Understanding high mortality rates among people with multiple and complex needs: exploring underlying factors and opportunities for prevention in Newcastle and Gateshead
People facing multiple and complex needs such as homelessness, substance misuse, repeat offending and/or mental ill health experience severe health inequalities and much higher death rates than the general population.
Our recent research project with Fuse and our peer research network shines a light on these deaths, exploring the underlying reasons and potential to target preventative interventions.. This work was funded by a small seed grant from Public Health England as part of the Research Hub Initiative.
About the project
Through a peer-informed qualitative study, we:
- Explored the underlying reasons for the high mortality rates
- Pinpointed opportunities to identify people at risk
- Explored potential interventions to prevent these unnecessary early deaths.
Research was carried out using focus groups of people with lived experience, frontline staff, and managers and commissioners along with a regional event for stakeholders across the North East.
Our findings: a summary
1) Understanding premature mortality
Factors identified that contribute to mortality rates:
- Double burden of mental health conditions and substance misuse
- Poor service provision and multi-agency collaboration
- Lack of hope for change and acceptance that death was common.
2) Identifying opportunities to intervene
Windows of opportunity are brief and not always easy to target, but with the right support in place critical life events (such as bereavement and relationship breakdown) and significant transitions (completion of treatment, release from prison, or service discharge) could be targeted.
3) Possible interventions to reduce high mortality rates
Four areas for intervention were suggested:
- Introducing holistic, person-centred approaches
- Developing communities
- Improving connections and supports across the system
- Placing a focus on prevention.
Main recommendations for policy, practice and research
Actions to prioritise prevention and health promotion:
- Make every contact count not just those in health and social care
- Target preventive interventions at ‘critical life events’
- Ensure timely and effective access to support services.
Actions to assist in focusing on the individual:
- Collaborate with people with lived experience for service provision/development and research
- Create a tiered person-centred treatment/care pathway that is trauma informed and free of stigma.
Actions to implement a whole-system approach:
- Improve collaboration and communication across all areas of service provision (especially mental health and substance use)
- Improve service continuity and navigation
- Introduce whole system commissioning models.
Actions to explore opportunities to support supporters:
- Create supportive work environments to ensure the workforce has the required supports to continue providing exceptional care
- Ensure families and carers have access to support to prevent burn-out and improve early recognition of support
- Create conditions that empower community led peer support services.
Click on the links below to access the reports. For more information or to discuss our findings further, please email our Research and Evaluation Lead at firstname.lastname@example.org.