ISLE OF WIGHT REPORT August 2015 – March 2017

CONTENTS Project Headlines 2 Welcome 3 SIM Objectives 4 SIM Results 5 Tiers of Intervention 6 High Intensity Population 7 s136 chart 8 Case Studies 9 Staff Feedback 27 Nursing Times Awards 32 HSJ Value Awards 33 National Scaling 34 1

teams in 5 other NHS Trusts. PROJECT HEADLINES 77 Service users supported by SIM Number of different people detained s136 - reduced by 52% Suicide rate of SIM supported service users SIM reduces s136 by 55% (DOES NOT include the 18% reduction by Street Triage) Most intense service user: 2013 - 11 s136 detentions 2016 - 3 s136 detentions MH Act assessment costs prevented: £41,200 SIM is now a multiple award winning model of care identified by NHS England as ready for national scaling. IOW NHS and Hampshire Police now leading the start up of SIM teams in 5 other NHS Trusts. 2

WELCOME Welcome to our SIM project review report for the first commissioned period (August 1st 2015 – March 31st 2017). This report provides the key statistics and feedback you will need in deciding whether to re-commission our work. Not only will you see some significant service and service user outcomes from the Isle of Wight but you will also read about how SIM has now become an award winning and ‘high priority’ mental health model of care for NHS England. We are now being supported by NHS England in scaling up SIM into other high intensity teams across England. We currently have teams being established in Surrey, Hampshire, Essex, Cambridge and London and are in the process of designing a national training portal so that we can develop consistency and best practice as a national network (one of the priorities of the Five Year Forward View) We are now being supported by the NHS NIA Programme and by a dedicated team at Wessex AHSN. Thanks for your support. Vicki, Ashley and Paul Sgt Paul Jennings Mental Health Team Hampshire Police Ashley McGrorty Former SIM Service User Now Service User Lead Vicki Haworth Innovations Lead IOW NHS Trust 3

SIM OBJECTIVES SIM was developed in July 2013, 9 months after the start of our Street Triage car, when the team recognised that Street Triage was only going to be able to reduce s136 detentions by a limited amount and that in order to make a significant break through in crisis demand, the team needed to focus on the small number of highly frequent and risky service users. SIM introduces a specially selected and trained police officer into local mental health community teams to work directly with the most intensive cases because the NHS are unable to manage the most intensive patients alone. SIM therefore combines clinical treatment with effective boundary setting and appropriate consequences in a relational, consistent and resilient new model of care that seeks to resolve the causes of crisis. Performance objectives of a SIM team therefore can include: (Objectives vary with each cases, depending on the nature of demand and risk) SERVICE OUTCOMES Reduction in police incidents Reduction in the use of s136 powers Reduction in Mental Health Act assessments Reduction in use of mental health bed occupancy Reduction in inappropriate Ambulance deployments Reduction in ED admissions Reduction in risks posed to the community SERVICE USER OUTCOMES Reduction in suicide risk and other personal risks Clinical progress within secondary mental health pathways Improved support with daily life in the community Avoidance of criminal justice outcomes Better physical health Progress with drug and alcohol addictions Support with volunteering and paid work Improved relationships with family and friends 4

SIM RESULTS ACTIVITIES UNDERTAKEN BY PC METCALFE August 2015 – March 2017 Leading SIM mentoring teams with 9 high intensity service users Preventing the escalation of 31 service users Assisting informally with the management of 37 other service users Agencies/teams/depts worked with: 23 Mental Health – CRHT Probation PREVENT Mental Health – Community IRIS IOM Mental Health – Early Intervention Psychosis GPs MAPPA Mental Health – Wards Sussex Police MARAC Mental Health – Woodlands Social Services MASH CID Children’s Services Third Sector Neighbourhood Policing Teams Leaving Care Team Families Housing Providers Fire Service s136 per year before SERENITY launch (2011-12) 188 Reduction in s136 (per year) from Street Triage: 34 - 18% Reduction in s136 (per year) from SIM 103 - 55% TOTAL REDUCTION FROM SERENITY PROJECTS 137 - 73% MH Assessment Costs prevented by SIM (103 X £ ) £41,200 Number of deaths by suicide of SIM service users 0 Reduction in service users detained s136 (2013-2016) 52% Highest frequency service user (2013) 11 x s136 Highest frequency service user (2014) 7 x s136 Highest frequency service user (2015) 4 x s136 Highest frequency service user (2016) 3 x s136 5

TIERS OF INTERVENTION KN TIER 3 IJ AC RW AT KA JR KW JF PA TIER 2 KC This shows how PC Metcalfe supported 77 service users in the 18 months she has been funded by the CCG and how they were distributed between 3 types of Tiered need from cases that needed immediate intervention to less risky, preventative work. KN TIER 3 IJ AC RW SUPPORT AT KA JR KW JF PA TIER 2 KC IP CS PREVENT JC KW CB PT JMC AC GH MS SC GI NL CI GF AW AG AM JA KC DB TS TIER 1 ST TB AC SO NR JK CH CJ DE-ESCALATE DD TM MS RT AE SF CW VK SR LG AM AW MW MB JW MF TA SD LD VH PB JM LH FA LB SH KF AL ST TJ MH SB ML GB JW BR TIER 1 Service users showing high intensity behaviour. TIER 2 Early intervention and management of service users at risk of escalating. TIER 3 Supporting behavioural management, risk management, data sharing, investigation standards or effective partnership. 6

HIGH INTENSITY POPULATION Numbers and impact (s136) each year 2013 2014 2015 2016 90 service users 77 service users 55 service users 44 service users Total number of service users detained by police s136 Top 10 most frequent service users each year (no of s136 detentions) 11 10 7 6 5 4 3 56 7 5 4 3 2 42 4 3 2 1 20 3 2 1 20 SIM has enabled us to manage service users in crisis better. The above data shows that we have helped to both reduce the number of people reaching crisis point and we have also reduced the repeated patterns of people who do. The chart on the next page shows how s136s have reduced by 55% since we started SIM in July 2013. 7

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32 Carol Kefford Chief Nurse with Nuffield Health Chair of Awards Panel   "This is a truly original project with tremendous impact. Lives have been changed; not only for the service users but for their loved ones, their communities and for those who had previously managed their care. Their work is not only sustainable but scalable, so that many more people can be reached both in this country and overseas. The winners have challenged established perspectives and brought two very different, very traditional cultures together, healing minds and changing mindsets along the way. Both nursing and policing will evolve as a result" 32

Clinical Support Services Managing Long Term Conditions SIM has been shortlisted in 4 categories at the 2017 Awards Mental Health Clinical Support Services Managing Long Term Conditions Workforce Efficiency Awards Ceremony – May 24th 2017 33

NATIONAL SCALING SIM is now one of 8 innovations from across health selected by Sir Bruce Keogh for national scaling. The SIM team are now being supported by two dedicated teams at UCL and Wessex AHSN. We are currently working with the following trusts to launch high intensity mentoring teams in their areas: Solent NHS Oxleas NHS Mid Essex MHS Surrey and Borders NHS Cambridgeshire and Peterborough NHS A national High Intensity Network is being formed to oversee all mentoring teams. We are currently building a national online training portal to ensure consistency in commissioning, project governance and clinical methodology. National workshops will be Organised so that best practice can be identified across the Network which will feed advanced level courses on the portal. This portal will go live in May 2017 34