What mental health care experiences and outcomes matter for people with complex health and social needs?

Abstract

Individuals with complex health and social needs (ie. those experiencing physical and mental multimorbidity and social marginalization) are poorly served by health systems. “Complex care” programs have been developed to address these needs. However, scholarly debate surrounds the question of what problem complex care seeks to resolve, and how success can be measured. Within this debate, limited attention has been given to mental health. This dissertation contributes to discussions of the objectives of complex care through three qualitative studies. First, a critical interpretive synthesis of literature is conducted to develop a novel framework for complex care policy. The framework integrates diverse academic and grey literature on complex care, while drawing on theoretical work on multi-level interventions. Second, a qualitative description study explores the perspectives of leaders (including operational and programmatic leaders, and individuals with lived experience in advisory roles) with respect to mental health outcomes that matter in complex care. Outcomes valued by participants include both individual-level objectives oriented along a dynamic continuum towards recovery, and system-level objectives. Finally, an interpretive description study unpacks the viewpoints of individuals with complex health and social needs on what constitutes a good experience in mental health care. Participants describe valuing mental health care that is founded on authentic relationships and that is tailored to the individual. Taken together, these studies posit that complex care must be individualized, relationally- centred care, and situated within a flexible, multi-level system. This dissertation advances conversations on the aims of complex care and the conditions that might render these aims attainable.