"Complex needs"

What's in a name?

We see the PIEs approach as a way to help services to identify better ways to work with people with 'complex needs'. But inevitable - almost by definition, perhaps - there are many ways to define 'complex needs'.

These are largely the issues that psychologists have identified in individual and developmental terms, as 'complex trauma'; and that psychiatrists had identified, in diagnostic terms, as 'personality disorder'. Seen more from a social systems or institutions perspective, however, these are needs that challenge the services to be more flexible, more resilient, usually more 'person-centred'.

But if so, with each change of terminology comes a change of perspective, a change in the implied underlying issues; and changes in the implications for practice.

  • 'Personality disorder', for example, locates the nature of the problem in the individual - and the medical model expects us now to find standardised, well-evidenced treatments, if not 'cures'.
  • 'Complex trauma', by contrast, locates the problem in the same individual's past life experiences - though now so ingrained that they are characteristics of the individual. This formulation suggests we try to help each individual in moving on, with new and more positive life experiences, but each in their own way.
  • 'Complex needs', however, suggests that it is the challenge for services, in reaching these groups, that also needs addressing. This formulation applies the social model or disability and exclusion, and requires 'system change' .

In the UK, at least, probably the subtlest and most effective current definition - and which touches on all three of these areas - was that adopted for the Big Lottery's 'Fulfilling Lives' programme. (For links see right hand column.)   'Complex needs' are here identified as any combination (i.e.: two or more) of:

  • homelessness
  • mental health problems
  • substance abuse
  • offending


It has been argued (See Johnson, 2014a, 2014b, column opposite for link) that 'complex needs', being then a relatively new term, was probably simply "commissioner speak' for a new-found recognition of the need to address long-standing issues of complexity and systematic marginalisation, that had previously been overlooked.

In a later video,'Three theories on the origins of homelessness', Johnson suggests how with different understandings of the origins or causes of homelessness we might see the work of homelessness services, and the 'psychology' they will need, quite differently. But all services, whatever their version of the origins, must be alert to the psychological issues they must then address.


See also:

"Reaching Out; an action plan on social inclusion", for the UK Cabinet Office's programme for tackling systemic exclusion (from 2005)

'Recognising complexity: commissioning guidance for personality disorder service', for the Dept of Health's changing views on personality disorder.

'Theory of Change: a summary' for the philanthropic funder perspective.

'Everybody's problem; the personality disorder dimension' is an excerpt from the book "Complex trauma and its effects; perspectives on creating an environment for recovery" (Edited: Johnson & Haigh, 2012): a full chapter by Rex Haigh, now in the library area.

Three theories on the origins of homelessness' appears in written, print form in 'Unfinished Business: Further essays on psychologically informed environments' by Robin Johnson (publication, September 2023) : HERE

Further background reading/listening/viewing

Complexity : HERE'

Joined up thinking' : HERE

Complex needs and relationships : HERE



Three models of the causes of homelessness : HERE

Further reading

"Do 'complex needs' need 'complex needs services'?" Part One:  HERE

"Do 'complex needs' need 'complex needs services'?" Part Two : HERE

Understanding homelessness and mental health: Dept of Communities and Local Government & Care Services Improvement Partnership (2008)  Housing Lin briefing 24 :  HERE

Inclusion Health : Improving primary care for socially excluded people : HERE

"Everybody's problem; the personality disorder dimension" : HERE

"Reaching Out; an action plan on social inclusion" : HERE

"Recognising complexity:  commissioning guidance for personality disorder services  :  HERE

"Theory of Change: a summaryHERE 

The Cynefin framework (video) : HERE

Big Lottery's 'Fulfilling Lives' programme (via their own website): HERE 

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