Complex Needs Peter Cockersell ©2016 peter cockersell

The Root of Complex Needs The root cause of so-called ‘complex needs’ lies in trauma, and especially compound trauma, usually combined with the impact of social deprivation and poverty Psychological and emotional responses to the experience of trauma (including vicarious trauma) interact with social determinants to create high levels of poor mental health, substance dependency, criminality and social exclusion ©2016 peter cockersell

Multiple Deprivation Lankelly Chase’s ‘Hard Edges’ report (2015): Severe multiple deprivation – prison, substance dependency treatment, homelessness within same year 58,000 people in England (164,000 with any two) No mental health data available 85% had experienced childhood trauma ©2016 peter cockersell

Complex Trauma ‘Complex Trauma’ is not complex The term is used to describe the experience of repeated and unprocessed experiences of trauma, usually beginning from an early age A more exact term for this would be ‘Compound Trauma’ ©2016 peter cockersell

Psycho-emotional Impact of Trauma Trauma damages development, including affect regulation, sense of self, sense of time, and problem-solving Trauma damages attachment patterns, and ability to form stable relationships Trauma enhances the fear responses, and heightens long-term stress levels Trauma stimulates the ‘claustro-agoraphobic dilemma’ ©2016 peter cockersell

Behavioural Impact of Trauma The way that the psychological and emotional effects of exposure to trauma and social deprivation appear in behaviours are multiple ©2016 peter cockersell

Behaviours associated with compound trauma NMHDU 2010 Self-harm Uncontrolled drug or alcohol use Impulsiveness, careless of the consequences Withdrawal, reluctance to engage Anti-social Self-isolation Depression, anxiety Aggression Lack of daily structure or routine Inability to sustain work or education Bullying, or being a victim of bullying, or both Offending Unstable relationships Relationships based on ‘using’ Personality disorders, psychosis ©2016 peter cockersell

Complex Needs St Mungo’s Client Needs Survey 2014 ©2016 peter cockersell

Damaging relationships damage people Trauma is Social Trauma occurs between people, and between groups of people and an individual, and between society and groups of people - it is a social process, and part of socialisation Damaging relationships damage people Compound trauma could be described as a kind of antisocial socialisation ©2016 peter cockersell

Trauma and Recovery Healing relationships heal people Along with equal and fair opportunities ©2016 peter cockersell

Most ex-homeless people cite a person who made all the difference to them (The Escape Plan, Groundswell) Never underestimate how important you can be to someone ©2016 peter cockersell

The Outcome – Increased Resilience “I didn’t believe in myself, but it seems that other people believed in me; through their belief I could begin to do things.” St Mungo’s client, 2014 ©2016 peter cockersell

References on Trauma and Mental Health Van der Kolk, Proposal for a Developmental Trauma Disorder Diagnosis, 2009; or Developmental Trauma Disorder, in Psychiatric Annals, 2005 Johnson and Haigh, eds, Complex Trauma and Its Effects, 2012 BPS Journal, special edition on psychology and social exclusion, January 2015 Solomon and Siegel, Healing Trauma, 2003 Roos et al, Homelessness and Adverse Childhood Events, in American Journal of Public Health, 2013 Masten, Ordinary Magic, in American Psychologist, 2001 ©2016 peter cockersell

petercockersell@intapsych.org ©2016 peter cockersell