Across the UK, emergency and healthcare services respond every minute to people in mental health crisis. Mental health crisis calls are increasing consistently each year.
But there is also ‘a problem within this problem’ because in every community, up to 40% of this demand is caused by the same patients. There are a small number of repeat callers who struggle with highly complex behavioural disorders and who, as a result place intensive demands on police, ambulance, A&E departments and mental health teams. These individuals require unique support to help them manage their behaviour effectively
Recognising that this small number of repeat callers were responsible for such a significant proportion of the demand and that NHS staff alone were not equipped to manage some of the most extreme levels of behaviour, specialist, integrated mental health care and policing teams were formed to provide a unique blend of nursing care and behavioural management. These new teams work alongside the patients and encourage clients with complex mental health issues towards more consistent and healthy coping strategies. This unique approach would provide the support needed to patients to effectively manage their behaviour and acute episodes.
The Academic Health Science Networks (AHSN) selected SIM as of one of seven programmes for national adoption and spread across the AHSN Network during 2018-2020.
As an AHSN UCLPartners has worked across our region to implement SIM. This has included supporting engagement between the SIM project and local stakeholders to create a case for change and implementation, and supported training and implementation throughout the project.
Impact: example interventions and outcomes
Case study: Male repeat caller of hoaxes and verbal threats
The patient was a male in his 40s who was repeatedly calling police with hoaxes and verbal threats to call operators, which often included racially aggravated comments. This could be up to 40 calls a day within a 2 to 3-hour period. He had a complex diagnostic profile, aggravated by an alcohol dependency. A difficult relationship with his mental health worker had also contributed to his discharge which was attributing mainly to his alcohol dependency.
SIM Team intervention
Upon reviewing the case history, this SIM team felt that an appropriate and immediate use of criminal justice interventions would benefit all parties. The service user was simultaneously moved from a brief intervention team to a community team where more support could be given.
Whilst with the community team, the patient was referred to a learning disability specialist where he was re-assessed, and diagnosed as autistic. The SIM team supported him to resolve his housing issues and he now lives within supported accommodation.
Outcome of intervention
This individual no longer makes hoax calls to emergency services and has been fully discharged from secondary MH services. He is now engaging in group activities, interacts well with staff where he lives and is developing healthier patterns of behaviour. He has also been given a mobile phone specifically designed for autistic service users.
The racially aggravated behaviour first encountered (without SIM intervention) would likely have resulted in a custodial sentence. This was avoided.
The true impact of the SIM London programme is now being seen in the positive difference it is making; to the service users it supports, to their families and to the crisis care teams that respond to them.
This collaboration between police, ambulance, A&E teams and mental health services can be truly life changing for individuals in mental health crisis.Paul Jennings, Network Director for the High Intensity Network, and the founder of SIM
Case study: Female repeat caller expressing thoughts of suicide and self-harm
This service user is a female in her 60’s who presented as a repeat caller to both police and ambulance. She would typically make about 20 calls per month, often expressing thoughts of suicide and self-harm. When emergency services attended her address to provide support she would usually refuse to go to hospital, and responders were unsure how best to help. This behaviour was aggravated by regular excessive alcohol consumption, which was also impacting her part time job, and had also led to her losing her driving licence.
SIM Team intervention
Although the service user was already under the care of a mental health care coordinator and was participating in therapy, it was felt that support from the SIM team would help her. SIM staff started to work with her wider clinical team and were able to map a complex combination of social and economic problems including imminent housing eviction, financial debt, digital poverty and isolation from her family.
The SIM team were able to help her to find a new home, living with a family. This improved her social connections and reduced loneliness. Additional behavioural support from the SIM police officer encouraged her to reduce her harmful behaviour on services and to reduce her alcohol consumption. Over time, she was then able to get her driving licence back which helped her to take on more hours at work – improving her financial circumstances.
Outcome of intervention
Ultimately, this service user’s high demand on 999 services had been caused by high levels of anxiety. Support provided by her SIM team enabled her to significantly reduce the intensity of her anxiety, which subsequently led to her completely stopping repeat suicidal calls to emergency services. Her family have recently re-engaged with her.