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There must be adequate support and care for our most vulnerable mental health patients, RCEM says

22 June 2021

Commenting on the recent reports about the Serenity Integrated Mentoring (SIM) scheme, Dr Catherine Hayhurst, Chair of the Mental Health Committee at the Royal College of Emergency Medicine, said:

“The Serenity Integrated Mentoring (SIM) project was innovative at its inception. The project took a compassionate, coaching approach to patients, some of whom are among the most extreme frequent attenders at our Emergency Departments.

“The SIM project worked with patients who suffered from very complex and difficult mental health conditions, who were already very well known to the police service because of the risks they posed when they self-harmed.

“The original results from the projects and the stories from the people and patients who were involved indicated success.

“The SIM project worked by forming teams made up of an experienced mental health nurse and a police officer. Together, they would mentor and support patients over a long period of time.

“The combination of an experienced nurse and a police officer aimed to help people manage their distress, reduce their self-harm, and help find more positive things in their life. Such help might involve housing, benefits, finding voluntary work and other activities to provide structure to people’s lives.

“Part of the project involved using the law to reduce illicit behaviours. Although somewhat controversial, this was meant as an incentive to encourage positive changes in behaviour. Uses of the law could include public order or trespassing offences.

“While the project was positive for many patients from the outset, the College is deeply concerned to hear that some patients may have been denied access to Emergency Departments as part of their management plans. No patient should ever be turned away at the door, especially if those patients are deeply vulnerable and suffering from severe mental health problems.

“Since the beginning of the SIM project, the College has encouraged the project to be more rigorous in its evaluation.

“The project was put on the NHS innovation accelerator programme by NHS England, which led to a rapid rollout. In retrospect, it is evident that as well as a more rigorous evaluation, a greater involvement of expert Psychiatrists to guide the management of complex patients, would have been beneficial. We believe NHS England should take responsibility for this. There should be a review to help ascertain which interventions worked and where teams may have strayed from the original compassionate, coaching approach.

“The College would like to see more research into effective care and support for our most frequent attenders to Emergency Departments, many of whom have experienced severe trauma and adversity.”

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