Susan Mizen, Felicitas Rost and Frederico Cardoso
Defining ‘complex mental health difficulties’
This report uses the phrase ‘complex mental health difficulties’ to describe people given a range of diagnoses, including ‘personality disorders’ alongside others such as eating disorders, persistent (sometimes described as ‘medically unexplained’) physical symptoms, and substance use. These often co-occur, including with neurodivergence, so that people with these diagnoses do not fit easily into existing specialist services or classifications of need. Many have experienced significant lifetime traumas, and too many encounter entrenched negative attitudes and discrimination, including from health and other public services.
The intention of this phrase is not to imply a new diagnostic category, but to identify opportunities to improve support for people who existing systems and classifications are failing. This phrase doesn’t seek to define clinical characteristics, but experiences of poor services.
Long spells in hospital far from home leave people isolated and dislocated from their communities. For some people with complex mental health difficulties, including people who have been given a diagnosis of ‘personality disorder’, a lack of effective support from mental health services means they get inadequate care and face long stays in hospital.
Until now the needs and experiences of this group of people have been overlooked by policymakers and commissioners. They are often referred to, and excluded by, multiple different services that are not geared up to meet their needs, and their long stays in hospital are not counted in official data. As a result, they have been neglected in national health and care strategies.
This report estimates that the costs of hospital care for people with complex mental health difficulties is between £480-785 million each year nationally. However, these (often long) stays in hospital can leave people dislocated from their support networks simply because their needs are not adequately met in the community.
The report highlights an alternative: local community-based support involving intensive psychotherapy, a psychodynamic therapeutic community day programme, and high support accommodation where appropriate. This service, trialled in Devon, provided a better experience for service users and their families, significantly reduced the number and duration of hospital admissions both locally and out of area, and reduced emergency service attendance.
People with complex mental health difficulties deserve skilled and tailored mental health support. Providing the right specialised care and support will result in both better clinical outcomes and improved value for money. Achieving this requires a commissioning focus on system-wide change in pathways and on building up well trained and resourced specialist teams.
