Using digital mediums to provice trauma-informed support to people with complex presentations

When we talk about ‘severe’ mental health difficulties or ‘complex presentations’, we usually mean mental health difficulties that significantly affect people in their day-to-day lives, often over a number of years or in conjunction with other health conditions. Some might consider particular diagnoses as evidence of a ‘complex presentation,’ such as psychosis or bipolar disorder. However, there is usually a spectrum of severity and experience within any ‘diagnosis,’ and a degree of overlap in signs and symptoms across conditions. For instance, the experience of hearing voices others can’t (be it internal or external) could result from: large doses of certain pain relief or immunosuppressant medication following a major surgery; intrusive thoughts associated with obsessive compulsive disorder (OCD) or eating disorders; psychosis; or dissociation. It is also widely recognised that stress, trauma and low self-compassion underpin many frightening and critical auditory hallucinatory experiences, for example. These are broadly psychosocial factors and not symptoms of illness. Therefore, for the purposes of this chapter, we will focus on supporting people with a range of ‘complex presentations’, rather than focusing on specific diagnoses or clusters of specific symptoms. The National Health Service within the UK recognise that complex mental health does not just refer to an individual’s diagnosis, but to a number of different factors (NHS England 2019). This includes: • The nature, duration and severity of mental health problems • Any co-occurring drug or alcohol dependency • The nature, duration and severity of co-existing physical health problems • Problems associated with ageing, such as frailty • The availability and quality of personal and social support and networks • Any associated functional impairment, or impact on activities of daily living • The effectiveness of current or past support or interventions