Complex Adult Mental Health Presentations
By David Hennessy, Clinical Psychologist
Understanding Complex Mental Health Presentations in Adults
Mental health challenges in adulthood can vary widely.
While some individuals experience relatively isolated concerns — like a single episode of depression or anxiety — others present with more complex mental health needs.
These presentations often involve overlapping conditions, longstanding patterns, and significant impacts across work, relationships, identity, daily activities, and physical wellbeing.
At Hennessy Clinical Psychology, we understand that complex presentations need careful, thoughtful, and individualised care.
If best outcomes are the objective, experiences need to be well understood and met with compassion, patience, and clinical skill.
This is where David’s clinical qualifications, many years of experience, and professional, kind and relatable manner allows for an insightful and compassionate client-centered focus — focusing on the person, over and above their complex set of symptoms.
What Makes a Mental Health Presentation “Complex”?
Complex presentations in adults often involve:
Multiple Diagnoses: For example, depression with post-traumatic stress, or bipolar disorder alongside substance use difficulties and/or a psychotic diagnosis.
Longstanding Symptoms: Sometimes beginning in childhood or adolescence, and shaped by life experiences.
Functional Impacts: Challenges in employment, study, social relationships, and daily routines — often extending to basic activities of daily living such as personal care, cooking, cleaning, and attending appointments.
Psychotic Experiences: Some individuals experience episodes of altered reality, such as hallucinations, delusions, or confused thinking — either occurring on their own or alongside other conditions.
Histories of Trauma: Early or ongoing trauma can profoundly shape emotional and relational patterns.
Difficulties with Trust and Connection: Building therapeutic relationships may require time, consistency, and attuned care.
Physical Health Challenges: Medical conditions and chronic pain often co-occur with complex psychological presentations.
No two stories are identical — complexity reflects a rich and meaningful history that, for the sake of best outcomes, needs to be understood and navigated.
Examples of Complex Presentations That Some People Find Themselves Living With
Some examples of adult complex mental health presentations we may see include:
An adult living with bipolar disorder, compounded by alcohol dependence and complex trauma history.
A person managing chronic depression, severe anxiety, and difficulties with emotional regulation.
Someone experiencing psychosis as features of another diagnosis or within the context of schizophrenia, schizoaffective disorder, or severe trauma-related dissociation.
An individual navigating borderline personality traits, substance use, and past attachment disruptions.
Each pathway is unique.
Effective care insightfully works where possible to recognise and understand the whole picture and meets the individual where they are, not where a complexity of diagnoses suggests they “should” be.
Psychosis and Complex Mental Health
Psychosis refers to experiences where a person’s sense of reality may be altered — for example, hearing voices, holding beliefs not shared by others, or feeling confused in thought or perception.
Psychotic symptoms can occur:
In primary psychotic conditions (e.g., schizophrenia, schizoaffective disorder)
As part of mood disorders (e.g., depression or bipolar disorder with psychotic features)
In the context of complex trauma or dissociation
Through substance use or medical conditions
Importantly:
Experiencing psychosis does not mean a person is “dangerous” or “broken.”
Effective treatments are available. Effectiveness is strengthened with early support.
With effective treatment, people can live meaningful, connected lives after psychotic experiences, or alongside ongoing psychotic experiences.
At Hennessy Clinical Psychology, we approach psychosis from a place of vast experience, insightfully, non-judgmentally, compassionately, and optimistically — focusing on the person, alongside the complex array of interconnected symptoms.
Why Specialized, Compassionate Care Matters
Working with complex mental health needs requires:
Comprehensive Assessment: Understanding the full personal, emotional, and physical picture.
Integrated Therapeutic Approaches: Using tailored combinations of therapies — such as CBT for psychosis (CBTp), trauma-focused therapy, or ACT for complex emotions.
Collaborative Multidisciplinary Care: Often working alongside GPs, psychiatrists, and other allied health professionals.
Building a Trusting Therapeutic Relationship: Where the person feels safe, heard, and respected.
Focusing on Strengths and Resilience: Recognising that each person carries skills, insights, and survival strategies that matter.
Healing is not about “fixing brokenness” — it’s about growing capacity, building a sense of meaning, and restoring connection.
Learning to be resilient amid the recurring challenges in the arena of our lives.
A Message for Those Living with Complex Mental Health Challenges
If you are living with complex mental health difficulties — including experiences of psychosis — you are not alone.
Every story, including yours, carries strength, meaning, and hope.
Healing may not always be linear — but progress is absolutely possible.
Good care meets you where you are. It honours your experiences without judgment.
It supports you to find your footing, even on uncertain ground.
We all need and deserve “a fair go.”
You deserve compassionate, skilled support.
Looking for Support?
At Hennessy Clinical Psychology, we have vast experience in working with adults facing complex mental health challenges.
This includes supporting those living with experiences of psychosis and other interconnected conditions.
We offer evidence-based, client-centered care, tailored to your unique story and your personal goals.
Learn more about our services or contact us for a confidential consultation:
👉 https://hennessyclinicalpsychology.com/contact/
