This is a difficult question to answer, because there are no official standards out there for repeat users of services.
There is no standard of clinical or professional excellence.
So...do we have standards for mental health crisis care at all?
Yes. In 2014, around 20 national organisations and institutions across the UK (Police, NHS, Ambulance, Royal Colleges etc) all signed the Mental Health Crisis Care Concordat. Whilst this was not made law, every region in the UK formed strategic delivery groups and made a commitment to deliver the same core standards of care relating to:
- Access to support before crisis point
- Urgent and Emergency access to crisis care
- Quality of treatment and care whilst in crisis
- Recovery and staying well/preventing future crises
THE CONCORDAT DOCUMENT
What has been delivered locally in each region has varied greatly and because this programme was as much of a 'culture changer' as a 'service standards setter', some concordat boards have lost momentum and are no longer working with the same intensity anymore. This programme simply aimed to set basic minimum standards of crisis care across NHS providers and it has achieved a great deal. A review of the Concordat was written in 2016.
But when it comes to improving excellent crisis care for people experiencing crises regularly, there are no national standards. That is why we formed the High Intensity Network in 2016 to begin this work and have written our own '9 Standards of High Intensity Care' - these can be found in our Resources section.
If any person who is struggling with mental or behavioural health issues reaches such a level of risk or intensity that they are posing regular risks to either themselves or others, then the emergency services have a professional duty to step in and ensure that risks are reduced. If public services step in to intervene in this way, then the new data law (the GDPR) states that the individual loses the right to give or withdraw consent because the need to intervene is more important than their choices or preferences.
This decision isn't taken lightly because of course it is better that we all have free choices all the time.
Our teams operate multi-agency panels each month to assess which patients should have their consent removed and to agree which patients need more than just NHS support to keep them and the wider community safe. These teams all use the same decision making matrix, so we can be sure that these decisions are consistent across the NHS.
If we do remove the patient's consent then we still have a duty to only share data that we need to share. We need to be measured and proportionate.
All our teams use the same set of information governance documents that we have written with help from an NHS specialist legal company called Capsticks.
If consent is removed, then the patient should always be informed of this both verbally and in writing. Whilst they do not have any rights to object, they do have a right to express how they feel. There should also be a discussion focussing on what circumstances need to change in order for these rights to be given back to them.
We have developed a simple assessment framework making it easy to compare the characteristics of any crisis care model to the core characteristics of SIM.
These assessments are independently led by a team of academics at University College London. The assessment is usually conducted over the phone.
Please contact us if you would like more information.
Whilst there are distinct advantages of employing dedicated officers in specialist SIM roles to support multiple clients, we recognise that many service users struggling with complex behaviours can live in remote parts of a county where it would not be cost effective to employ a full time team to support them. So we are now supporting teams to launch a community model where SIM skills can be taught to staff working in neighbourhood policing teams and more remote community mental health teams.
These police/NHS teams may only be supporting one service user.
Contact us for more information.
If you have been approached by your local mental health provider to talk about being supported by a high intensity team, then it is highly likely that a multi-agency panel called a High Intensity User Group (or similarly named risk panel) will have already met to discuss your care and safety. This panel consists of key decision makers from the NHS, the police, the ambulance service and local A&E departments. The panel could also include: Social Care, Drug & Alcohol Services and specialist 3rd Sector/Charity providers.
The panel assesses individual patients who may have been nominated by a local professional or may have been highlighted by unusually high patterns of demand. The panel will assess each case from a number of perspectives including:
- The quality of the care provided so far
- The success of the care received so far
- The risks posed by the individual to themselves and others
- The likelihood that these risks/safety levels would require police intervention (such as responding to a crisis call or any offences likely to be committed if the crisis repeats)
- Any unreasonable, inappropriate and avoidable demands placed on services by the individual
- The impact of their behaviour upon the wider community
- The transient nature of the risks posed (e.g. how far the person travels across different healthcare and policing boundaries when in crisis)
The panel usually makes a decision based our recommended '5 point national assessment' but overall they are assessing whether the patient would be less risky and the community would be safer if other safeguarding agencies worked with the mental health team. If the panel agree that the NHS staff do need assistance, then the SIM model of care is introduced. This doesn't stop or replace other NHS treatments and therapies that the individual might already be receiving. SIM acts as an additional resource.
Having been placed on the programme, there are 4 legal questions that service users often have, as follows:
Q1 Can SIM teams operate without my consent?
Yes. Because the panel has been told that you have been demonstrating intensive patterns of demand, risk or impact outside of the NHS, the public duty to reduce risk and/or harm will for the time being outweigh your ability to add/remove consent. If risk and harm reduces then the panel can re-assess your right to have your power of consent back.
Q2 Can SIM teams share data about me without my consent?
Yes. For the same reasons outlined above, public services have a professional duty to provide more support to both you and the wider community. To do this, the law allows them to share whatever information they feel is reasonable and this (again for the time being) outweighs your right to give or withdraw consent. If this decision has been made then the team should explain to you why and how data will be shared between agencies, until the risks have been managed or are unlikely to return. They should also give you an information leaflet called a Privacy Notice which explains the law and why it applies to you.
Q3 Do I have to engage with the high intensity team?
No - even though the high intensity team will now be making joint decisions about your welfare and safety, this does not mean that you have to work with them. You have the right to refuse their offers of support. There is no legal requirement for you to cooperate.....however see Q4 below.
Q4 What happens if I do not engage with the high intensity team?
Even if you do not want to accept help from the team, they will still be trying their best to support you regardless. They will endeavour to make the best decisions possible in your absence, which will obviously be much harder to do without your cooperation. Refusing to be helped does not mean that the team stops working. Remember....they have been asked by the HIUG/panel to wrap more support around you, regardless of your response. Should your crisis patterns continue to cause risks to yourself and/or other people or the community, then they will make decisions about how to intervene. That is why we encourage every patient allocated to these teams to come and be part of the crisis and care planning process. It is so much easier and effective with you, than without you.
For more information about your rights as an NHS patient, please go to the 'Resources' section of the website and select the document called 'Delivering the NHS Constitution'.