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Why do so many people with complex needs die young?
Many people with multiple and complex needs die early as they become desensitised to death through suffering vast loss and lack of hope.

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Vast experience of loss

Last month Fuse, the Centre for Translational Research in Public Health, working in collaboration with Fulfilling Lives Newcastle Gateshead and its peer research network published a report which explores why so many people with multiple and complex needs are dying and dying early, in order to find ways to identify those at risk and to prevent unnecessary deaths in the future.

Multiple and complex needs

The researchers explore the concept of multiple and complex needs and acknowledge that there are several definitions
currently used to describe the nature of a person facing more than one complex issue, such as poverty, mental ill-health, substance misuse and homelessness including: “Severe and multiple disadvantage”, “multiple exclusion homelessness,” “inclusion health” and “multiple and complex needs”. The authors of the report use the phrase “multiple and complex needs” (MCN)  as the overarching term to describe co-occurring issues of homelessness, offending, substance misuse and mental ill-health.

Historically, it has been difficult to estimate the numbers of people with multiple and complex needs because most services that support people who have MCN address each need individually. Limitations in data sharing across these services mean that it has been difficult to estimate the number of people experiencing MCN in a given population. In its 2015 Hard Edges report the Lankelly-Chase Foundation attempted to link data from a variety of statutory and voluntary services to estimate the number of people with lived experience of MCN in England. It estimated that over a quarter of a million people a year have contact with at least two out of three of the homelessness, substance misuse and/or criminal justice systems, and at least 58,000 have contact with all three. Research suggests that poverty, childhood trauma and economic and social marginalisation are common features shared among those living with MCN.


Researchers found that those with lived experience of multiple and complex needs had vast experience of loss and this, coupled with a lack of hope that things could change for the better, meant they had become desensitised to death.

The study also found that mental ill health when combined with drug and alcohol problems, and poor coordination and collaboration between support services, increase vulnerability and the risk of people dying prematurely.

The report identifies windows of opportunity when someone with multiple and complex needs should receive targeted support through critical life events, such as bereavement and relationship breakdown, and significant transitions, such as completing treatment, release from prison, or service discharge.


The report makes a series of recommendations; arguing that the

early and premature deaths of people with multiple and complex needs could be prevented by:

  • introducing holistic, person-centred approaches
  • building a sense of community for those who feel excluded from society
  • improving connections and support across the health and wider care system
  • placing the focus on prevention, particularly in early childhood; and
  • exploring opportunities to support carers, providers, and families.

These recommendations are elaborated on in the report but are neatly encapsulated in the infographic reproduced below. 

Thanks to Stefano Pollio for the header image, previously published on Unsplash.

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