it to be sutured and is starting to kick off a bit.'

'And there's this guy who's been waiting just over an hour,' he says, handing you a cas card.

You quickly scan through the card. The patient is Joseph Graham, a 24 year old caucasian male who lives locally and has had no previous A&E attendances. He has been waiting for an hour and twenty minutes.

The nurse has written the following in the triage section: 

Brought in under section 136 of Mental Health Act. Victim of assault, noted to be acting agressively towards passers by and talking to himself. Has bruise over left eyebrow and cut lower lip. Hallucinating. Observations: Temp 36.9, HR 87, RR 16, SaO2 97% in air, BP 117/64.