Adam is an 18-year-old man who was banned from the family home after repeated physical attacks to his mother and has been living in his own apartment for several months. His male family members bring him food every day. Adam's family contacted mental health services several times, but Adam will not engage with the services. Adam tells his mother several times that he will kill himself, but when being assessed under the Mental Health Act says that he was 'kidding' and just trying to get his mother's attention. He later reports that the angels told him he needed to say this. He regularly complains about the neighbors being noisy, but the neighboring apartment is unoccupied. It is unclear whether he is hallucinating or has very sensitive hearing. He has threatened to 'deal with the neighbors' if nothing is done. He does not make eye contact with his family members or the doctors who are trying to help him. Additionally, Adam's mental health staff encourage him to see his primary care doctor because they notice that his hands and forearms have become red and raw in places because he is washing his hands and arms frequently and for increasingly long periods of time. They have tried to divert him from this behavior, but he became anxious and quite agitated if interrupted when in 'washing routine'. This is a relatively new problem. While the staff is not worried about OCD, they are worried about the repetitive behaviors, rigid thoughts, resistance to change AND the hallucinations. These issues have been present for multiple years, according to his family.