Individuals experiencing multiple and complex needs (MCN) may face issues of homelessness, substance misuse, repeat offending, and/or mental ill-health. Individuals facing these issues experience disproportionate levels of health inequalities and mortality rates. Furthermore, there is little evidence on strategies to prevent the high mortality rates. Through a peer-informed qualitative study, the underlying reasons for the high mortality rates among those with MCN were explored. Additionally, the study aimed to: 1. Pinpoint opportunities to identify people at risk 2. Explore potential interventions to prevent these unnecessary early deaths

1) Understanding Premature Mortality The following were identified as factors contributing to mortality rates:

• Double burden of mental health conditions and substance misuse

• Poor service provision and multi-agency collaboration

• Lack of hope for change and acceptance that death was common

2) Identifying Opportunities to Intervene Windows of opportunity are brief and not always easy to target, but with the right support in place critical life events (bereavement and relationship breakdown) and significant transitions (completion of treatment, release from prison, or service discharge) could be targeted.

3) Possible Interventions to Reduce High Mortality Rates Four areas for intervention were suggested:

• Introducing holistic, person-centred approaches

• Developing communities

• Improving connections and supports across the system

• Placing a focus on prevention