You are the case manager for a man who has only recently had a first manic episode. He had submitted to treatment, responded well, and returned to work. However, he is currently experiencing another episode, and this one seems more severe. He is not sleeping or eating, is sending cryptic messages on the Internet, and believes everything he reads there is directed at him. He believes the government is “monitoring” him, and that he has an important job lined up with a record company in New York. You have determined that he is not leaving his house, and that he is preoccupied with what is happening on message boards and chat rooms on the Internet. You have checked in with him several times by phone. Each time he assures you that he is fine and does not need help.

What is the best course of action? Do you risk seeking an involuntary commitment, knowing that he seems just well enough to convince the emergency room physician he is not in need of hospitalization? Will this alienate him and make it impossible for you to work with him? Do you wait for things to get worse? If so, is there a chance he may leave the house and get into trouble? What might happen if you wait it out? 

Sit with a small group of other students and decide how you will handle each situation. There are many areas both ethically and legally that are not clear, so the discussion you have with your colleagues about these cases is much like a discussion you might have in a real agency. There are no “correct answers.”