1. ISLE OF WIGHT REPORT
August 2015 – March 2017

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

3. 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:
s136 detentions
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

4. WELCOME Welcome to our SIM project review report for the first
commissioned period (August 1st – 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

5. 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

6. 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 ( ) 188
Reduction in s136 (per year) from Street Triage: %
Reduction in s136 (per year) from SIM %
TOTAL REDUCTION FROM SERENITY PROJECTS %
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 ( ) 52%
Highest frequency service user (2013) x s136
Highest frequency service user (2014) x s136
Highest frequency service user (2015) x s136
Highest frequency service user (2016) x s136 5

7. 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

8. 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

9. 8

10. 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

11. 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

12. 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