Systems Change Themes
Our lived experience groups, clients and Specialist Workers have identified approximately 200 gaps and barriers in services for people with Multiple and Complex Needs.
From this activity six key thematic areas have emerged that we feel require change to better meet the needs of this group. We will be focusing our energies around these themes to bring about positive developments in these areas.
Theme 1: Health Inequalities
Restricted access to healthcare is a strong and consistent theme in our casework. Client case studies evidence a stark and disturbing picture of the very real health inequalities experienced by people with multiple and complex needs.
Theme 2: Domestic Abuse and Complex Needs
Domestic abuse and violence is a very common experience for this client group. In a snapshot survey in December 2018, 93% of the women on our caseload had experienced domestic abuse (25 out of 27 women) and at the time of the snapshot 13 of the 25 women were currently experiencing domestic abuse. This prevalence has been consistent throughout the lifetime of the project.
Theme 3: Criminal Justice System - repeat offending
People with multiple and complex needs are over-represented in the criminal justice system. Many of our clients are caught in cycles of repeat re-offending, with their offending often driven by active addiction. They receive short custodial sentences and are regularly released as street homeless where the chaotic nature of their lives leads to breaching license conditions and being recalled to prison.
Theme 4: Treatment Pathways for co-existing conditions
Substance misuse and mental ill health are the most commonly experienced problems for people on the Fulfilling Lives caseload and there is a high degree of overlap between the two conditions. People are often denied access to mental health unless they address their substance use first, despite best practice guidance being clear that a ‘no wrong door’ principle should apply, with no one being turned away from services because of co-occurring conditions.
Theme 5: Unsupported Temporary Accommodation
When clients with multiple and complex needs are placed in unsupported temporary accommodation this frequently ends in their placements breaking down, leading to them returning to homelessness.
Theme 6: Repeat removals of children into the care system
Every Local Authority in Britain has experience of working with women who have multiple children removed from them and placed into the care system. Many of these women face multiple disadvantages and have complex histories. Fulfilling Lives is not seeking to challenge decisions to remove children, but to identify and highlight opportunities for more supportive interventions to be considered and for the cycle of repeat removals to be interrupted.