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Mental health and substance misuse

The issue of complex needs and how to best meet the challenges posed arguably falls into the definition of a ‘wicked’ problem. Wicked problems occur in situations where information is incomplete, where there are multiple actors who may have contradictory or incompatible attitudes or needs and when non-linear, holistic and ‘big picture’ solutions may be required.

However, while it is often more useful to think in terms of better or worse responses rather than right or wrong ones, wicked problems are not irresolvable problems. Innovation, flexibility, a commitment to continuous review and a willingness to work across organisational boundaries can all contribute to overcoming even the most significant obstacles.

This briefing has several aims. These include:

  • To outline the prevalence of dual diagnosis and multiple needs within the subject population and some of the consequences and causes of this;
  • To provide an overview of where progress has been made and where it has fallen short;
  • To consider the role of mental health services and substance use services as part of a network of potential and actual support providers;
  • To give consideration to dual diagnosis and complex needs as one factor in a system of often self-reinforcing exclusions and characteristics;
  • To consider four areas where there is either clear potential for progress or else potential for retrograde developments, focussing on the 2002 Dual Diagnosis Guidelines and the proposed review; complex needs and offending, complex needs and young people, and how people with histories affected by complex needs can build a better life for themselves;
  • To offer a limited number of practical recommendations for services as well as for central and local government.