“ Complex care seeks to improve health and well being for people with complex health needs by coordinating and reshaping care delivery at the individual, community and systems levels.” NDIS Complex Support Needs Pathway “

Introduction:
The purpose of the “Side by Side Complex Needs Group” at MerseyCare NHS Foundation Trust is to collectively reimagine support for complex lives so that it puts the well being of the person at the centre and treats people with kindness. There is a need to debate and consider the terms and meaning of complex lives and and explore the various journeys and narratives represented by people living with such complex needs.

A Personal Narrative:
“ Complex patients, defined by the Agency for Healthcare and Quality (AHRQ) are persons with two or more chronic conditions where each condition may influence the care of each other condition.”

The Life long Lived Experience of a Mental Disorder and Physical illnesses are complex and go hand in hand, they are inseparable. From the early age it is possible to experience a life time of mental and physical illnesses. They can be complicated and mutually connected and need to be co-ordinated and integrated to achieve well being. Generally, lived experiences indicate that all the complications of treatment have to be be well coordinated. Trusted professionals need to coordinate care, share information and avoid gaps at transition points, avoiding duplication and repetition of information.

Personal experience of a complex life can be unique to the person and research into comparable complex needs is limited. For this reason a life long Journey and Narrative was presented to The “Complex Lives Workshop- Co-Production & Engagement ( System P) Microsoft Teams Meeting which was held on 6th October 2022. Hopefully, the objective was to explore and expose the complex needs and highlight the need for more research into this in between area of illness and well being.

Its important that service users are enabled to talk, be listened too and give voice of their lived experiences of complex needs. The presentation was supported by Helen Bennett MerseyCare Participation Manager and and the author Robert MacDonald is grateful to MerseyCare for this
presentation opportunity.

Bi-Polar Disorder:
The author has been Bi-polar since the age of 19 and Is now 71. During this time the author has experienced many manic episodes and depressive periods. These include being taken to a low security hospital, hand cuffed in a police car, restrained and sectioned under the Mental Health Act and held in a seclusion suite without a window. His situation was considered by a Mental Health Tribunal comprising a Consultant Psychiatrist, GP, Social Worker and an Independent Pastoral Observer.

Bi-Polar is a serious life long mental illness characterised by extreme high manic and low depressive mood swings. It can reduce the life span and long levity by about ten years and manic episodes can seriously result in suicidal acts and self harming behavior. Bi-Polar can be self managed with medication especially lithium and anti psychotic drugs.

Regular psychiatric appointments are required and adjustments in medication are made by telephone or face to face. During COVID lockdowns face to face therapeutic psychiatric consultations were limited and relied only on telephone consultations which tended to be very confusing.

Diabetic Type 1:
For twelve years the author has been diagnosed Diabetic Type 1. This started with a Diabetic Ketoacidosis DKE Episode when he went into a coma and was hospitalised. It is necessary to learn to manage daily insulin and medication and Diabetic Sensors can now be fitted and connected to a Smart Phone. Regular foot inspections and retinal photography are required.

In addition CKD Chronic Kidney Disease, (which is now a global epidemic of 37 million people) developed.

Diverticulitis:
The Ageing population aged over 60 and 80 are prone to Diverticulitis which is condition of the lower abdomen. It can be extremely painful and can even involve an emergency hospital visit to an AE followed by long term hospitalisation.

Ageing and Dementia:
Dementia can develop gradually with loss of memory, mobility problems and is now effecting large numbers of individuals nationally and internationally.

Parkinson’s Disease:
The symptoms of Dementia and Parkinson’s Disease can overlap. Parkinson’s requires a medical assessment of mobility, agility and numerical intelligence. The symptoms of both can be similar and might also reveal and show the signs of a ‘stroke’.

Walking and Mobility:
Over a period of time walking can become difficult and the ‘gaite’ becomes quite uneasy. Mobility aids are useful, walking sticks and wheelers all can assist unsteadiness. However, falls can become damaging resulting in hospitalization for hip replacement.

Cataracts:
During the 2-3 years of The Pandemic lockdowns cataracts in both eyes presented problems. The Eye Sight Clinic closed down completely and the author virtually lost all sight until the clinic reopened. Eye surgery and laser treatment enabled better eyesight to be returned and regular visits to the opticians.

Glaucoma:
After cataract treatment long term glaucoma was diagnosed and medicinal eye drops were prescribed.

Dental Treatment:
Ageing brings with it dental problems, painful extractions and fillings.

Conclusions:
Given the complexity of all the different mental and physical needs and conditions there is an important and urgent requirement for integrated and coordinated care.

The GP surgery is very important in this role but there are also many other health care professionals and agencies responsible for health and well being. It is not sufficient to rely on medical and mental health awareness because new ways of training in coordinated care is vital.

Increasingly the self management and therapeutic care of well being is recognized as being important.

The question is can any of the different types of therapy help people experiencing these complex needs and conditions ?

The MerseyCare NHS Foundation Trust have set up a number of Life Rooms. These include Art for Well Being Classes, Music Classes and Poetry etc.

The question is how can better awareness of complex needs be delivered in the context of the life rooms ?

Perhaps there can be classes and training in complex needs for MerseyCare Staff and Service Users in the life rooms ?