Understanding complexity in psychological services: A modified Delphi study

Abstract

Rationale, Aims and Objectives The concept of patient or case complexity is relevant—and widely used—at all levels and stages of mental health service provision, but there have been few methodologically robust attempts to define this term. This study aimed to establish a consensus on factors contributing to patient complexity in adult psychological services using Delphi methodology. Method Applied psychologists in a single urban/suburban UK National Health Service setting took part in a three‐round modified Delphi study. Twenty‐eight respondents in Round 1 gave qualitative data on factors they considered when assessing complexity, which was subject to thematic analysis. Twenty‐five respondents in Round 2 rated how central/peripheral each theme was to their judgement using Likert scales. In a third round, 20 respondents addressed discrepancies and possible utilities of the emerging framework. Results Thirteen factors contributing to patient/case complexity (active severe/enduring mental health, current coping/functioning, engagement, forensic history, iatrogenic factors, interpersonal functioning, neurocognitive functioning, physical health, problematic substance use, risk, severity/chronicity of presenting problems, systemic and socioeconomic factors and trauma) were identified with a high degree of consensus. All were rated as central to complexity. Conclusions We conclude that applied psychologists do have a shared understanding of complexity and make recommendations for further research validating, developing and applying this empirically derived framework.