Rethinking the use of 'complex' in child mental health care to improve access and clarity

Dr Rachel Bryant-Waugh highlights how the ambiguous use of the term ‘complex’ in mental health diagnoses can hinder access to care for children and young people, calling for clearer, more descriptive language to ensure effective support.

In mental health care, the word “complex” can do more harm than good. Dr Rachel Bryant-Waugh, writing for the Association for Child and Adolescent Mental Health, argues that while the term is often used to describe overlapping difficulties, severe symptoms or the need for multidisciplinary support, it can also become a shorthand that closes off access to care rather than improving it. Her concern is especially acute in children and young people, where labels can shape how quickly families are heard, how confidently clinicians respond and whether local services feel able to help.

The phrase is used in several different ways. In trauma care, for instance, complex trauma usually refers to prolonged or repeated exposure to harmful events, often over time and often in interpersonal settings. The National Centre for PTSD says complex post-traumatic stress disorder is recognised in the ICD-11 but not the DSM-5, while reviews of trauma-informed care describe the condition as carrying longer-term effects on emotional regulation, self-image and relationships. That usage is more specific than the looser clinical habit of calling a patient or presentation “complex” simply because more than one issue is present.

Bryant-Waugh says that vaguer use of the term can have practical consequences. A child may be turned away from a service that could otherwise help because their needs are judged too complicated, too specialised or outside a team’s usual remit. In eating disorder care, she notes, that can affect young people with avoidant restrictive food intake disorder, or ARFID, especially when they also have neurodevelopmental differences or another health condition. The result, she argues, may be delayed treatment, greater risk and a growing sense among families that they must search elsewhere for help.

There is also a human cost to the language itself. Families may hear “complex” as a warning that recovery will be difficult, or that professionals are uncertain what to do. Clinicians, too, can become less confident if the label suggests the problem lies beyond their skills. Bryant-Waugh says the word can reinforce a perception that care should be elsewhere, even when local services have the expertise to provide assessment, guidance and joined-up support. In that sense, a label meant to signal need can instead foster hesitation.

At the same time, she does not dismiss the word entirely. In an informal exercise asking people what comes to mind when they hear “complex”, she found responses clustered around three ideas: interconnected parts, something hard to untangle and a condition that is nuanced and layered rather than reducible to one cause. Those interpretations, she suggests, align with broader moves towards person-centred and integrated care. The problem is not that the word has no meaning, but that it can be too elastic to guide action.

Her conclusion is that clinicians should favour clearer, more descriptive language. Instead of saying a child is “complex”, she says, it is often better to explain what is going on, how different issues may interact and why coordinated care is needed. That approach may take more time, but it is more transparent for families and more likely to support effective treatment. In an overstretched system, precision matters: the right words can either widen access or quietly narrow it.