Supporting high intensity users of emergency services
Since April 2020, the Thames Valley mental health and domestic abuse charity Elmore has been providing a High Intensity User (HIU) Project alongside the John Radcliffe (JR) Hospital in Oxford. The HIU Project provides brief community-based support to people who frequently attend hospital emergency departments or use emergency services.
The service itself
As of April 2022, Elmore’s HIU Project had supported 26 patients, made 59 onward referrals for longer-term intervention (including 4 safeguarding referrals), supported 14 patients to avoid homelessness, and enabled 18 patients to engage in employment, education, or other meaningful activities.
The project is available to patients of the JR Hospital’s Emergency Department (ED) as long as they are aged 18+ (with no upper limit), living in Oxfordshire and believed to be likely to benefit from community-based support which the hospital-based High Intensity User (HIU) Team are unable to provide.
The HIU Project is a closed referral pathway, though occasionally another hospital department has initially flagged the need for referral. Ultimately, all referrals will be agreed by the JR-based HIU Team after consent has been received from the patient. The service criteria are broad in recognition of the fact that the project is aiming to support people with complex needs who do not fit easily into services.
The project provides intensive, proactive, practical and emotional support which may last for up to 12 weeks. Further support is possible for a further 12 weeks. Each client is allocated a lead Elmore worker who meets with the individual on a weekly basis or as often as needed. This is to help the individual identify the goals they want support with and to make progress towards achieving them.
Common Areas of Support
Improving mental and physical wellbeing and enabling recovery
Building up confidence and self-esteem
Providing support with housing, money, benefits, or debt
Providing support and tools to prevent isolation and loneliness
Acting as an advocate to ensure the client’s voice is heard
Providing information and assistance to the client to access employment, education, volunteering, or training opportunities
Working alongside clients to help them learn or improve practical life skills
Supporting with any contact with the police and criminal justice system
The project’s goal is to empower clients to stabilise their lives and access longer-term practical and emotional support from specialist services to better manage their mental health and related issues. Elmore’s team helps to signpost and guide clients as a founding member of the Oxfordshire Mental Health Partnership and through the provision of floating support to people over a longer timeframe.
Case Study
In mid-2022 an Elmore HIU worker supported a 28-year-old male referred to the project by the JR HIU Team due to very frequent ED attendances often related to self-harm. The client had been ‘struggling to cope’ with aspects of his life and relationships, and this had negatively affected his mental health. He had been homeless, sleeping rough, and had a history of offending behaviour.
By supporting the patient to create a written support plan of small and achievable goals related to housing, custody, mental health, and finances, our HIU worker was able to empower him to develop improved strategies to better manage his mental wellbeing and to avoid the self-harming behaviours which had been leading him to stays in hospital.
The Elmore HIU worker supported the client to build better relationships with other support services such as his housing provider and the local community drug and alcohol team. He was supported to address financial issues, linked into a benefits support agency, and supported to find accommodation of his own.
As a result of making these changes, the client reported feeling more motivated and positive about his life and more able to face things on his own. Over their 12 weeks of support, the client only attended the JR ED once and not at all during the last 7 weeks of support. The single presentation was because of an overdose.
In giving feedback at the end of his support by an Elmore HIU worker, the client reported that his support had contributed significant positive impacts on different aspects of his life: ‘My mental health has always been a problem, but now I feel like something is being done…I want to show that I can be a good dad…I want to be the best dad for my son”. The client also wanted to say, “Thank you for all of this, it is making a difference…we are actually getting somewhere now!”.
A distinguishing features of Elmore’s HIU Project is the ability to quickly take on a ‘care co-ordination’ role, as shown by the case study, pulling different aspects of a person’s care needs together and supporting them to regain control of their life.
Impact on the public purse
An evaluation by the JR Hospital HIU Team showed that Elmore’s contribution had led to a 72.22% decrease in ED attendances from April-December 2020.
The same evaluation demonstrated that Elmore’s support of just two HIU clients had produced an estimated saving of £27,846 for the ED and £4,398 to the South-Central Ambulance Service (SCAS).