Turning Point’s Richard Kramer on poverty and complex needs

Often, in some of our poorer communities, people’s most challenging needs are not being met. The government’s Social Exclusion Task Force suggests that in the UK, almost 70,000 adults face multiple and complex issues that require specialised interventions and support. These people are removed from society and are disengaged from the services on offer. Too often these service users are seen and labelled under “mental health”, “drugs”, or “alcohol” rather than “complex needs” and this needs addressing.

There are groups of people characterised by chronic exclusion who find services difficult to obtain or they discover that services are not designed around what they need.

We know that current services focus on people’s problems in isolation from the rest of their life. But one might ask whether people’s needs are complex because services are unable to meet them fully, or are services not working effectively because people’s needs are complex?

Who are we talking about? Many will have poor health prospects, be it mental or physical health issues. They will experience a history of exclusion such as family breakdown. Problems are likely to increase as they don’t have the support they need. They may turn to drugs or alcohol, or get caught up in the criminal justice system, or be at risk of homelessness. There is currently a high concentration of people with multiple needs in prisons and among the homeless population. Poor educational achievement and a patchy employment history is common.

Take Joanne, who has to knock on three doors and tell her story three times. She has mental health, substance misuse and self-injury issues. She would like to access mental health, substance misuse and counselling services (ideally concurrently), but each have different criteria. Because she cannot get help, she resorts to drinking and this may reinforce professionals’ conceptions that her choice to drink or self-harm is self-inflicted and that she is not ready to change. This serves to reinforce her exclusion, when in fact her behaviour is a coping mechanism in the absence of getting help.

The statistics paint a picture of exclusion. Seventy thousand people have complex needs 90% of prisoners have mental health problems or substance misuse issues, or both. One important statistic is that eight million people live in poverty in England and Wales. On top of this the 10 most under-resourced health trusts cover some of the poorest areas in the country with above average ill-health.

That is why Turning Point has welcomed the government’s programme, which looks at adults facing chronic exclusion. Our Connected Care project is a response to the idea that some people will always fall through the gaps in services if the current provision status quo is kept in tact. We are working with agencies in Hartlepool and Bolton, two of England’s most deprived areas, to provide better health, housing and social care. We will be working as partners with these local communities, to get their vital input in designing and delivering those essential services. That way, we can start to tackle the chronic social exclusion that exists in England and Wales today.

Richard Kramer is director of Turning Point’s Centre of Excellence in Connected Care