Document shows NHS England apologised for backing harmful SIM scheme

NHS England has apologised – in a co-produced document it has refused to publish – for its serious failures over the widespread use of a mental health scheme that it admits was discriminatory, coercive and punitive.

Senior NHS executives had secured widespread backing for a document in which the organisation admitted its failings had harmed service-users who were subjected to the Serenity Integrated Mentoring (SIM) scheme.

NHS England (NHSE) had worked closely for more than a year with disabled activists from the StopSIM Coalition on a national response and policy position on how SIM and SIM-type schemes were being used across NHS mental health trusts, but it then went back on its word to publish it.

The coalition believes that NHSE halted publication because of a legal challenge by Wessex Academic Health Science Network (Wessex AHSN) “and in doing so failed in their duty to put patients at the heart of the NHS and to be accountable to the public, communities and patients they serve”.

Wessex AHSN was one of the networks set up by NHSE in 2013 to “spread innovation at pace and scale”, and it played a significant role in supporting SIM in its early development.

Now, as activists from the coalition announce their decision to disband their two-year campaign (see separate story), they have decided to publish the most up-to-date version of the draft policy they co-produced with NHSE, which was sent to them and other stakeholders in late December.

The policy had been “fully agreed” with “a number of other teams within NHSE” and was described in an email from NHSE’s head of adult mental health as the “final version of the position statement”, before the intervention of Wessex AHSN.

The StopSIM Coalition has now decided to share the report with Disability News Service before releasing it publicly later today (Thursday).

In the report, NHSE expresses its regret for endorsing the SIM model without applying “sufficient scrutiny” to that decision or involving people with lived experience of mental distress.

It says: “This compromised the safety and quality of care for service users and has caused hurt to patients. For this, NHS England is sorry.”

It also concludes that some of the SIM schemes could have amounted to torture, inhuman or degrading treatment or punishment, or discrimination under the Human Rights Act because of the way that some service-users were treated.

NHSE and the coalition conclude in the draft policy that three key features of SIM and SIM-type schemes “must be eradicated” from mental health care.

They say police should never be involved in delivering therapeutic interventions in “planned, non-emergency, community mental health care”, while the use of coercion, sanctions, withholding care and other punitive approaches with mental health services “must end”.

They also call for an end to the discrimination faced by service-users who engage in self-harm and suicidality and those described as “high intensity users” of mental health services.

The document, which examines the results of a review of the use of SIM that was launched by NHSE in May 2021, says that examples of SIM-type “poor practice” appear to be “ingrained” across the country.

Of the 54 trusts that responded to the review, 26 of them said they had used a SIM or SIM-type model at some stage, and 20 of them appeared to be continuing with key features of the SIM model.

NHSE says in the draft policy that it is now in contact with all mental health trusts “to seek assurances” that they will “eradicate” these “features of concern” from their care provision.

In the document, NHSE says: “NHS England must hold itself to the highest level of scrutiny in carrying out these duties so that local health teams, patients, carers and the public can have confidence in how decisions are made to support people.

“In endorsing and facilitating the rollout of SIM without sufficient scrutiny and critical evaluation to identify concerns with the model, as outlined in this document, NHS England did not meet this responsibility.

“The lack of scrutiny compromised the safety and quality of care for service users who were put under SIM and similar models.”

In a statement announcing its decision to disband and publish the draft policy, the StopSIM Coalition said NHSE had breached all three principles they had agreed when deciding to work together: confidentiality, equal partnership, and that neither party would publish without the consent of the other.

An NHSE employee had leaked part of the document to the Health Service Journal in February, and excluded the coalition from key conversations with executives.

NHSE also “went back on its word” not to publish an altered version of the policy without the coalition’s consent when Professor Tim Kendall, NHSE’s national clinical director for mental health, published a short letter in March that had not been approved by the coalition, stripped the policy “down to the bare minimum”, and used the coalition’s words without its members’ consent.

The coalition said: “NHS England has dissolved the agreement they entered into with us through these series of choices.”

It said that, despite campaign successes, the “criminalisation of distress remains endemic across mental health services”.

It added: “While we welcome important steps in challenging the violent, discriminatory and harmful practices SIM promoted, such as the new NICE guidelines on self harm, this falls short of the fundamental ‘culture shift’ urgently needed.

“Numerous trusts across England continue to exploit the lack of an authoritative national policy position by continuing elements of SIM and SIM-like practices, while providing assurances they have never used such approaches.

“Much more work is needed to ensure that protections for patients are embedded both at national and local levels, within policy and practice.”

SIM-type schemes focus 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.

SIM was first trialled in 2013 on the Isle of Wight, but it was eventually rolled out to nearly half the mental health trusts in England, and it was backed by NHSE and recognised with national awards.

But an increasing number of disabled activists began to warn that it was based on coercion and denial of potentially life-saving support and was causing some service-users to live in fear of arrest or even prosecution when they were in mental health crisis.

The coalition’s campaigning revealed the flaws in the “sinister” and “disturbing” scheme and persuaded NHSE to order local reviews of how it had been implemented by trusts across the country, eight years after it was first piloted on the Isle of Wight.

Wessex AHSN did not deny this week that it had taken legal steps to stop the publication of the policy.

But in a statement, it said: “The reason for the non-publication of NHS England’s report and the contents of it are matters for NHS England and it would be inappropriate for us to comment further.”

An NHSE spokesperson declined to say if legal action taken by Wessex AHSN had prevented the policy being published.

But the spokesperson said in a statement: “We are extremely grateful for the work of the StopSIM coalition, which has highlighted significant policy concerns and helped us mobilise to address them.

“We are clear that the SIM model should not have been extended and are committed to ensuring the practices of concern related to SIM and other similar models are no longer used.

“Although we have not been able to agree a joint position statement with the coalition, our review of SIM was based on the voice of lived experience, and we are strengthening our processes to ensure the voices of patients remain central to our future policy-making.”

A StopSIM Coalition spokesperson said in response: “It is absolutely misleading to suggest NHSE and the coalition were ‘unable to agree’ on a position.

“The public can read the details of our joint position in the draft policy we’ve published.”

Picture: A protest banner displayed by StopSIM supporters

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