C-19 and the impact on people with multiple complex needs (MCN)

Tuesday 28th April 2020 by Cherri Blissett
man with beard holding a sign saying seeking human kindness

The world is already a very different place as a result of C-19 and it is going to continue to change. It is important to think about what comes after covid-19, as well as what we can do during the lockdown and recovery phases, to minimise the impact for people with multiple complex needs.

We know that employment was at a record high before C-19, and we know it will collapse; benefit claimants are already increasing and will continue to rise; the self-employed sector will shrink; some sectors will shrink in the short term and be slow to recover. Based on recovery from previous recessions, we predict it will take at least 7 years for the employment rate to recover.

What we don’t know is the social impact of the lockdown and recovery phases, and the uncertainty for people with multiple complex needs. 

  • It is likely that drug and alcohol consumption has increased, while drug supplies are changing (availability, price, purity) and drug treatment services are being delivered remotely. There is likely to be an increase in drug related deaths as a result.
  • There is an increase in cases of domestic abuse, but victims are unlikely to seek help during the lockdown phase. During lockdown people are struggling to access a route to safety, and there is a reduction in reported incidents. While demand increases, services may be at risk of closing due to lack of funding.
  • More people are resorting to selling (or exchanging) sex– often for the first time – as they have no other options to meet basic needs such as food and shelter.
  • C-19 will also put pressure on existing mental health services with rises in cases of isolation and loneliness, loss of motivation, depression, and risk of self-harm. C-19 could have a profound effect on people’s mental health – now and in the future. Often, people with multiple complex needs don’t access community mental health support, or if they have an addiction, can’t access mental health support.
  • Many people are in financial distress, and food poverty and food insecurity is a real worry for many people. Before C-19, there were already more families accessing foodbanks so this is going to exacerbate the trend .
  • While there has been an urgent call from Government to get all rough sleepers housed (‘everyone in’), this really needs to be in self-contained accommodation, with access to a private bathroom. People experiencing homelessness are three times more likely to have a chronic health condition and it is not possible for people living in hostel and shelter accommodation to self-isolate.
  • For some new Universal Credit claimants, the wait for payments presents a severe risk of homelessness. Some groups, such as single parent households in private rented accommodation, are at even more risk.

This raises several questions:

  • How can we minimise the impact of C-19 for people with Multiple Complex Needs? Can we deliver preventative support or early interventions for people with mild to moderate mental health conditions? Can we start that delivery now? Can we ensure people with MCN get the health support they need, and are not at the ‘back of the queue’?
  • How can we continue to effectively support people, as well as bringing new people into support programmes, if needed? Which methods of remote delivery are most effective? And are these as effective (or more) than previous ways of working? How do we effectively respond to an increase in demand? How do we redesign existing services to maximise impact?
  • How do we redesign services, to ensure rough sleeping does not increase to levels before C-19?
  • As the numbers of people accessing mental health support after lockdown will undoubtably increase, how can we deal with this effectively, whilst also ensuring those most in need of support aren’t left at the back of the ‘employment queue’? Can people with mental health needs be supported back in to work concurrently with accessing services.  Can we identify and provide additional support for those at particular risk, ensuring the most vulnerable are not forgotten / left behind?
  • The emergence of online resources, designed to help those in recovery from addictions during the current crisis, is essential. There is a need to carry out more research on the effectiveness of remote treatment delivery and ways to build trusting relationships, without in-person interaction, particularly for new people accessing services.

How can we respond:

  • Providers can ensure that frontline staff are trained and well prepared to deal with safeguarding issues, if working remotely.
  • Providers can put regular reflective practice sessions in place, to ensure the wellbeing and psychological safety of frontline staff.
  • Commissioners must ensure that those with multiple, complex needs or facing multiple deprivation are able to access services quickly and get the right support at the right time.
  • We should all be aiming to identify what works in remote delivery, and share this, to build an evidence base.

Cherri has worked as an Executive Director in leading charities, managing complex service areas, in the North East of England, with coverage across England and Scotland. She returns to Rocket Science with a unique perspective of the issues facing the most vulnerable in society.

To get in touch for a discussion, please email cherri.blissett@rocketsciencelab.co.uk or call 07887 673 407