In a health service context, symptoms can manifest beyond the client presenting with 'complex needs'. Individual workers and teams can experience a range of difficulties including confusion, anxiety, reactivity, splits, frustration and chaos. This is most pronounced in those working with clients described as complex or severe and personality 'dis-orders'. Where workers and teams struggle to formulate their work, the treatment can be compromised, which may be reflected in a deterioration in the client. Consultation is a leadership and reflective process embedded in workers’ experience and allows individuals and teams to navigate their work, delineate their roles, sustain their practice, develop formulations and treatment plans, and manage risk. Consultation works best when the various elements of the system are represented in the discussion.

Clients and systems

Identified complex clients can lead to complex service systems.

'Complex and severe' clients can sorely test the capacity of services and give rise to significant medico-legal issues. Around one individual, a wide range of services can be represented, including clinical mental health, primary health, non-government welfare, child protection, housing, disability, justice, private, education, and financial. In addition, family and carers can have an important presence in client’s lives, and should have a seat at the table wherever possible. Delineating roles, arriving at shared formulations, treatment planning, and risk management can be especially challenging for systems working with clients identified as complex. Different elements of the system can have strongly held and competing beliefs, sometimes due to their role, and sometimes due to a marked difference in their experience of the client. Consultation brings all these elements together in a shared difference, bringing the client to the foreground in their particulars. With this approach new understandings of the client and the system around them can emerge, which guides more effective and sustainable practice. 

I provide reflective practice for organisational teams and inter-service care and support teams across a range of sectors. I also attend care team meetings to provide my perspective.