DESPITE ALL THE HARSH CRITICISMS, SIM STILL EXISTS IN MANY NHS TRUSTS,
STOP SIM: MENTAL ILLNESS IS NOT A CRIME
More of STOP SIM
At the forefront of efforts to combat the advance of the scheme are StopSIM, a coalition of users with lived experience of mental health services. StopSIM has questioned the methodology behind the scheme, which lacks evidence and trauma-informed input from service users. The coalition has also raised concerns about the sharing of medical information with the police without patient consent, which, they say, is likely to have a “disproportionate impact on ethnic minorities […]”. History backs this prediction up; ethnic minority communities are less likely to approach healthcare services when police and government agencies are involved
We object in the strongest terms to the Serenity Integrated Mentoring (SIM) programme, which is currently being operated in 23 out of 52 NHS trusts, with plans for continued rollout.
SIM is marketed as a cost-saving measure which works by reducing the use of NHS services by so-called “high intensity users” — that is, frequent users of emergency and mental health services. Based on the sadistic logic that self-harm and suicidal behaviour is “attention-seeking,” SIM attempts to actively discourage such people from contacting or seeking help from NHS services, considering their engagement an “unnecessary financial burden.” This is in direct opposition to the standard advice to call emergency services if feeling suicidal.
To make matters worse, a key aspect of SIM is the employment of so-called “high intensity officers” (HIOs) under NHS contracts. These are police officers who have taken a three-day crash course taught by Paul Jennings, a former police sergeant, who founded the “High Intensity Network” with his wife. These officers are given full access to service users’ medical records, and are also able to share police records with medical staff.
Very simply, their role is to coercively prevent “high intensity users” from accessing mental health services until they stop “demonstrating intensive patterns of demand.” This is under the implicit or explicit threat of legal repercussions, such as the use of Community Behaviour Orders — which can lead up to 5 years in prison if the service user refuses to cooperate with authorities.
This repugnant system represents the expansion of the carceral state in Britain. In particular, because people with BPD diagnoses have been explicitly highlighted in some SIM reporting, we point to the long-standing use of BPD diagnosis to pathologise and isolate women of colour who do not comply with the strictures of healthcare professionals. The carceral approach to mental health care has also been specifically weaponised by the British police against people of colour (which we can see in their treatment of Osime Brown, Kingsley Burrell and others). These examples clearly show the ways in which SIM will undoubtedly be used, not only to harm members of marginalised communities, but to strengthen the very structures that marginalise them in the first place.
Disability justice is central to the struggle against police violence and incarceration. It is our hope that those fighting for disabled liberation and those opposing the expansion of police powers as part of the “Kill the Bill” movement can find common cause in opposing the rollout of SIM and organising to destroy it in places that have adopted it.
As of present, the “High Intensity Network” — the company responsible for devising SIM and training HIOs — has seemingly vanished from social media after receiving increased public scrutiny. Whilst this may seem like a victory, we fully expect this project to reemerge under a different name once the heat has cooled off. We owe it to our disabled comrades to remain vigilant and to struggle against it, whenever it reappears and however it attempts to disguise itself when it does.
We would not be aware of SIM’s rollout if not for the efforts of the StopSIM campaign, who have compiled a list of local NHS trusts and relevant bodies which have already established a SIM team over the past three years. We urge full support of this campaign: we must reject the criminalisation of disability, resist the expansion of the British carceral state, and definitively #StopSIM.
Serenity Integrated Monitoring is an approach to coordinating multi-professional and multiagency responses - including health and the police - to ‘demand …caused by a small number of ‘high intensity users’ who struggle with complex trauma and behavioural disorders’, according to the High Intensity Network website.
Developed over the last decade, in 2016 SIM was adopted by NHS England for scaling up. More recently, SIM projects have been connected through the Network.
The BASW England Mental Health Group has discussed deep concerns about the High Intensity Network and SIM raised by practitioners and particularly by people with lived experience of using mental health services and created this statement.
The concerns regarding the SIM model of practice raised include:
- Despite claims of a focus on quality, SIM prioritises cost reduction and financial savings from people receiving less contact with emergency services rather than being driven by the impact on service users in the short and long term.
- That in order to achieve those reductions in cost, people in acute distress, and experiencing or acting on thoughts of self-harm or suicide are dissuaded from accessing the support and interventions they find helpful.
- The apparent lack of co-production in the design and delivery of these services, that is despite the High Intensity Network stating that ‘we are experts of our own care’ in their three core principles.
- That the evidence base for this approach is limited at best. Outcomes for many services adopting this model appear to be based on the reduction in contact with emergency services and the associated cost reduction.
- That the model may increase the risk of harm for some people who feel they are not allowed to access services in a crisis and /or unwelcome if they do
We would add to this list our concern that there is no reference in the model to ensuring people entitled to support and/or assessment under the Care Act can access this.
UCL PARTNERS NO LONGER ACTIVELY INVOLVED
SIM
SIM was one of seven national programmes that was supported by the AHSN Network from April 2018 until March 2020, when the two-year national programme came to a close.
UCLPartners provided support for the local adoption of SIM as part of its NHS England-funded AHSN commission.
UCLPartners are no longer actively involved in SIM.
Read the AHSN Network statement on SIM
(Same sort of ambiguous treatment by police)
DEATHS OF ANDREW BOW AND OTHERS
(my 2016 blog post)
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