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.

Complex Community DoL and Section 16 Orders and Complex Welfare

In the wake of the Supreme Court Judgement of 2 June 2026 resulting in the AGNI case, we now work to support with complex cases in conjunction with independent healthcare providers and public bodies. This includes providing reviews and evidence on cases that no longer meet the criteria for a DoL, however, requires full review and assessment against the new criteria. We in conjunction with Legal teams who provide oversight on the evidence generated from commissioners and providers required for these complex cases as instructed to ensure that it meets the criteria for submission to the COP. 

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, Education and Coaching

• Governance Reviews: We review the governance relating to highly complex cases and conduct objective, independent reviews where these have stalled, are high-risk, or there are multi-agency deadlocks, offering clear pathways to resolution using our unique model as a benchmark.

• Safeguarding and MCA/DOLs Audits: We support your organisation by reviewing the governance surrounding MCA and  DoLS to ensure it is legally defensible and aligns with current best practice. This includes where the organisation may require support with high risk cases and where these should sit within the governance framework that provides a 'wraparound' support for individuals involved.

• 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, which are developed in conjunction with Legal teams.

• Trauma Informed Approaches - we review the governance relating to Trauma Informed Approaches and how this can be implemetned within practice to protect people supported, as well as staff.

 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.”