Management of Complex Cases 

Management of Complex Cases

 Navigating Complex Case Management

 Where Human Rights, Mental Capacity, and Person-Led and Person Centred Safeguarding provides a wraparound care for the person

 In health and social care, a "complex case" is rarely just a clinical or social care challenge, it involves multiple agencies, who all should focus on an integrated approach and not work in silo. 

Our Framework: The Integrated Complex Care Model

We have evolved the pioneering framework from Pat Hobson’s book, Enabling People with Dementia: Understanding and Implementing Person-Centred Care, to meet the demands of complex case management. By overlaying the Care Act 2014 Wellbeing Principle, we focus on a similar person led and person centred approach to ensure that a wraparound approach that meets the needs of the people supported by health and social care are maintained.

 Unique Life and The Wellbeing Principle

 A complex case cannot be resolved without understanding the person’s history, values, and definitions of personal dignity. We map the individual’s Unique Life against the Care Act's wellbeing domains (such as personal relationships, control over day-to-day life, and contribution to society) to determine what an enabling outcome looks like for them.

Unique World and Behavioral Literacy

When individuals express distress through high-risk behaviours, we do not see "management problems" we see communication and trauma. By stepping into their Unique World, we examine behavioural indicators of distress and how this can be explored within a trauma informed approach.  

Unique Environment and Proactive Safeguarding

 The physical and social space surrounding a person can either amplify or de-escalate complexity. We critically review the Unique Environment to identify how environmental stressors or hidden restrictive practices impact the person's safety and liberty. Safeguarding is embedded here as an active, preventative factor rather than a post-incident reaction.

The Legal Interface: Examining Rights Within Safeguarding

We work with legal teams in navigating the highly scrutinised legal challenges where care delivery meets statutory restrictions. We examine these key legal interfaces directly through the lens of safeguarding and human rights:

Section 21A Challenges (MCA 2005)

 When a person or their family challenges a Deprivation of Liberty Authorization (DoLS) under Section 21A, we work with Legal teams to help organisations generate the evidence required that help review the restrictions, ensure the person’s voice and rights are represented. We also provide objective clinical and social care analysis as instructed by Legal teams.

Section 16 Orders and Complex Welfare

For cases falling outside standard standard authorisations, such as complex community care packages, tenancy disputes, or severe self-neglect, we work closely with Legal teams to provide evidence from commissioners and providers required for Section 16 (MCA) Welfare Orders, as instructed. 

COPDOL11 (The Streamlined Procedure)

Managing judicial deprivations of liberty in community, supported living, or domestic settings requires precise legal handling. We offer the full COPDOL11 process and work with commissioners and Legal teams  through the COPDOL11 streamline process. We ensure that capacity assessments, best interests statement and decisions, care and support plans, and consultation requirements are scrutinised before being submitted for review by Legal teams prior submission to the Court or Protection.

How We Partner With Your Organisation

PMH provides in depth support, as instructed by commissioners, health and social care organisations and legal teams in the 3 core pillars:

Expert Consultancy

• Independent Case Reviews: We conduct objective, independent reviews of stalled, high-risk, or multi-agency deadlocked cases, offering clear pathways to resolution using our unique model as a benchmark.

• Safeguarding and MCA/DOLs Audits: We support your organisation’s by reviewing documentation surrounding MCA, Best Interests, and DoLS to ensure it is legally defensible and aligns with current case law. This includes where the organisation may require support with high risk cases or the review and provision of evidence that may be required by Legal teams as part of COP work. This also includes the provision of expert witness and specialist reports.

• Best Interests Facilitation: Act as independent expert facilitators in highly conflicted multi-agency or family meetings to find consensus centred on the individual.

Evidence-Based Education and Coaching

• The Legal Interface Masterclass: Advanced training for clinical leads, social workers, and managers on the practical intersection of the Care Act, Human Rights Act, and the Mental Capacity Act (including S21A, S16, and COPDOL11) delivered in conjunction with Legal teams.

• Decoding Complexity: Practical modules on translating behavioural expressions of distress into actionable, person led and person-centred care plans that minimise the need for restrictive practices.

• This uses trauma informed approaches.

 The PMH Resolution: “Complexity in care should never lead to defensive, risk-averse practice that strips an individual of their rights. We bring evidence based clarity and person-led and person centred framework needed to keep people safe, empowered and enabled.”