Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-745bb68f8f-hvd4g Total loading time: 0 Render date: 2025-01-09T15:52:24.328Z Has data issue: false hasContentIssue false

Chapter 24 - The Complex Needs Patient

Published online by Cambridge University Press:  15 March 2024

By
Sanjith Kamath  and
Vishelle Kamath
Edited by
Roland Dix ,
Stephen Dye  and
Stephen M. Pereira
Roland Dix
Affiliation:
Gloucestershire Health and Care NHS Foundation Trust, Gloucester
Stephen Dye
Affiliation:
Norfolk and Suffolk Foundation Trust, Ipswich
Stephen M. Pereira
Affiliation:
Keats House, London
Get access

Summary

The phrase ‘complex needs patient’ is often used by clinicians to describe a patient who presents with challenges and needs that require management approaches that are resource intensive and multi-focused. These individuals are often passed from service to service, with high costs to services across the board. In this chapter, we seek to define ‘complex needs patients’, recognising that for many clinicians the phrase refers to those individuals who present with severe mental illnesses together with other comorbid challenges including, but not limited to, serious physical illness, substance misuse or addiction, social problems including a lack of support, homelessness as well as problematic, absent or abusive relationships and the presence of another comorbid mental illness. This chapter explores the possible aetiological factors of complexity as well as its background and characteristics and discusses useful treatment modalities. Lastly, it considers the impact that the Covid-19 pandemic has had both in terms of disease presentation and the impact it has had on services.

Keywords

psychiatric intensive care unit (PICU)complex needs patientmultimorbidityCOVID-19mental illnesssubstance abuselearning disabilitytraumatic brain injurygenderethnicity
Type
Chapter
Information
Psychiatric Intensive Care , pp. 295 - 306
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albrecht, JS, Hirshon, JM, Goldberg, R, Langenberg, P, Day, HR, Morgan, DJ, et al. (2012) Serious Mental Illness and Acute Hospital Readmission in Diabetic Patients. American Journal of Medical Quality 27 (6) 503–8.CrossRefGoogle ScholarPubMed
Ambrosetti, J, Macheret, L, Folliet, A, Wullschleger, A, Amerio, A, Aguglia, A, et al. (2021) Impact of the COVID-19 Pandemic on Psychiatric Admissions to a Large Swiss Emergency Department: An Observational Study. International Journal of Environmental Research and Public Health 18 (3) 1174.CrossRefGoogle ScholarPubMed
Archer, M, Lau, Y and Sethi, F (2016) Women in Acute Psychiatric Units: Their Characteristics and Needs: A Review. BJPsych Bulletin 40 (5) 266–72.CrossRefGoogle ScholarPubMed
Baandrup, L, Rasmussen, JO, Klokker, L, Austin, S, Bjørnshave, T, Bliksted, V, et al. (2016) Treatment of Adult Patients with Schizophrenia and Complex Mental Health Needs: A National Clinical Guideline. Nordic Journal of Psychiatry 70 (3) 231–40.CrossRefGoogle Scholar
Beer, MD, Pereira, SM and Paton, C (2001) Psychiatric Intensive Care, 1st ed. Cambridge: Cambridge University Press.Google Scholar
Beer, MD, Pereira, SM and Paton, C (2008) Psychiatric Intensive Care, 2nd ed. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Brown, C, Keene, A, Hooper, C and O’Brien, A (2020) Isolation of Patients in Psychiatric Hospitals in the Context of the COVID-19 Pandemic: An Ethical, Legal, and Practical Challenge. International Journal of Law and Psychiatry 71: 101572.CrossRefGoogle ScholarPubMed
Buckles, J, Luckasson, R and Keefe, E (2013) A Systematic Review of the Prevalence of Psychiatric Disorders in Adults With Intellectual Disability, 2003–2010. Journal of Ment Health Research and Intellectual Disabilities 6: 181–207.CrossRefGoogle Scholar
Buckley, PF, Miller, BJ, Lehrer, DS and Castle, DJ (2009) Psychiatric Comorbidities and Schizophrenia. Schizophrenia Bulletin 35 (2) 383–402.CrossRefGoogle ScholarPubMed
Bujold, M, Pluye, P, Légaré, F, Haggerty, J, Gore, GC and El Sharif, R (2017) Decisional Needs Assessment of Patients With Complex Care Needs in Primary Care: A Participatory Systematic Mixed Studies Review Protocol. BMJ Open 7 (11) e016400.CrossRefGoogle ScholarPubMed
Chen, LP, Murad, MH, Paras, ML, Colbenson, KM, Sattler, AL, Goranson, EN, et al. (2010) Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-Analysis. Mayo Clinic Proceedings 85 (7) 618–29.CrossRefGoogle ScholarPubMed
Commander, M and Rooprai, D (2008) Survey of Long-Stay Patients on Acute Psychiatric Wards. Psychiatric Bulletin 32(10) 380–3.CrossRefGoogle Scholar
Conway, KP, Compton, W, Stinson, FS and Grant, BF (2006) Lifetime Comorbidity of DSM-IV Mood and Anxiety Disorders and Specific Drug Use Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 67 (2) 247–57.Google ScholarPubMed
Davies, M and Hogarth, L (2021) The Effect of COVID-19 Lockdown on Psychiatric Admissions: Role of Gender. BJPsych Open 7 (4) e112.CrossRefGoogle ScholarPubMed
De Hert, M, Detraux, J and Vancampfort, D (2018) The Intriguing Relationship Between Coronary Heart Disease and Mental Disorders. Dialogues in Clinical Neuroscience 20 (1) 31–40.CrossRefGoogle ScholarPubMed
Diabetes.co.UK (2019) Diabetes Prevalence. Website. www.diabetes.co.uk/diabetes-prevalence.html.Google Scholar
Doherty, AM and Gaughran, F (2014) The Interface of Physical and Mental Health. Social Psychiatry and Psychiatric Epidemiology 49 (5) 673–82.CrossRefGoogle ScholarPubMed
Emerson, E, Kiernan, C, Alborz, A, Reeves, D, Mason, H, Swarbrick, R, et al. (2001) The Prevalence of Challenging Behaviours: A Total Population Study. Research in Developmental Disabilities 22: 77–93.CrossRefGoogle ScholarPubMed
Fann, JR, Burington, B, Leonetti, A, Jaffe, K, Katon, WJ and Thompson, RS (2004) Psychiatric Illness Following Traumatic Brain Injury in an Adult Health Maintenance Organization Population. Archives of General Psychiatry 61 (1) 53–61.CrossRefGoogle Scholar
Feinstein, A and Holloway, F (2002) Evaluating the Use of a Psychiatric Intensive Care Unit: Is Ethnicity a Risk Factor for Admission? International Journal of Social Psychiatry 48 (1) 38–46.CrossRefGoogle ScholarPubMed
Felitti, VJ (2002) The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead. The Permanente Journal 6 (1) 44–7.Google ScholarPubMed
Gemine, R, Davies, GR, Tarrant, S, Davies, RM, James, M and Lewis, K (2021) Factors Associated with Work-Related Burnout in NHS Staff During COVID-19: A Cross-Sectional Mixed Methods Study. BMJ Open 11 (1) e042591.CrossRefGoogle ScholarPubMed
Gonzalez, JS, Peyrot, M, McCarl, LA, Collins, EM, Serpa, L, Mimiaga, MJ, et al. (2008) Depression and Diabetes Treatment Nonadherence: A Meta-Analysis. Diabetes Care 31 (12) 2398–2403.CrossRefGoogle ScholarPubMed
Grant, BF and Weissman, MM (2007) Gender and the Prevalence of Psychiatric Disorders. In Narrow, WE, First, MB, Sirovatka, PJ and Regier, DA (eds.), Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda for DSM-V. Arlington: American Psychiatric Association. pp. 31–45.Google Scholar
Green, A.I, Canuso, CM, Brenner, MJ and Wojcik, JD (2003) Detection and Management of Comorbidity in Patients with Schizophrenia. Psychiatric Clinics of North America 26 (1) 115–39.CrossRefGoogle ScholarPubMed
Grimshaw, B and Chaudhuri, E (2021) Mental Health-Related Admissions to the Acute Medical Unit During COVID-19. Clinical Medicine 21 (1) e77–9.CrossRefGoogle Scholar
Grube, M (2007) Gender Differences in Aggressive Behavior at Admission to a Psychiatric Hospital. Aggressive Behavior 33 (2)97–103.CrossRefGoogle ScholarPubMed
Gunnell, D, Appleby, L, Arensman, E, Hawton, K, John, A, Kapur, N, et al. (2020) Suicide Risk and Prevention During the COVID-19 Pandemic. Lancet Psychiatry 7 (6) 468–71.CrossRefGoogle ScholarPubMed
Hamilton, JE, Heads, AM, Cho, RY, Lane, SD and Soares, JC (2015) Racial Disparities During Admission to an Academic Psychiatric Hospital in a Large Urban Area. Comprehensive Psychiatry 63: 113–22.CrossRefGoogle Scholar
Howes, OD, McCutcheon, R, Agid, O, de Bartolomeis, A, van Beveren, NJM Birnbaum, ML, et al. (2017) Treatment-resistant schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. American Journal of Psychiatry 174: 216–29.CrossRefGoogle Scholar
Huband, N, Furtado, V, Schel, S, Eckert, M, Cheung, N, Bulten, E, et al. (2018) Characteristics and Needs of Long-Stay Forensic Psychiatric Inpatients: A Rapid Review of the Literature. International Journal of Forensic Mental Health 17 (1) 45–60.CrossRefGoogle Scholar
Kasmi, Y (2007) Characteristics of Patients Admitted to Psychiatric Intensive Care Units. Irish Journal of Psychological Medicine 24 (2) 75–8.CrossRefGoogle ScholarPubMed
Killaspy, H, Harden, C, Holloway, F and King, M (2005) What Do Mental Health Rehabilitation Services Do and What Are They For? A National Survey in England. Journal of Mental Health 14: 157–65.CrossRefGoogle Scholar
Killaspy, H (2014) The Ongoing Need for Local Services for People With Complex Mental Health Problems. Psychiatric Bulletin 38 (6)257–9.CrossRefGoogle ScholarPubMed
Kleinsinger, F (2010) Working with the Noncompliant Patient. The Permanente Journal 14 (1) 54–60.CrossRefGoogle ScholarPubMed
Knapp, M, McDaid, D and Parsonag, M (2011) Mental Health Promotion and Mental Illness Prevention: The Economic Case. London: Department of Health and Social Care.Google Scholar
Knudsen, M and Vogd, W (2014) Systems Theory and the Sociology of Health and Illness: Observing Healthcare. Oxford: Routledge.CrossRefGoogle Scholar
Koopmans, B, Pouwer, F, de Bie, RA, vanRooij, ES, Leusink, GL, and Pop, VJ (2009) Depressive Symptoms Are Associated With Physical Inactivity in Patients With Type 2 Diabetes: The DIAZOB Primary Care Diabetes Study. Family Practice 26 (3) 171–3.CrossRefGoogle ScholarPubMed
Kuo, C-J, Yang, SY, Liao, YT, Chen, WJ, Lee, WC, Shau, WY, et al. (2013) Second-Generation Antipsychotic Medications and Risk of Pneumonia in Schizophrenia. Schizophrenia Bulletin 39 (3) 648–57.CrossRefGoogle ScholarPubMed
Liao, C, Chiu, W, Yeh, C, Chang, HC and Chen, TL (2012) Risk and Outcomes for Traumatic Brain Injury in Patients with Mental Disorders. Journal of Neurology, Neurosurgery, and Psychiatry 83:1186–92.CrossRefGoogle ScholarPubMed
Lin, EHB, Katon, W, Rutter, C, Simon, GE, Ludman, EJ, Von Korff, M, et al. (2006) Effects of Enhanced Depression Treatment on Diabetes Self-Care. Annals of Family Medicine 4 (1) 46–53.CrossRefGoogle ScholarPubMed
Loeb, DF, Binswanger, IA, Candrian, C and Bayliss, EA (2015) Primary Care Physician Insights into a Typology of the Complex Patient in Primary Care. Annals of Family Medicine 13 (5) 451–5.CrossRefGoogle ScholarPubMed
Mann, S. A. and Cree, W. (1976) ‘New’ Long-Stay Psychiatric Patients: A National Sample Survey of Fifteen Mental Hospitals in England and Wales 1972/3. Psychological Medicine 6 (4) 603–16.Google ScholarPubMed
Manning, E and Gagnon, M (2017) The Complex Patient: A Concept Clarification. Nursing & Health Sciences 19 (1) 13–21.CrossRefGoogle Scholar
Martin, CM and Félix-Bortolotti, M (2010) W(h)ither Complexity? The Emperor’s New Toolkit? Or Elucidating the Evolution of Health Systems Knowledge? Journal of Evaluation in Clinical Practice 16 (3) 415–20.CrossRefGoogle ScholarPubMed
McGlashan, TH, Grilo, CM, Skodol, AE, Gunderson, JG, Shea, MT, Morey, LC, et al. (2000) The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scandanavia 102: 256–64.CrossRefGoogle Scholar
Merikangas, KR, Akiskal, HS, Angst, J, et al. (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry 64: 543–52.CrossRefGoogle ScholarPubMed
Merikangas, K, He, J, Burstein, M, Swanson, S, Avenevoli, S, Cui, L, et al. (2010) Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry 49 (10) 980–9.Google ScholarPubMed
Merrick, J and Merrick, E (2007) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Journal of Policy and Practice in Intellectual Disabilities 4 (1) 73–73.CrossRefGoogle Scholar
Miller, KA, Miller, KA, Hitschfeld, MJ, Lineberry, TW and Palmer, BA (2016) How Does Active Substance Use at Psychiatric Admission Impact Suicide Risk and Hospital Length-of-Stay? Journal of Addictive Diseases 35 (4) 291–7.CrossRefGoogle ScholarPubMed
Mustafa, FA, Bayatti, Z and Faruqui, RA (2013) Gender Differences in Referral Pathways and Admissions to a Psychiatric Intensive Care Unit in a County Psychiatric Hospital in the UK. International Journal of Social Psychiatry 59 (2) 188–9.CrossRefGoogle Scholar
National Institute of Mental Health (2021) Mental Illness. www.nimh.nih.gov/health/statistics/mental-illness.Google Scholar
National Mental Health Development Unit (2011) In Sight and in Mind: A Toolkit to Reduce the Use of Out of Area Mental Health Services. Royal College of Psychiatrists.Google Scholar
Naylor, C, Das, P, Ross, S, Honeyman, M, Thompson, J and Gilbert, H (2016) Bringing Together Physical and Mental Health: A New Frontier for Integrated Care. London: The Kings Fund.Google Scholar
Open Access News (2021) Committee Report Finds NHS ‘Burnout Is Widespread Reality’. www.openaccessgovernment.org/nhs-burnout/112353/.Google Scholar
North, CS, Eyrich, KM, Pollio, DE and Spitznagel, EL (2004) Are Rates of Psychiatric Disorders in the Homeless Population Changing? American Journal of Public Health 94 (1) 103–8.CrossRefGoogle ScholarPubMed
Osborn, DPJ, Levy, G, Nazareth, I, Petersen, I, Islam, A and King, MB (2007) Relative Risk of Cardiovascular and Cancer Mortality in People with Severe Mental Illness from the United Kingdom’s General Practice Research Database. Archives of General Psychiatry 64 (2) 242–9.CrossRefGoogle Scholar
Osby, U, Brandt, L, Correia, N, Ekbom, A and Sparén, P (2001) Excess Mortality in Bipolar and Unipolar Disorder in Sweden. Archives of General Psychiatry 58 (9) 844–50.CrossRefGoogle ScholarPubMed
Parker, GB (2010) Comorbidities in Bipolar Disorder: Models and Management. Medical Journal of Australia 193 (4) S18.CrossRefGoogle ScholarPubMed
Parsonage, M, Hard, E and Rock, B (2014) Managing Patients with Complex Needs: Evaluation of the City and Hackney Primary Care Psychotherapy Consultation Service. Centre for Mental Health.Google Scholar
Pary, R, Patel, M and Lippmann, S (2017) Depression and Bipolar Disorders in Patients with Alcohol Use Disorders, Federal Practitioner 34 (Suppl 2) 37S–41S.Google ScholarPubMed
Pereira, S, Walker, L and Dye, S (2021) A National Survey of Psychiatric Intensive Care, Low Secure and Locked Rehabilitation Units. Mental Health Practice 24 (4).CrossRefGoogle Scholar
Pincus, HA, Tew, JD and First, MB (2004) Psychiatric Comorbidity: Is More Less? World Psychiatry 3 (1) 18–23.Google ScholarPubMed
Ribeiro, WS, Andreoli, SB, Ferri, CP, Prince, M and Mari, JJ (2009) Exposure to Violence and Mental Health Problems in Low and Middle-Income Countries: A Literature Review. Brazilian Journal of Psychiatry 31 (Suppl 2) S49–57.CrossRefGoogle ScholarPubMed
Tiihonen, J, Lonnqvist, J, Wahlbeck, K, Klaukka, T, Niskanen, L and Haukka, J (2009) 11-Year Follow-Up of Mortality in Patients With Schizophrenia: A Population-Based Cohort Study (FIN11 Study). Lancet 374 (9690) 620–7.CrossRefGoogle ScholarPubMed
Tyrer, P, Reed, GM and Crawford, MJ (2015) Classification, Assessment, Prevalence, and Effect of Personality Disorder. Lancet 385 (9969) 717–26.CrossRefGoogle ScholarPubMed
Tulloch, AD, Khondoker, MR, Fearon, P and David, AS (2012) Associations of Homelessness and Residential Mobility with Length of Stay after Acute Psychiatric Admission. BMC Psychiatry 12: 121.CrossRefGoogle ScholarPubMed
Van der Meer, L, Jonker, T, Wadman, H, Wunderink, C, van Weeghel, J, Hendrika, G, et al. (2021) Targeting Personal Recovery of People with Complex Mental Health Needs: The Development of a Psychosocial Intervention Through User-Centred Design. Frontiers in Psychiatry 12: 635514.CrossRefGoogle Scholar
Vorstenbosch, ECW, Bouman, YH, Braun, PC and Bulten, EB (2014) Psychometric Properties of the Forensic Inpatient Quality of Life Questionnaire: Quality of Life Assessment for Long-Term Forensic Psychiatric Care. Health Psychology and Behavioral Medicine 2(1) 335–48.CrossRefGoogle ScholarPubMed
Wolfson, P, Holloway, F and Killaspy, H (2009) Enabling recovery for people with complex mental health needs. A template for rehabilitation services. Faculty report FR/RS/1 Faculty of Rehabilitation and Social Psychiatry of the Royal College of Psychiatrists November 2009.Google Scholar
Zanarini, MC, Frankenburg, FR, Dubo, ED, Sickel, AE, Trikha, A, Levin, A et al. (1998) Axis I Comorbidity of Borderline Personality Disorder. American Journal of Psychiatry 155:1733–9.CrossRefGoogle ScholarPubMed
Zubair, UB and Brown, R (2021) Audit of Documentation of Forensic History on Admission Form in a Psychiatric Intensive Care Unit. Journal of the College of Physicians and Surgeons–Pakistan 30 (6) 707–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×