Complex needs, consistent relationships

David Baker

Over the last few months I’ve been working with several London Boroughs and service providers, looking at some of their most complex and challenging people – usually those who’ve been around ‘the system’ for a number of years but are still causing a lot of problems both for themselves and others. Part of our analysis has been about whether these people have any good, consistent relationships - either in the system or in the community – that could provide a basis for change. The evidence is consistent and sobering, clearly showing that there are a small but significant number whose lives seem caught in a downward spiral of chaos and harm. Hard pressed services often struggle to work with these people, if they are able to engage with them at all.  

This is partly because their complex needs and challenging behaviour do not fit neatly within the usual categories and structures such as drug treatment, housing or mental health services. It is also because the underlying causes are often deeply personal: trauma or abuse, underlying vulnerability and chaos, and a complex poverty of relationships, resources, hope, control and resilience. These deep-rooted causes may result in a range of issues such as personality disorders, disrupted relationships, self-harm, risky or anti-social behaviour, isolation, addiction or offending. This can often be alongside on-going experience of violence, abuse or exploitation. While some estimates suggest 60,000 people in these kinds of situations in the UK, it is generally regarded that the numbers are on the increase.

While none of this new, the key question as always is what can be done in response. We all know that increases in demand will have to be met by significantly reduced public resources and capacity. Many existing responses are facing steep reductions in funding, and consequently reduced staff numbers and lower levels of pay and training. Adding to this the anecdotal evidence that many of the most chaotic and vulnerable individuals are already experiencing the sharp end of changes to the welfare system, then energy and capacity for positive change may further be sapped from support services.  

What has, however, been shown to create the basis for positive change is the enduring value of consistent, stable and trusted personal relationships – especially those which are able to transcend, and are not dependent on, any specific services and institutional structures. This is not surprising - if the underlying causes of chaos and complexity are often deeply personal, then it follows that sustainable progress is likely to require engagement, over time, at a deeply personal level. Organisations that can build strong, flexible relationships rather than just delivering services or imposing structures are likely to be best at engaging with the ‘whole person’, whatever complexities that brings, and sticking with them for the long-term.  

Whether or not these kinds of relationships can, or ever have been, resourced through the public sector is open to debate. But even if they have been until now, then we will increasingly need to look more widely to the voluntary and community sector, social enterprises and faith-based organisations to step up and work in partnership with the existing players. This may seem ‘unprofessional’ and high-risk, with many likely failures. But no-one said that building relationships is easy, especially in the most challenging circumstances. It may, though, be our best chance of forging the conditions for real, sustainable, positive change.

If you would like to comment on the scaling report, please email:

view all blog entries