34 QUALITY & SAFETY components within our teams

Organisations on the High Intensity Network operate with a collective confidence that the training they receive and the methods they use are supported by 34 individual quality and safety components.
By working as a national network we can collectively evolve and improve our working practices, measure outcomes consistently and learn as a single community of practice.
Our team operates largely within a digital space, using online training resources, self assessment and data collection tools.
The Network is built on the principles outlined within the Five Year Forward View for Mental Health (p38) which recommended the rapid scaling of new interventions, supported by a digital network.

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High Intensity Mental Healthcare: The Core Numbers

The key statistics driving why - and showing how - we are leading safer practice in high intensity crisis care

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'In 10 Year's Time' Report 2019

This report was published on the 10th anniversary of the Bradley Report. It focuses on 'Improving outcomes for people with mental ill-health, learning disability, developmental disorders or neuro-diverse conditions in the criminal justice system'. It highlights the progress that has been made across the Health and Justice sector in recent years and makes 10 recommendations for the future.

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Delivering the NHS Long Term Plan 2019

The NHS Long Term Plan was published in early 2019 and sets out the strategic direction and core objectives for the NHS over the next 10 years.

The SIM model of care and the High Intensity Network deliver 15 objectives within the plan.

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HMICFRS Report: 'Picking Up the Pieces' Report 2018

In November 2018, a report was published by Her Majesty's Inspectorate of Constabulary, Fire & Rescue Services. It reported on the current ability of the police service to respond to mental health incidents and highlighted a number of areas where NHS mental health services needed to improve.

The report made 4 recommendations, one of them being to:
'Understand the drivers behind repeat crisis calls and to assess what needs to be done to improve care for frequently calling patients".

This is the area of work that we lead in the UK.

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Five Year Forward View for Mental Health 2016

The SIM model of care and the High Intensity Network were supported by NHS England from October 2016, as a direct response to the FYFV report, which on page 38 states:

"Alongside new standards we need to see further innovation in three areas:
• new MODELS OF CARE to stimulate effective collaboration between commissioners and providers to develop integrated, accessible services for all
• expanding access to digital services to enable more people to receive effective care and provide greater accessibility and choice
• a system-wide focus on quality improvement to support staff and patients to improve care through effective use of data, with support from PROFESSIONAL NETWORKS".

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Mental Health Crisis Care Concordat 2014

In 2014, 22 different national bodies came together to make a pledge to improve care for people in crisis.
It was a game changing moment for the country as we set out to collectively eliminate any post code lottery of crisis care.
Now 5 years on, some regional Crisis Care Concordat Boards still operate and some have lost their momentum but improvements in crisis care all over the UK are still happening as a result of this crucial document.
Teams on the High Intensity Network collectively agree that developing one national standard is vital for many aspects of healthcare - no more so than for people struggling with suicidal thoughts who put themselves and others in danger when a crisis hits.

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SIM Update Report 2015-2017

This second report was written for IOW CCG in Spring 2017.
Teams based on the SIM methodology are still operating on the Isle of Wight and in Portsmouth. A new team is about to launch in Southampton. The project name has changed but the core design and principles remain and the same staff are still in the same posts.

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SIM Pilot Report 2013-2015

Shortly after the launch of 'Operation Serenity' a Street Triage crisis response car on the Isle of Wight, a small number of service users who were still calling in crisis repetitively, were identified by the team.
If better crisis response wasn't working, then how could we provide better clinical care to these specific patients?
We needed a more intensive and preventative support package. This new care model needed to integrate clinical care but also provide a more consistent and confident response to repeating patients. It also needed to develop a new kind of relationship with the patient, where they were empowered and encouraged to learn new skills and re-take control of their lives, using a more mentoring style approach. Serenity Integrated Mentoring (SIM) was born. SIM was tested from 2013-2015 placing the patient at the centre of their own care as much as possible.
Here is the full Project Pilot Report which provides feedback from clinicians, patients, police officers and an A&E consultant.

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Delivering the NHS Constitution 2011

Published in 2011, the NHS Constitution is a national set of principles, values, rights, pledges and responsibilities.
It outlines how the NHS will provide care to the population, what rights you have as a patient and what it expects from its staff.
In this document we outline how our network and the teams within it, comply with the Constitution and help to deliver these national objectives.

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Understanding how and why the NHS adopts innovation

An incredibly useful insight outlining the factors that influence why NHS trusts choose to adopt an innovation.
One of our teams (SHIPP) is profiled in the report.
Published: 5th November 2018

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How best to scale and adopt SIM: Sharing best practice

Written by Aileen Jackson and Josh Brewster, our SIM project management team in South London, this report will guide project management staff around the country.

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12 ways to improve high intensity crisis care

All the teams on the network operate to a set of quality standards that we have developed over a number of years.
By delivering all these 12 standards in the same team design, we believe this provides the highest quality of care.
When High Intensity Network staff support commissioners. MH Trusts, Police Forces and 3rd Sector MH providers, we embed as many of these 12 principles into the new models and design them into local systems.
Teams choose their own name but work together across operational borders within the High Intensity Network to mentor and support each other's continual professional development.

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4 variations of the SIM model

We are currently operating 4 different models of SIM based teams.
3 employ a police officer/staff member in a specialist/dedicated/protected role (officers can do this full time or part time).
1 employs a police officer/staff member whose main role is not managing high intensity callers but who is allocated a client alongside their MH care coordinator.
e.g. a community police officer or PCSO may have a regular crisis caller living on their beat. They complete the training course with that person's MH care coordinator and then for x number of sessions a week, they jointly engage with and support the individual.
Some teams now operate using a local combination of these models. For example in Derbyshire, 50% of patients on their programme are supported using Model 2 and 50% are supported using Model 3.

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A Day in the Life of a High Intensity Police Officer

Do you want to know what a high intensity mentor does in a typical day?
There are two core staff in a mentoring team: a mental health care coordinator and a police officer. This team will have attended a national training course, will also have ongoing online training resources and be able to contact similar teams in other areas of the country for advice. They will probably support multiple patients within the same NHS Trust as they will have been given protected time to work with specific service users.
The team has 2 core tasks:

Task 1: To work with patients struggling with complex trauma and intensive emotions. These patients will often be demonstrating their distress in unsafe ways in public places (hence why we use police officers too). The team use a mentoring approach with the patients. They do this when the individual is not in crisis so that they can make plans that will ensure the patient and the community are safer, should they experience another crisis moment. The patient is taught how to write their own crisis care plan. The mentors will also contribute to what is written in this plan. This joint approach ensures that the patient still gets adequate support but the emergency service staff can also be better briefed and make better decisions.

Task 2: Once the crisis care plan is finished and the patient, mental health nurse and police officer have all signed it, then the mentor's job now is to ensure that local 999 staff understand the plans and have access to them, just in case the document is needed in an emergency.

By reading this document, you will understand how the NHS and Police Service together, have helped to develop this specific role. When a service user presents risk to both themselves and other people, the best solution lies with combining medical leadership and community safety leadership.

This diary is based upon a police officer working using a Model 1,2 or 3 model.
Other officers around the network do not work in this role full time but add these skills onto an existing role (model 4).

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AHSN National Programme Brochure

We are now a nationally adopted AHSN programme. Read about us on pages 11 and 21

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AHSN 1 Page Summary

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Maps of Mental Health Trusts in England

A map of all 57 NHS mental health trusts/providers that deliver crisis care services

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SIM Leads within Academic Health Science Network teams

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NHS Innovation Accelerator Brochure (February 2018)

The SIM model of care is supported by the NHS Innovation Accelerator Programme.
Select 'View Document' to download the 2018 NIA Brochure.

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Journal of Criminological Research, Policy and Practice Vol 3 - Issue 2 (July 2017)

A journal article written about the SIM pilot in 2013-14

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The High Intensity Network works with: