The Big Lottery Fund has defined people with multiple and complex needs as individuals who experience at least two of the following:
- Addiction and problematic substances misuse
- Risk of reoffending
- Mental ill health
We remember this list by thinking of the word ‘HARM’
The project focuses on long-term service and system change to support individuals to lead a fulfilled life and to ensure that successful models and approaches pioneered through this project become mainstream.
- Services must be seamless and integrated
- There must be better and earlier identification and diagnosis of complex needs so that an integrated, holistic service response is triggered sooner
- Better tracking and monitoring of progress and outcomes is needed
- Data needs to be shared between providers so that service users are not repeatedly required to “tell their story”.
- Support needs to be more intensive and more ‘guided’.
- Better signposting and referral pathways and mechanisms are needed.
- Service users must be at the forefront of service design and system change.
- Partners too will need support and encouragement in this challenging work.
The main proposals contained in the business plan include:
- Every Step of the Way – a commitment to involve at least 120 experts by experience each year involved in design, development and monitoring of services;
- Lead workers advised by Peer Mentors – to help individuals with complex needs navigate services to find the right recovery and support package;
- A ‘No Wrong Door Network’ – a group of organisations committed to not turning people away and to a collaborative approach to delivering services;
- iCAT – an intelligent common assessment tool – so that people with complex needs only need to tell their story once, by sensitive sharing of information while respecting confidentiality;
- Inreach/Outreach signposting, especially involving experts by experience in face-to-face communication;
- Beyond the Basics programme – opportunities and support in developing positive lifestyles and friendship groups which will help sustain recovery;