Introduction

Mental health workers are increasingly faced with patients who not only suffer from a severe mental illness, but also have a number of additional problems, which further complicate their treatment and management. This is especially so in urban inner city areas. Very often, the treatment of the mental illness alone is not sufficient and resources focused specifically to their needs are scarce or non-existent.

Such patients are often admitted to psychiatric intensive care or acute inpatient units due to their disturbed behaviour. Their management often tends to be problematic and incomplete, and unless attention is paid to meet their specific needs, a ‘revolving door’ phenomenon is a likely outcome. In Psychiatric Intensive Care Units (PICU), patients with complex needs are often those who cannot be transferred out or discharged within 8 weeks, either because their symptoms are resistant to treatment, or there are other needs that have not been adequately addressed. They display frequent verbal or physical violence and often find ingenious methods of abusing drugs, even in very carefully controlled ward environments.

We will attempt, in this chapter, to define the ‘complex needs patient’ and examine the commonly encountered diagnoses and additional problems (with reference to their possible aetiological factors) in such a patient. Finally, we will examine how such patients can be treated and managed.