Multiple and Complex Needs definition

The system is broken for people with multiple and complex needs.

Multiple and complex needs (MCN) are persistent, problematic and interrelated health and social care needs which impact an individual’s life and their ability to function in society.  They are likely to include; repeat street homelessness, mental, psychological and physical health problems, drug and/or alcohol dependency, and offending behaviour. People with MCN are more likely to experience violence and abuse, including domestic violence, live in poverty and have experienced trauma in childhood and throughout their lives.

They have ineffective contact with services, partly due to the fact that most public services are designed to deal with one problem at a time and to support people with single, severe conditions. Lacking effective support from services, people easily end up in a downward spiral of mental ill health, homelessness, drug and alcohol problems and crime.

While relatively small in number, this group imposes disproportionate costs on government and society. Current commissioning processes for services relevant to this group typically do not consider how having simultaneous needs can potentially exclude them from help when they need it the most.

When people with multiple and complex needs try to fit into inappropriate systems, they often experience increased negative outcomes and become more unwell through exclusion. Services themselves can also experience service disruption when they are not designed to cope with the behaviours associated with trauma. In this way those most in need in our community are being overlooked precisely because their needs are so great.

To put the issue into a national context, the Making Every Adult Matter (MEAM) Coalition estimate that 85% of people with the most complex needs experienced some form of trauma in childhood. For women in particular, this frequently continues into adulthood, when they experience domestic abuse and violence. It is also estimated that 58,000 in England people face problems of homelessness, substance misuse and offending in any one year. Within this group, a majority will have experienced mental health problems.

(Lankelly Chase, Hard Edges: Mapping Severe and Multiple Disadvantage in England, 2015)