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Chapter 24 - The Complex Needs Patient
- Edited by Roland Dix, Gloucestershire Health and Care NHS Foundation Trust, Gloucester, Stephen Dye, Norfolk and Suffolk Foundation Trust, Ipswich, Stephen M. Pereira, Keats House, London
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- Book:
- Psychiatric Intensive Care
- Published online:
- 15 March 2024
- Print publication:
- 28 March 2024, pp 295-306
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- Chapter
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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.
11 - Working with challenging behaviour
- from Part 2 - Treatment approaches
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- By Shawn Mitchell, Consultant Psychiatrist, St Andrew's Healthcare, Northampton, Sanjith Kamath, Consultant Psychiatrist, St Andrew's Healthcare, Northampton
- Edited by Frank Holloway, Sridevi Kalidindi, Helen Killaspy, Glenn Roberts
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- Book:
- Enabling Recovery
- Published online:
- 02 January 2018
- Print publication:
- 01 July 2015, pp 171-187
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Summary
Introduction
‘Challenging behaviour’ is a phrase that has gained much currency within mental health services since it was first introduced in the 1980s. The initial usage of the term was confined to descriptions of problematic behaviour in younger individuals with intellectual disabilities but it has since been generalised to similar behaviours across the spectrum of psychiatric diagnoses and irrespective of age. Despite its acceptance in everyday psychiatric parlance, the precise meaning and definition of ‘challenging behaviour’ is often unclear and the phrase has been used as a substitute for a diagnosis or as a pejorative term to encompass those aspects of the behavioural manifestations of mental disorder that are less well understood and consequently difficult to manage.
It is likely that all clinicians working with behaviourally disordered patients will be familiar with the term ‘challenging behaviour’, and while most will have a notion of what they mean when using the phrase, a precise definition is hard to articulate. Emerson (1995) defined it as follows:
culturally abnormal behaviour of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities.
It is of significance that a diagnosis of a mental disorder or illness is not a prerequisite to classify an individual's behaviour as challenging if it meets the above broad criteria. It is therefore important for mental health practitioners to understand that challenging behaviour is not a diagnosis and can be observed in individuals with no mental disorder. It is most usefully conceptualised as a social construct that describes behaviours that fall well outside the usually accepted ideas of ‘normal’.
Types or categories of challenging behaviour
Classifying challenging behaviour allows clinicians and sometimes the patient to identify the processes involved in the expression and consequences of the behaviour. Challenging behaviours can be divided into those that are likely to cause harm to the person and those that might lead to harm to others. Each of these can be further subdivided into direct and indirect behaviours.