A national framework for recovery-oriented mental health services: guide for practitioners and providers

People with coexisting conditions and complex care needs

Page last updated: 2013

Experiencing coexisting conditions is normal for people, not exceptional (Graham & White 2011). Rates of mental illness are high for people with intellectual disability, autism spectrum disorders, alcohol and drug use, physical disability, brain injury, problematic gambling, and those who are experiencing homelessness. Multiple physical health problems are also commonly present9. Yet many people with high and complex needs remain undiagnosed and not effectively connected to mental health services. General practitioners and community health centres play a key role in recovery for people with coexisting conditions by offering medical advice and help for physical and mental health needs (including substance use).

The experience of coexisting conditions frequently goes hand in hand with socioeconomic hardships, isolation and a lack of personal, family and social support at key transition points.

Implications for practice

  • Share information with people and their families and friends about self-help and peer support groups that are relevant to their needs and circumstances.
  • In the absence of family or other natural supports for advocacy, psychiatric advance directives can assist people with complex needs to have some control over what happens to them when they become unwell.
  • Form close relationships and share information with other practitioners and services to respond to events and ensure that people's recovery goals coalesce and complement each other to form an integrated support and wellbeing plan.
  • Assist people to gain maximum benefit from the services and programs they offer.
  • Support people to reconnect with family and close friends as well as to build new personal relationships and support networks (Graham & White 2011).

Implications for service delivery

  • Services should be responsive irrespective of a person's entry point and should not prioritise the needs arising from one condition over another.
  • Responses should be multidisciplinary and include primary health care and specialist health services.
  • Understanding of recovery paradigms used in other fields—for example, in the alcohol and drug sector (Best 2012)—need to be incorporated into jurisdictional-wide and local guidelines for working with people and families with coexisting conditions.
  • Services should take the lead in challenging stigma, myths and stereotypes and low expectations about particular groups with coexisting conditions.
... I'm born with an ABI mild Brain Damage and profound disability ... plus I’m borderline Autistic too ... Bugger ...
Ya! ... Where there's a will there's a way ... that's what I keep saying to myself ... I've done a lot of things on my own with little to no help. I've been going to workshops and conferences on my own to help me in my hidden Intellectual Disability World that I was born into ... being labelled both ways doesn't help but its who I am and I am tapping into funding when I can YA! I just do the best I can each day ... I am growing.
Participant in the framework consultations


9 The experience of coexisting conditions commonly involves multiple health problems, especially physical health issues—heart disease, diabetes, hepatitis C, liver issues, oral health, skin conditions, effects of poor nutrition and effects of musculoskeletal and orthopaedic conditions.