TANDEMplus: Mobile Crisis Support and Social Network Development – Belgium

‘TANDEMplus’ is a small mobile crisis service that supports people during, and shortly after, they experience a crisis. A key aim of TANDEMplus is to help a person to ‘(re)activate her/his local support network’ (Submission 7). This includes identifying the kind of support that the person would like to receive based on her/his expressed needs, and connecting the person with the appropriate people or community services. TANDEMplus only intervenes on a short-term basis, in a completely non-coercive manner, with the average length of intervention being 29.5 days. (“L’équipe mobile Tandemplus,”. According to Human Rights Watch (Hancock, 2019), which has promoted the service:

The only “treatment” TANDEMplus offers is support, in the form of regular home visits to talk through people’s emotions and concerns. They help the person find coping strategies and tackle practical problems that have brought them to the point of crisis, be it a debt issue, help with household bills, or mending ties with family members. They also refer them to social workers or other services. The support is only given with the person’s full consent, reflecting TANDEMplus’ core philosophy: that the person has control over their own life.

TANDEMplus is a bilingual service (French and Dutch). It operates mainly in areas of Brussels with lower socio-economic status and works with adults over 18 years of age who are experiencing a crisis or have difficulty finding psychiatric support that meets their needs.

Outreach workers are sent in pairs to meet the caller either in their homes or in another place of their choosing. If possible, the person who contacted the service is asked to be present for this first visit. The agreement of the relevant person is always needed before any meeting takes place.

At the time of writing, the service has 8 outreach workers. The staff members do not require professional mental health training to be part of the service, though most have a professional background in mental health. A strong emphasis is placed on staff member’s ability to communicate, collaborate, be personable, creative, and so on. At present, the team includes clinical psychologists, social workers, nurses and educators. The team has one psychiatrist.

People seeking support can call a hotline that operates from 9:00am-3:00pm during the week. At least one staff member on the hotline team is someone with lived experience of using mental health services. Just under half of calls tend to result in a home visit, while the other calls typically relate to information sharing and guidance and advice (Submission 7).

Following the first visit, the service provides regular home visits (on average 2-3 per week), as well as regular phone calls (available from 9:00am-5:00pm). TANDEMplus does not prescribe or manage psychotropic medication or diagnose people, but rather attempts to find ways to address the issues that have led the person to experience a crisis. A staff member describes the service thus, “Our work is to lay a foundation around the person that’s sufficiently solid for them to continue making progress psychologically” (Submission 7).

An important aspect of TANDEMplus is that it connects with other health and social services, community groups, and so on, to create long-term support system for the person. TANDEMplus is part of the larger network of dozens of social and health services (“Partenaires Archief,” Hermesplus,). TANDEMplus seeks to liaise actively with these other systems of support to avoid a situation of fragmented service provision that a person must navigate alone.

If there is a risk of violence, the initial meeting with the person will take place in a safe public setting. If the risk is too great, the support will be interrupted. If there is serious risk (either to the person or others), then the person’s family or care providers are given information about how they can initiate an involuntary intervention. If appropriate, the team will stay involved during the crisis period and may accompany the person to hospital if she/he wishes. The TANDEMplus team will not initiate an involuntary hospitalisation. Some circumstances have required police intervention, which temporarily ends the involvement of TANDEMplus. The policy of TANDEMplus is that ‘care is not compatible with police intervention’ (Submission 7).

According to a 2019 evaluation, the TANDEMplus intervention connected 49% of the service users to the ambulatory care system in Brussels, including mobile structured care and outpatient facilities, mental health centres, health care providers, home care, assistance to the homeless, consultation and coordination services, and other community organisations (Submission 7). 22% of the referrals made by TANDEMplus were to inpatient care, either in a psychiatric hospital or mental health unit in a general hospital. The remaining individuals were not connected to other services, either because they did not want it, or because they did not maintain contact with TANDEMplus (Submission 7).

According to Human Rights Watch access to the program is entirely free of charge for people using the service (Hancock, 2019). Furthermore, their names are not registered, they do not need to have medical insurance or ID, and they can remain entirely anonymous if they wish.

Human Rights Watch have also conducted a cost-benefit analysis and indicated that compared to a stay in a psychiatric or general hospital ward, the type of home-based support provided by TANDEMplus is more economical than hospital-based care (Hancock, 2019).