Across the UK, emergency and healthcare services respond every minute to people in mental health crisis and calls of this nature are increasing each year. But did you know that as much as 70% of this demand is caused by a small number of ‘high-intensity users’ who struggle with complex trauma and behavioural disorders? These disorders often expose the patient to higher levels of risk and harm and can simultaneously cause intensive demand on police, ambulance, A&E departments, and mental health crisis teams.

In 2012, we recognised that these individuals had unique needs and that we needed to develop:
1. A more integrated, informed, calm approach in the way we responded to them during a crisis and
2. A better form of multi-skilled, personalised support after the crisis event was over.

So in July 2013 we invented, the Serenity Integrated Mentoring (SIM) model of care. This is how it works:

1. SIM brings together all the key urgent care agencies involved in responding to high-intensity crisis service users around the table, once a month.
2. This multi-agency panel selects each individual based on demand/risk data and professional referrals.
3. They use a national 5-point assessment process to ensure that the right clients are chosen and in a way where we can ensure a delicate balance between their rights an individual but our need to safeguard. Selected individuals are then allocated to a SIM intervention team.
4. The SIM team is led principally by a mental health professional (who leads clinically) and a police officer (who leads on behaviour, community safety, risk and impact).
5. The team supports each patient, to better understand their crises and to identify healthier and safer ways to cope. In the most intensive, harmful or impactive cases, the team also does everything it can to prevent the need for criminal justice intervention.
6. Together, the mental health clinician, the police officer and the service user together create a safer crisis plan that 999 responders can find and use 24 hours day.
7. The crisis plan is then disseminated across the emergency services.
8. The SIM team reinforces these plans by training, briefing and advising front line responders in how to use the plans and how to make confident, consistent, higher quality decisions.

It really is that simple - the service user is invited to be involved in planning their care and the professionals responding to them now have high quality information on which to base their conversations with the service user and their decisions.
Everyone wins.

In 2016, after a 15 month pilot, SIM was adopted by NHS England for 'national scale and spread' (NHS Innovation Accelerator) and has since also been recognised as good practice by both the National Police Chiefs Council and Her Majesty’s Inspectorate of Constabulary, Fire and Rescue.

Four years later and we now support over 40 crisis care organisations who use the SIM model of care each day.

But it gets better!
All of our SIM teams have joined forces, to be part of the High Intensity Network (HIN), which ensures that:
- All teams learn and develop together and rely on each other, as a national 'community of practice'.
- All patients receive consistent care, even if they cross an NHS or policing border.

The network provides a range of support services including;
- A national 'High Intensity Quality and Safety Manual'
- CPD High Intensity Courses (both classroom based and online)
- An interactive, map based 'Team Directory'
- A 'Data Portal' that allows teams to gather, analyse and report quantitative and qualitative performance outcomes, demand and cost data for each individual they are supporting.
- A 'Quality Improvement Matrix'
- A 'Behaviour Directory' (where teams can find each other, based on the crisis behaviours they are encountering)
- Assistance and advice in managing complex cases
- A range of 'Programme Leadership' resources, including a full, multi-agency, Information Governance pack
- Bi-monthly National Webinars.
- Daily email, telephone and webinar based advice
- Professional support for the highest risk, complex cases.

Safer I Together
The strap line of the High Intensity Network is Safer I Together because SIM is based on 3 core principles:

That: A patient frequently in crisis, is safer whilst in crisis, if the emergency services responding to that individual have pre-planned their responses with the patient as much as possible, through the careful co-production of a crisis plan.
We are safest when: We are empowered and supported to find our own solutions. We are experts of our own care.

That: 999 and other critical care teams within any town, city or borough can only provide the highest quality of crisis care if they all work as one single team, within one programme of work, using the same collective methods and information sharing.
Professionally, our decisions are then made on solid ground - balanced - confident - consistent - less prone to stress, criticism, complaint, or allegation.
We are safest when: We make risk decisions based on high quality clinical and risk advice, supplied to us spontaneously but calmly during highly dynamic incidents.

Hundreds of people in crisis cross NHS, Ambulance, Policing and Mental Health borders each year, arriving in places they do not know, responded to by teams who do not know them.
That: Crisis care organisations across England and Wales can only provide the very highest quality of care, if they all safeguard vulnerable people using the same national methodology and if they are all digitally connected with high quality, clinically based, safeguarding information.
By being connected in this way, any crisis patient presenting anywhere in the country can receive care based upon a crisis plan written in their own home.
We are safest when: We connect as a single, national health and urgent care community.

We are working passionately every day to achieve these 3 objectives through the delivery of our 40 Quality and Safety Components.

Why not speak to us today and find out how we can connect your organisation or how you or a loved one can receive this model of care in your area.

12 reasons why we need to professionalise high intensity mental health care

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