“This is a truly original project with tremendous impact. Lives have been changed; not only for the service users but for their loved ones, their communities and for those who had previously managed their care. Their work is not only sustainable but scalable, so that many more people can be reached both in this country and overseas. The winners have challenged established perspectives and brought two very different, very traditional cultures together, healing minds and changing mindsets along the way. Both nursing and policing will evolve as a result”

Carol Kefford – Chief Nurse with Nuffield Health, Chair of Awards Panel

Overview

SIM 1

Serenity Integrated Mentoring (SIM) is a pioneering project integrating mental health care and policing on the Isle of Wight. It is led by Hampshire Constabulary and the Isle of Wight NHS Trust, and is supported by Wessex Academic Health Science Network (AHSN). The project is recognised as effectively bringing together policing and healthcare skills to achieve a positive difference to the lives of patients with complex mental health needs and their families.

Results show an integrated approach and has produced significant clinical improvements; In ALL cases, crisis calls to the police and ambulance service reduce, and in most cases are almost completely eliminated

In ALL cases, crisis calls to the police and ambulance service reduce, and in most cases are almost completely eliminated

  • Admissions to A&E for false, malicious or disproportionate reasons had reduced greatly and in most cases completely stopped.
  • Exhausted families felt reassured that ‘all was being done’.
  • Mental health nurses reported improved relationships with patients and were subject to less abusive behaviour.
  • Thousands of pounds of treatment costs had been saved and spent elsewhere within the NHS.
  • Community risk and suicide risk had reduced.
  • Service users had refocused on the need to participate in recommended pathways.

Serenity Integrated Mentoring: Supporting and preventing high intensity mental health crisis from Wessex AHSN Limited on Vimeo.

Challenge/ problem identified

  • Across the UK, emergency and healthcare services respond to people in crisis. Many will have crises relating to their mental health and for most the care offered by emergency and mental health teams will meet patients’ needs. However, for some patients, their crisis behaviours become cyclical and regular and they are unfairly labelled as ‘time wasters’ or ‘attention seekers’ by the healthcare system and emergency services.
  • Police forces are also struggling to manage a small number of repeat callers with complex mental health needs.
  • In a typical policing district, a very small number of known people will regularly cause up to a third of all crises, mental health demand, not only to police but also to other emergency and healthcare services.
  • These individuals are often chaotic in nature, anti-social in behaviour and occasionally criminal in their conduct towards relatives, friends, members of the public and public service personnel.
  • In the most extreme of cases, mental health professionals describe them as ‘unmanageable’.

Actions taken

  • Evidenced based: SIM is supported by strong data that has been gathered using both qualitative and quantitative methods.
  • Involving critical partners: We always seek the feedback from service users who have been supported by SIM at every opportunity and we are currently in negotiations with a leading mental health charity to see if we can further professionalise towards ‘co-production’.
  • Understanding of commissioning: Innovation must be constantly ‘commissioning compliant’. We are moving towards commissioning structures that will select projects for ‘speed of access’ – ‘local needs’ – high priority groups’ – ‘pathways and partnerships’ – ‘outcomes’ – ‘costs reduction’ and ‘data strength’. SIM can be measured using all of these parametres.
  • Open minded about adaptation: We remain constantly open to adapting this model of care to fit different clinical environments. SIM can also potentially be applied to both ED and GP practices.

Impacts/ outcomes

SIMSo far, we have proven that this model:

  • Reduces the intensity and frequency of this types of crisis.
  • Reduces operational response costs to all 4 teams by up to 92%.
  • Leads to improved personal outcomes for service users.
  • Reduces pressures on hospital wards.

Utilisation of public services more than doubled within the two years before the intervention.

The two year period after the start of the intervention demonstrated significant reduction in utilisation of public services:

  • Police incidents: -97%
  • NHS assessments: -94%
  • Ambulance deployments: -81%
  • A&E attendances: -69%
  • Mental health bed days: -100%
  • Other NHS bed days: -57%

Total costs for 4 High Intensity Users for the utilisation of the public services was reduced substantially from £78,000 in the year of the intervention (Y0) to £35,000 in year 1 and £6,200 in year 2.

The benefits to the mental health community, clinical settings, wards and patient health include:

  • More accurate and collaborative management of risk.
  • Increased transparency and consistency in managing behaviour
  • A reduction in hospital admissions
  • Less staff sickness and improved professional outlook towards their clients.
  • Calmer wards and clinical environments due to less chaotic and disruptive behaviours triggered ill-health in other service users.

Our Health Economic Analysis demonstrates how basic operational costs to police, ambulance, ED and mental health settings were around £19800 a year per patient but when managed by a SIM team, these costs reduced by 92% within 2 years. It shows how demand for each team reduced following SIM intervention, how the use of section 136 powers by police officers (to take people to a place of safety for mental health assessment) reduced overall by 70.2% by using a combination of:

A. Street Triage as a crisis response team.

B. SIM working behind the scenes with each patient as they are identified.

Finally we demonstrate the reduction in Mental Health Act assessment costs due to decreasing number of people in crisis arriving at places of safety. Since SIM, we have reduced these costs locally by over £40000. That itself pays for employing the SIM police officer.

Wessex AHSN nominated this project for several HSJ Value in Healthcare Awards (2017) and went on to win the Clinical Support Services and Mental Health categories and was Highly Commended in Workforce Efficiency:

The judges were blown away by the real impact on people’s lives, families and communities. They started small and are now exemplars sharing their work across the UK and world wide

Sam Sherrington – Head of Stakeholder & Cultural Transformation, NHS England; Chair of the HSJ Judging Panel for the Clinical Services Category

Plans for the future

Further growth of the network will be achieved by the ongoing support SIM is already receiving from the National AHSN Network and senior leaders within NHS England (NCD – Tim Kendall and team) who already endorse the initiative along with the NHS Innovation Accelerator programme team.

Which national clinical or policy priorities does this example address

  • Care and Quality
  • Funding and Efficiency
  • Health and Well Being
  • Driving Economic Growth.

Start and end dates

SIM evolved from the Street Triage pilot that was initiated in 2012.  In 2013, Hampshire Constabulary and IW NHS Trust took the service one step further and created SIM. In 2015, the IW CCG recognised the multifactorial benefits of SIM and adopted it as a funded service providing 50% of the costs of a SIM officer.

SIM is now being scaled and spread through the 2016 NIA Fellowship programme and supported by Wessex AHSN and Health Education Wessex.

By March 2017, in addition to the embedded programme on the Isle of Wight, four sites have identified funding to implement SIM:

  • Surrey & Borders NHS Trust with Surrey Police
  • Solent NHS Trust with Hampshire Constabulary
  • Oxleas Trust with Kent Police
  • Mid Essex NHS Trust with Essex Police

Further expressions of interest have been received from international partners including;

  • Holland Police – funding secured and set-up planned for June 2017
  • Minnesota Police Force
  • New York Police Department (Staten Island).

Contact for help and advice

Project contact for further information:
Rachel Dominey, Associate Director of Wealth & Enterprise, Wessex AHSN
E: Rachel.dominey@wessexahsn.net

Media contact for further information:
Michael Goodeve, Head of Comms, Wessex AHSN
E: Michael.goodeve@wessexahsn.net