Coalition calls for halt to use of ‘unethical and unsafe’ mental distress emergency scheme

Disabled activists are calling for an immediate halt to the use of a multi-agency scheme that they believe is unethical, unlawful and unsafe, and which they say puts people in severe mental distress at risk of being denied vital support.

Under the leadership of a police officer and a mental health professional, Serenity Integrated Mentoring (SIM) puts pressure on users of mental health services – often those at high risk of suicide and self-harm – who have not committed a crime but are seen as “high intensity users” of emergency services.

There are concerns that this can involve withholding assessment and treatment, and gives police officers a key role in making clinical decisions when service-users are in crisis.

The new StopSIM Coalition has warned that the system is being rolled out across NHS England, despite the lack of high-quality research into its impact on service-users.

The coalition of service-users and allies says it has “grave concerns” about SIM and wants to see the use of the scheme halted while an independent review is carried out into its “evidence base, safety, legality, ethics, governance and acceptability to service users”.

SIM is supported by the High Intensity Network, which is led by director Paul Jennings, the founder of SIM and himself a former police officer with experience of mental distress and using mental health services.

He says his network is already working with 23 of 57 mental health trusts in England.

This week, he told Disability News Service (DNS) that some of the criticism of SIM was unfair, but he admitted there was a need for an independent review of the programme.

He claims that there are good reasons for putting pressure on service-users through “positive risk management”, which he said was a well-known principle in mental health care.

He added: “All we have done is expand the knowledge and confident use of positive risk management through a centralised crisis plan.”

He said it was “not oppressive pressure” or “heartless”, but a “well thought-through, well-intentioned, good balance of risk management”, while he claimed the crisis plans were always co-produced and signed off by the service-user.

Jennings said: “All we are doing is providing high-quality information to police officers and paramedics so they can… make a higher-quality decision in the moment of distress.”

But the coalition’s concerns and its calls for a halt to the use of SIM-type programmes and an independent review have already been backed by the National Survivor User Network (NSUN).

NSUN warned this week that there did not seem to be a sound evidence base for the intervention or much oversight of service-user outcomes not relating to cost, demand and staff time.

And it said there had been “little to no involvement of service-users or ‘experts by experience’ in the development of the model or feedback on experiences of being under it”.

Jennings said the criticisms of a lack of high-quality research were “absolutely true and fair because of the difficulty of securing high-quality data from multiple teams across the NHS and police and because the number of service-users nationally was naturally very small”.

He added: “We are continuously in the process of improving our research methodology but our teams are telling us they are confident that the data they already have, clearly shows really strong qualitative and quantitative outcomes.”

His work has been backed and funded by the NHS through its “Innovation Accelerator Fellowship”.

But one of the pieces of evidence the coalition points to that highlight its concerns is an NHS England report (PDF) on innovation within the NHS.

The report says that SIM schemes can prevent the “revolving door” of service-users repeatedly “moving in and out of police custody and mental health wards”.

It also describes how professionals engaged with a service-user who was being dealt with through a version of the SIM scheme being run in Surrey.

Police officers in Surrey had been briefed about the scheme and, the NHS report said, “had started to understand that over-reactive decisions, made in fear, did not help the patient but actually gave the message that high-risk behaviours would be ‘positively reinforced’ by 999 teams (meaning that it would encourage the patient to repeat the high-risk behaviour)”.

As a result, she was not detained under the Mental Health Act and the police took her home and left her there.

Soon afterwards, she intentionally overdosed and had to be admitted to an accident and emergency department for treatment.

According to the NHS report, the Independent Office for Police Conduct concluded that the officers had no case to answer for misconduct “because they followed due procedure according to the clinically endorsed care plan”.

Jennings defended the police action, and said it “was not an autocratic decision, in this case, it was police and clinicians and the service-user working through an opportunity to build emotional resilience”.

He said the police officers had followed a “co-produced plan” and that the service-user subsequently “found safer ways of going into crisis”.

The StopSIM Coalition says it has concerns about the evidence NHS trusts and police forces are relying on to justify adopting the scheme, the risks to service-users who have SIM imposed upon them, and potential breaches of human rights.

In a statement, the coalition said: “To our knowledge, no robust, high-quality research has been conducted, which would justify such a rapid implementation of this novel, complex and high-risk intervention.

“There is also a wider absence of evidence that attests to the safety, efficacy and acceptability of interventions that involve withholding potentially lifesaving assessment and treatment across multiple agencies, which also utilises police officers as interventionists.”

Jennings told DNS that police officers do not take control of the crisis situation, but play a joint role with the mental health professional and the service-user “to see if we can help the service-user much more effectively when they are in crisis”.

The StopSIM Coalition also says that the little research that has been carried out has failed to measure the experience of the service-users themselves, focusing instead on how heavily services are being used and how much they cost.

It also believes there is a risk that suicides could increase if service-users are forced to hide their self-harm and suicide attempts from services.

They say SIM treats service-users’ behaviour as attention-seeking and manipulative when research on self-harm and suicide attempts shows they are usually driven by an attempt to manage acute distress.

Jennings said this was “deeply unfair” and that SIM was “exactly the opposite” and was “trying to challenge the labels, challenge the stereotypes”.

The coalition has now launched a petition that calls for SIM’s rollout and delivery to be halted and for an independent review.

In a statement supporting the coalition’s campaign, NSUN said: “We know that forced police contact can already be part of the response you receive if you ‘repeatedly’ reach out for help when deeply distressed.

“This risks exacerbating this, particularly for those from minoritised or racialised communities for whom the possibility of police brutality and discrimination is a very real fear.

“NSUN supports the #StopSIM Coalition and together we call for the delivery of this intervention to be halted and independently reviewed with regards to its evidence base, legality, ethics, governance, and acceptability to service-users.”

Jennings said he would “totally and utterly welcome” an independent review of SIM.

He said: “We know we are not a gold standard model yet. We know this whole health and justice movement is in its first decade of something probably like 70 or 80 years of evolution before you get close to it, so we totally welcome any review.”

He added: “It is my wife [a former police member of staff] and I running this network, with the sporadic support of some NHS teams, and it is a major weakness of the programme that we are not supported more by NHS England.

“Why is a care programme for the most traumatised patients in the NHS being run by two ex-cops from their spare room on the Isle of Wight?”

By noon today (Thursday), Surrey and Borders Partnership NHS Foundation Trust, Surrey Police and NHS England had all failed to respond to the concerns about the SIM programme, despite being approached by DNS last Friday (23 April).

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