In 2021/2 a social media campaign using the twitter hashtag #StopSIM began in objection to a police-mental health programme which had been adopted in many areas. You can read much of the detail of the scheme and the impress service user campaign to stop it on the impressively collated website. If you don’t want the detail, SIM was the idea of embedding a police officer in to community mental health services and attempting to tackle repeat demand on emergency and other services, including by implied or explicit threat of prosecution, most usually involving those patients who were involved in or on the fringes of anti-social behaviour or criminal conduct whilst in crisis.
Controversial stuff, no doubt at all – a real ethical minefield, to say the least and today, NHS England has called for it to stop, if it hasn’t already. I will say only for my part that I cautioned against SIM from the very start and was not the only one who objected and raised a variety of concerns. I also want to note my disappointment that the actual review of SIM itself conducted by NHS England has not been published at all.
UDPATE (11/03/23): since first publishing the post with the two paragraphs above, social media reveals more that concerns me and raises questions. The #StopSIM coalition claim to have had 1-2hrs notice of NHS England’s letter being published and the review-report document remaining unpublished was a surprise to them. They claim the below letter contains work from service users, used without permission after some spent time over 15mths contributing unpaid to the review-report’s development. Whether this volte-face is connected to NHS England having funded and promoted SIM, you will have to judge for yourself.
The NHS England press release is below —
10th March
Dear colleagues,
NHS England position on serenity integrated mentoring (SIM) and similar models
Thank you for the responses submitted to my letter of July 2021 commissioning local reviews of SIM and similar models. We have reviewed all the material received and also consulted with a range of experts by experience, clinicians and stakeholders to produce a clear national position which we are setting out in this letter.
We are grateful to the STOPSIM coalition for initially highlighting concerns about the SIM model, for giving these concerns a platform via their campaign and also for the time they have put into assessing the model and making constructive proposals for change.
It is NHS England’s position that SIM or similar models must no longer be used in NHS mental health services. More specifically, the following three elements, which were all included within SIM but were not exclusive to it, must be eradicated from mental health services:
- Police involvement in the delivery of therapeutic interventions in planned, non-emergency, community mental health care (this is not the same as saying all joint work with the police must stop).
- The use of sanctions (criminal or otherwise), withholding care and otherwise punitive approaches, as clarified in National Institute for Health and Care Excellence (NICE) guidance.
- Discriminatory practices and attitudes towards patients who express self-harm behaviours, suicidality and/or those who are deemed ‘high intensity users’.
More detail on each of these elements is set out in Annex A to this letter.
The work of the STOPSIM coalition and the subsequent review has taught us valuable lessons about the vital importance of engagement with lived experience in the design, delivery and evaluation of service models at national and local level, and the risks involved if this is overlooked.
NEXT STEPS
NHS England will continue to review the key principles for ensuring people in crisis get the right support at the right time as we agree a framework for joint working between police and mental health services over coming months. Ongoing engagement with people with lived experience will be critical as we do this work, alongside government and policing partners.
We know services up and down the country are making significant shifts in the involvement and engagement of people with lived experience in the design and delivery of services. This is particularly critical as local systems deliver on plans to expand all age community and crisis services using the additional £2.3 billion of NHS Long Term plan funding.
Meanwhile, NHS England will continue to engage with the small minority of trusts that indicated in their responses that one or more of the above elements may have been present in their services, to ensure that:
- these elements are eradicated and work is underway to engage with experts by experience locally to co-design alternative services. These alternatives need to be evidence based, trauma informed and based on meeting people’s needs
- patients who have previously been under SIM or similar services now receive a care review to make sure that they are receiving care in line with NICE recommendations relevant to their condition(s).
Thank you all for your commitment to working with and learning from patients and experts by experience to deliver evidence based, trauma informed and therapeutic treatment and support across the mental health pathway, and to ensuring that we as the NHS learn from this.
Yours faithfully,
Professor Tim Kendall
National Clinical Director for Mental Health
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2023
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 