1. Purpose This paper describes the design, implementation and evaluation of a small UK case study of a mentoring style pilot intervention integrating a specially trained police officer alongside mental health professionals to support highly intensive service users of emergency services. 2. Design/methodology/approach The development of the conceptual framework informing the mentoring intervention is described and its implementation evaluated using a range of qualitative and quantitative outcome measures. 3. Findings The four high intensity service users involved in the pilot had internalised the need to participate in recommended recovery pathways. Mental health nurses reported improved compliance with treatment. Although the sample was small, the number of police mental health crisis detentions was reduced by 66% after one year and by 100% after 18 months. Usage of other emergency public services had also drastically reduced, or been eliminated altogether. 4. Research limitations/implications Limited time and resources and the need for a solution that could be implemented as soon as possible meant a pragmatic design, implementation and evaluation. 5. Practical implications The study indicated that a wider roll-out of the new multi-agency mentoring model would be beneficial. 6. Originality/value This is the first intervention to integrate mental health a trained police officer directly into the care pathway of repeated users of emergency public services with complex mental health needs.

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Background:Key issues in both the USA and England have been how to deal appropriately and effectively with the increasing number of mental health related incidents, in particular 1) the rising number of people with mental health issues detained in police custody until they can be clinically assessed and 2) the negative impact on public safety of the high intensity service users [HIUs] who draw a disproportionate amount of emergency and crisis services and are well known to both police and mental health services.Aims and objectives:To provide an overview of what is known about current quality improvement interventions undertaken to address these two key issuesi.e.reducing both the number of police mental health crisis detention and the disproportionate amount of emergency and crisis service usage [police, ambulance, ED] from HIUs with complex mental health problems to help inform policy and practice decisions in a context of lack of best evidence and lack of evidence based studies.Methods:PubMed and Google Scholar were searched to undertake a narrative synthesis of what is known of the various quality improvement interventions that have been introduced in both the USA and England to address these two key issues. Authors’ knowledge was also used to describe two quality improvement interventions not included/not yet listed in Google Scholar or PubMed.Results:In the USA, the dominant approach to reduce mental health police detentions is the CIT model, first introduced in 1988, now increasingly implemented with the addition of the older model of police and mental health co-responder (which go back several decades earlier) to increase its effectiveness. The CIT model has been adopted and spread worldwide despite methodological shortcomings in evaluations. Although a best evidence model with increasing data being gathered on effectiveness, it has yet to become an evidence based model. The Street Triage models introduced in England in 2012 were inspired by the older police and mental health co-responder model. Despite a primarily descriptive approach and methodological shortcomings in evaluations and only a handful of studies published, ST has also been widely adopted and spread within England. Only a handful of interventions have focussed on supporting HIUs with the implementation in England of a unique model but evolving model of integrating a police officer within a multi-disciplinary mentoring style intervention which has now adopted by other English police forces and could usefully be adopted by USA police forces.Conclusion:More data need to be systematically gathered on effectiveness and analysed against a range of clear success criteria, including a cost benefit analysis of the relative merits of their different variations before and in order that they can be called evidence-based models.

Background Issues of medication adherence, multimorbidity, increased hospitalisation risk and negative impact upon quality of life have led to the management of polypharmacy becoming a national priority. Clinical guidelines advise a patient-centred approach, involving shared decision-making and multidisciplinary team working. However, there have been limited educational initiatives to improve healthcare practitioners’ management of polypharmacy and stopping inappropriate medicines. This study aimed to evaluate the impact of a polypharmacy Action Learning Sets (ALS) tool across five areas: i. healthcare practitioners’ confidence and perceptions of stopping medicines; ii. knowledge and information sources around stopping medicines; iii. perception of patients and stopping medicines; iv. perception of colleagues and stopping medicines and v. perception of the role of institutional factors in stopping medicines. Methods The ALS tool was delivered to a multi-disciplinary group of healthcare practitioners: GPs [n = 24] and pharmacy professionals [n = 9]. A pre-post survey with 28 closed statements across five domains relating to the study aims [n = 32] and a post evaluation feedback survey with 4 open-ended questions [n = 33] were completed. Paired pre-post ALS responses [n = 32] were analysed using the Wilcoxon signed-rank test. Qualitative responses were analysed using a simplified version of the constant comparative method. Results The ALS tool showed significant improvement in 14 of 28 statements in the pre-post survey across the five domains. Qualitative themes (QT) from the post evaluation feedback survey include: i. awareness and management of polypharmacy; ii. opportunity to share experiences; iii. usefulness of ALS as a learning tool and iv. equipping with tools and information. Synthesised themes (ST) from analysis of pre-post survey data and post evaluation feedback survey data include: i. awareness, confidence and management of inappropriate polypharmacy, ii. equipping with knowledge, information, tools and resources and iii. decision-making and discussion about stopping medicines with colleagues in different settings. Conclusions This evaluation contributes to developing understanding of the role of educational initiatives in improving inappropriate polypharmacy, demonstrating the effectiveness of the ALS tool in improving healthcare practitioners’ awareness, confidence and perceptions in stopping inappropriate medicines. Further evaluation is required to examine impact of the ALS tool in different localities as well as longer-term impact.