Individuals with multiple diagnoses most often present with social difficulties, with either aggressive or withdrawn behaviour predominating. In individuals with behaviours that represent changes at a neural level, and in those with comorbid psychiatric diagnoses, these behaviours often represent obstacles to rehabilitation. Consequently there is little consensus as to how such patients can be assessed, treated and interacted with, and so too there is little potential to improve outcomes with guided training. When multiple agencies are involved, such patients may ‘fall between the cracks’ and undergo prolonged and disempowering interventions with poor outcomes in the absence of individual programmes. This article addresses the core issue of empowerment in the assessment and community-based rehabilitation of patients with multiple mental health issues, and utilises a case report format to illustrate the methodology.