Vignette 5

Isabella has a car and, up until a month ago, a driver's license. She let her license expire so that she wouldn't have to drive anymore. Her car is currently parked at a neighbor's house. She has not driven following an accident 9 months ago. She is unable to drive due to her anxiety and mania. When she experiences mania, she cannot concentrate, gets lost and has difficulty following directions. Isabella "bums" rides from friends when possible. This has been problematic when her depression causes her to be late because she cannot get ready (bathed and dressed). Isabella can read and follow a bus schedule to take public transit but she becomes anxious and "panicky" when on the bus or train. When anxious, she experiences her "soldier hallucinations" becomes tearful and describes heart palpations and "freaking out". When Isabella experiences her mania, she talks loudly and quickly to strangers and has been asked to leave the bus by the driver.

Isabella has access to a car, gets rides from friends and can use buses and trains. She let her driver's license expire a month ago. She wants her case manager to drive her to appointments but the case manager is unable to do so.