Arin is a 22- year-old male who has been “couch surfing” between family members for a number of years. He has a low self-image, causing him to hear every comment made to him as a criticism and to be argumentative to the point of never conceding that there is a different interpretation of events. He has significant mood swings from severe depression to violent rage. He lives in a constant state of anxiety. He sleeps very little and paces throughout the night.  His extended family has been extremely supportive, taking turns having Arin live with them. They are all exhausted and when he trashed his brother’s apartment over a mild dispute about household chores Arin left in a rage and refuses to see anyone in the family because, in his eyes, they are all out to get him. He is now living on the street and fighting attempts by family members to get him to see a psychiatrist for a diagnosis. The family doctor believes Arin may have a borderline personality disorder; however, he needs a formal diagnosis to qualify for assisted living arrangements supported by a local community mental health agency. The M-Heart team (a joint team of mental health workers and police officers) has been checking in with him twice a week. They are having very little success in convincing Arin to follow through with appointments set up with a psychiatrist. He is consistently a “no show” and the team, although willing to get him there, cannot find him the day of the appointment.  

Tanzia is a 45-year-old female currently living in an encampment in a large city. She is working with a local agency to find housing. In the past 15 years she has lived in 23 different apartments/rooming houses with a large number of different roommates. When she is drug-free she has a sunny disposition and positive outlook on finding work. She is very social. She has worked in the food service industry off and on. Unfortunately, due to many reasons, she has a history of reverting to substance misuse. When she is using, she has inconsistent moods, steals from her roommates and from her employers to buy her drugs. She becomes sexually aggressive. Subsequently she is asked to leave her housing and reverts to the streets. She has been bounced from one agency to the next and has not found the support she needs to break this pattern. Tanzia has experienced 3 overdoses in the last 12 months where friends have revived her with Naloxone. She worries that her luck is running out.