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Appendix One - Other perspectives on 'multiple' and/or 'complex' needs
1. The Social Exclusion Unit (2005a) 14 focused on 4 groups of people considered to be particularly disadvantaged in using services, in their report on Improving Services, Improving Lives. These were: people with low levels of literacy; disabled people and people with long-term health conditions; people from certain ethnic minority groups and people who are multiply disadvantaged. Until recently there has been no consistency of definition or usage of the term 'multiple needs' in the literature (Rioux and Bach 1994). However by 2002, a consistent definition was increasingly being applied in the sphere of homelessness research.
2. The ODPM (2002) refers to multiple needs in respect of homelessness, building on the definition developed and applied by Homeless Link in 1998, multiple needs relates to:
"A homeless or formerly homeless person who has 2 or more of the following problems and usually lacks effective contact with services: mental health; multiple substance misuse; personality disorders; offending behaviour; learning difficulties; physical health problems; challenging behaviour; vulnerability because of age". (Para 6.11.1) … "If one of these needs were to be resolved, the others would still give cause for concern". … "People with multiple needs may make frequent demands on many services, but not have their needs effectively by any". (Para 6.11.2).
3. In a similar vein, Clark in discussing new challenges in day services for a range of groups, uses the term 'multiple needs' to refer to people with disabilities 'whose behaviour is challenging to service providers' (Clark 2001), while other studies have stressed that a large proportion of disabled people have 'multiple disabilities' (Seed and Lloyd 1997).
4. It should be noted that some of our key consultees stressed that multiple needs are prevalent in the mainstream population as well as among particular client groups. It was argued that rather than being a minority issue multiple needs are common to the life experience of most people at different stages or over time. The central problem to confront in relation to multiple needs in this context would be whether or not multiple needs are addressed or persist unmet.
'Dual diagnosis'
5. From a health perspective and originating in the U.S., the term 'dual diagnosis' (or 'co-morbidity' has been commonly used to refer to the dual assessment of severe mental illhealth and substance misuse problems ( NSF 2001). The Department of Health emphasises that the coexistence of substance misuse alongside mental health problems is common rather than exceptional ( DOH 2002), while studies have identified that dual diagnosis is associated with poor prognosis, higher relapse and non-compliance with service regimes (Keene 2001).
6. The term 'dual diagnosis' has been used, although less commonly so to refer to mental health and learning disability (Robbins 2000). The NSF recognises that there may be "many different definitions of the term 'dual diagnosis' " which may be used to describe "a number of complex or multiple needs".
In relation to 'dual diagnosis' or 'co-morbidity', the NSF identifies the relevance of Turning Points and other services. One particular service identified is the CASA Multiple Needs Service in London which was developed in 1995 to address gaps in service provision for people who experience mental health and substance misuse services in Islington and Camden. This service adopts a holistic approach "working with the whole person and their presenting difficulties. It also offers specialist training nationally" ( NSF 2001). |
'Complex needs'
7. In The same as you? Review (Scottish Executive, 2000), 'complex needs' is defined as needs arising from both learning disability and from other difficulties such as physical and sensory impairment, mental health problems or behavioural difficulties (Extract page 3). Further, the Glossary (page 128) states that 'complex needs' describes, "the needs a person has over and above their learning disability. For example, extra physical or mental health problems, challenging behaviour or offending behaviour".
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