SIM Image (p20)

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; a small number of repeat callers who struggle to manage highly complex behavioural disorders and who, as a result place intensive operational demands on police, ambulance, A&E departments and mental health teams.

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 even the most challenging of clients towards more consistent and healthy coping strategies.

These SIM teams were developed by Paul Jennings, a former mental health sergeant from Hampshire Constabulary. Such was the success of this approach that in 2017, Paul left the police service to work full time for NHS England, leading the delivery of new teams all across England.

SIM carefully selects and trains police officers and police staff alongside their clinical colleagues. Together they learn about the trauma and triggers that lead to high intensity behaviour, they discuss how best to manage risk and how to ensure that the service user does not keep on repeating the same high risk, high harm behaviour. It is demanding and intensive work but can bring significant breakthroughs in the lives of people whose behavioural risks are likely to result in them entering the criminal justice system or even worse, dead from accidental suicide.

Health economic analysis has demonstrated that this type of intensive crisis behaviour can cost police, ambulance, emergency departments and mental health services between £20,000 and £30,000 a year per patient. It is estimated that there are around 2,000-2,500 people across the UK who place these repeat demands upon services.

SIM intervention teams slowly reduce this pattern of high cost behaviour. Every patient is different, but the best results so far have seen crisis calls and demand reduced by up to 90%.

Based on its success to date, in 2016 SIM was adopted by the NHS Innovation Accelerator programme, and in 2018 it was selected for national scaling and spread across the AHSN Network.

AHSNs across the country will partner with mental health trusts and police services to roll out the SIM model. Nine mental health trusts have already launched teams, another 13 are in the process of setting up a team and a further 12 are actively considering starting. This accounts for over half of mental health trusts across the country. In addition, SIM is also live in the Netherlands and is being planned in Sweden, USA, New Zealand and Australia.

More information about SIM can be found at www.highintensitynetwork.org.

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