Clive is a 39 year-old man who has been living alone in a block of Homeswest flats in Subiaco for many years. He has a long history of schizophrenia and has a complex set of delusions including a belief that he is God and he has been crucified.

Clive was admitted to a psychiatric hospital 8 days ago after he assaulted a worker at the local drop-in centre which he has attended for several years. He assaulted the worker by holding the man in a headlock and threatening to punch him. When the police were called he physically assaulted one of the officers. It is unclear as to whether the assault was directly related to his psychosis – it probably was not – but occurred because he believed the worker was preventing him from accessing all of the facilities at the drop-in centre.

Clive has had no suicidal thoughts over the past few months. He does not drink alcohol or use drugs. He displayed no cognition problems on examination. Since his admission he has complained of acute abdominal pain. He finds it really painful to move around, especially when getting in and out of bed. An X-ray has revealed that he has two cracked ribs – an injury he sustained in his fight with the police. His mobility on the ward has been moderately affected by this injury. An endoscopy yesterday revealed that he has reflux oesophagitis and but he has improved today after taking medication for the condition yesterday.

Clive has suffered from delusions and hallucinations over the past few years and it is doubtful if medication has made any significant impact on these. His preoccupation with these delusions and hallucinations is difficult to assess but since admission to hospital it is clear that he is extremely distressed by some of his beliefs and paranoid delusions. He is also very isolated and socially withdrawn. He is troubled with guilt (delusional crimes etc), has a depressed mood and poor self-esteem, particularly since being admitted to hospital. Nursing staff have noted that Clive has been sleeping and eating well.

Ordinarily Clive spends most of his time either praying at the local church, or at the drop-in centre where he receives substantial care and support from paid workers (his difficulties are monitored here). He has no close friends and has only very transient conversations with acquaintances that attend the drop-in centre. He has no contact with any family members and withdraws from almost all social contact with people, which distresses him greatly.

Clive takes reasonable care of himself and his personal hygiene. He is generally untidy at home and only just manages to budget his finances with a lot of help from a community welfare worker at the drop-in centre.

Although Clive does not know many of his neighbours, he likes the flat he lives in. Homeswest attends to any maintenance needed in the flat, but at present nothing needs any major repairs.

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