What can be done to support persistent 999 callers while protecting services?

Chloe repeatedly dialled 999 and ended up in prison

Thousands of people persistently dial 999 in times of mental health crisis. As a national scheme to deal with these so-called "high intensity users" ends, what can be done to help them and protect vital emergency resources?

Chloe ended up in prison after years of dialling 999 when she felt suicidal.

Diagnosed with emotionally unstable personality disorder, a court eventually banned her from going near bridges in Suffolk.

"I used to threaten to go to certain places like bridges and call up services just saying that I was feeling low, suicidal," she says.

"It was like, 'what else do I do, who else can I call'?"

Chloe says there needs to be more support available for people in her position

When she breached the court order, she was imprisoned.

Three years on, Chloe has found some sense of peace on her allotment.

"I'm not better," she says, "but things are under control. For now.

"I'm quite good at noticing my emotions nowadays but it's sometimes hard to cope with that and to deal with the emotions in a productive way or in just a normal, standard way."

Paul Jennings started a scheme on the Isle of Wight in 2013 which went on to be adopted across England

In 2013, former police sergeant Paul Jennings set up the first national model of care for people like Chloe, called Serenity Integrated Mentoring (SIM).

A police officer and a mental health professional led SIM teams, who made frequent visits and calls to individuals and formed a care plan.

He says they mainly dealt with people diagnosed with emotionally unstable personality disorder and autism.

"It is about mentoring. SIM is parenting," he says.

The approach was adopted by more than half of mental health trusts across England.

It aimed to reduce the number of calls made by service users, visits to hospital emergency departments and detentions under the mental health act.

"It was a group of 23 mental health trusts and 18 police forces that recognised that more needed to be done to understand and support people with complex mental health and behavioural, health and learning disabilities, that were presenting in crisis all the time," says Mr Jennings.

"They wanted to explore that and work together as a national programme to make sure that health care and policing was better."

But the network has now been closed down and the future of local SIM teams is uncertain.

NHS England's mental health lead Claire Murdoch has ordered reviews in each area.

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Serious concerns about the efficacy, training in mental health and evidence around SIM have been voiced.

Prominent among these is the #StopSIM campaign, which describes itself as a "coalition of service users and allies" asking for the model to be stopped and for an independent review.

The #STOPSim campaign was the catalyst for the NHS ordering a review of the service

The group believes people with mental health problems have been criminalised and claims SIM is too focused on reducing calls to the emergency services.

It also has concerns about the sharing of personal information and claims the mentoring, police-led approach is coercive.

Mr Jennings says officers have to balance the safety of service users and the public - and uphold the law.

"Can our SIM teams be coercive? Yes. Can they be punitive? Yes. Because they actually get to a point where they have to [be]," he says.

Mr Jennings admits a small number of service users have ended up in court but maintains they are not "over punished" and behaviour is only escalated within the criminal justice system when "absolutely necessary".

Penny, not her real name, is a SIM client and is part of a scheme in the east of England.

Diagnosed with a borderline personality disorder, Penny was also struggling with anxiety and depression when the SIM team approached her.

"They just simply said that they thought I needed more help and support," she says.

Penny denies being a frequent caller to the emergency services

But Penny fears prison because of the police involvement.

"I've been really scared," she said. "I have lived just kind of with the fear of that one day I could be arrested and sent to prison. It's a real fear and they do say things to you like 'you know, you could be wasting our time and money'.

"'You could potentially be arrested'. They do say those things to you."

She disputes her classification as a persistent caller, though she does not know how many times she has phoned the police.

Penny believes the service is being used as a replacement for proper support or trauma therapy for people with behavioural disorders.

"People that are mentally unwell need proper treatment and care. They don't need to see a police officer every week or month.

"I think it's really odd because if you hurt your arm or leg or something you go to your GP or hospital. If you're mentally unwell you wouldn't go to a police officer," she says.

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From 31 July, Suffolk will no longer use Joint Engagement Team JET (its name for SIM).

Both the Royal College of Psychiatrists (RCPsych) and the Association of Clinical Psychologists have aired concerns about SIM.

The RCP claims the scheme is about saving money and resources "without considering clinical benefit".

"I think I'd tell them that they need to actually speak to us," says Chloe.

So what is the future of support for people like Chloe and Penny?

High intensity users suggest it must start with fresh communication.

"I think I'd tell them that they need to actually speak to us," says Chloe.

"See what we have to say about it because we're the patients as such, we're the ones that are going through that."

She says police should not be dealing with persistent callers, claiming "they have no mental health training at all, especially in personality disorders".

As for Penny, she too would like less police involvement.

"We know that it should be compassionate, non-judgmental, kind, supportive," she says.

According to Mr Jennings, SIM "was commissioned by the NHS to reduce demand and to reduce cost" - a principle he says he never supported.

But he says he was accepted onto an NHS innovation programme which paid his salary.

He claims some trusts have written to him pledging to continue the scheme under a different name without his support, an outcome he calls "horrific" because they'd be dealing with one of the most complex patient groups without national standards or training.

A spokesman for NHS England said: "NHS England does not mandate the SIM model and has asked trust medical directors to review its use to ensure that care is being provided in line with NHS Long Term Plan ambitions to expand community services for people with complex mental health needs and in line with NICE guidance".