Practice issue :

The case manager is working with a 23 year old male, who lacks capacity for managing finance and affairs. He is living in supported accommodation, where staff struggle to maintain his positive engagement and are often manipulated into providing false accounts to the external MDT by the client. He frequently engages with less desirable people in the community which leads him to engage in destructive/illegal acts.

The client recently engaged with a local alcoholic drug dealer, and has then become enmeshed in a world he cannot understand, and cannot retreat from.  Adult Social Care do not understand the frontal lobe paradox and explain his behaviour away as being a ‘life-choice’.  The client’s parents are exceedingly concerned.  The client ends up stabbing the alcoholic drug dealer, is arrested but released on bail. However, he is then served notice on his placement (with immediate effect) and thought to be in danger of retribution.

The case manager needs to find a way to support the client which will provide the best long-term outcomes, ensuring that the client and all involved are actively participating and in agreement.

Case Management Actions:

  • liaison with all other parties involved but then determine the best route.
  • Consider capacity assessment on this specific area and client’s understanding of the position he is in
  • Gather information on the criminal charges, likely outcome, the possible routes and options for the client while the legal process is underway
  • Complete risk assessments for the various scenarios and take action to mitigate risks.
  • Seek supervision to support case manager decision making
  • Education and support given to parents around mental capacity, best interests, risk taking and the role of the case manager to establish an agreed way forward if possible
  • Engage services and funders for possible funding options to find placement.
  • Agree the best course of action, communicate this in a flexible and dynamic way, using different approaches as required


Skills used:

7a: Leadership- accepting responsibility, determines strategic vision and potential pitfalls/difficulties, negotiation

7b: Fostering independence- Active listening, advocacy

7c: Ingenuity and innovation- utilising large range of resources, innovative approach



Positive indicators demonstrated:

  • Has a level of independence from the team that is safe but maximises the services to the requirements of the client.
  • Constructive resolution of conflict within the team and services.
  • Makes decisions, communicates these, and negotiates with services to achieve outcomes.
  • Awareness of client, family, and services dynamics, and actively works to resolve conflict.
  • Is aware of and facilitates the client’s potential to succeed in the longer term, and was able to communicate this to professionals and family.
  • Understanding where skills and responsibility begin and end for all services concerned (or ascertain this information), exploring and engaging relevant services to their full extent, enhancing their knowledge on the client specific issues (frontal lobe paradox)

Bear traps avoided:

  • Client disengages due to case manager not communicating the bigger picture
  • Client’s inability/lack of capacity to understand choices is ignored/misinterpreted
  • Behaviour is put down as a lifestyle choice, rather than lacking capacity or environmentally led.
  • Case manager is not listened to (especially ABI knowledge)
  • Burn out due to large burden of care/stressors on a regular basis
  • Case manager not being understood and respected.


Personal attributes

Duty of care


Coordination and management





BABICM Code of Ethics and Conduct in Case Management Practice

Mental Capacity Act 2005

Mental Health Act 1983

NHS CHC assessment criteria


Practice reflections:


  • Sometimes events happen with clients in a rapid manner that require a case manager to work swiftly, flexibly, and draw in support from various sources, then take a strong lead.
  • Case managers should use all available support and advice from other professionals, parties and agencies to support decision making and the case management process, and then be able to take responsibility for the decision when no clear/obvious/ideal path is available.


  • Case managers will at times be unpopular, however, are able to use their personal attributes to pull a team together by being flexible, innovative, and providing clarity as to why decisions are being made.