Almost by definition, perhaps, there are many ways to define "complex needs".
These are largely the issues, seen from a social systems or institutions perspective, that psychologists have identified, in individual and developmental terms, as "complex trauma"; and that psychiatrists had identified, in diagnostic terms, as "personality disorder". 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 to find a "cure". "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. "Complex needs", however, suggests that it is the challenge for services, in reaching these groups, that also needs addressing.
In the UK, at least, probably the subtlest and most effective current definition - and which touches on all three of these areas - has been 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:
- mental health problems
- substance abuse
It has been argued (See Johnson 2013a, 2013b, column opposite for link) that "complex needs", being a relatively new term, is 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.
See also "Reaching Out", for a statement from the overall Government perspective, "Recognising complexity", for a Dept of Health view on personality disorder; and "Theory of Change: a summary' for the philanthropic funder perspective.
Housing Lin briefing 24, Understanding homelessness and mental health: Dept of Communities and Local Government & Care Services Improvement Partnership (2008) in Housing Learning & Improvement Network collected papers, also available at: http://www.housinglin.org.uk/Topics/browse/Homelessness1/Mental_health/?parent=5953&child=2667
"Inclusion Health; improving primary care for socially excluded people": Dept of Health/Cabinet Office (2010): also available at www.cabinetoffice.gov.uk/media/346571/inclusion-health.pdf
"Everybody's problem; the personality disorder dimension" - a full chapter by Rex Haigh,, now in the library area, which is an excerpt from the book "Complex trauma and its effects; perspectives on creating an environment for recovery" (Edited: Johnson & Haigh, 2012)
"Reaching Out; an action plan on social inclusion", the UK Cabinet Office's programme for tackling systemic exclusion
"Recognising complexity: commissioning guidance for personality disorder services", for a UK Dept of Health view on personality disorder; and
"Theory of Change: a summary' for the philanthropic funder perspective.
NB: these two published papers can be read as one long article, in two parts. by Robin Johnson, now in the library area.
Big Lottery's 'Fulfilling Lives' programme via their own website: HERE