NHS England ‘must do more’, despite ordering reviews of ‘unsafe’ mental distress scheme

Disabled activists have demanded stronger action from NHS England over the use of a mental health scheme they have branded unethical, unlawful and unsafe, despite a senior NHS figure telling individual trusts to review their use of the programme.

There has been mounting concern about the use of the Serenity Integrated Mentoring (SIM) system, and its rapid rollout across the NHS in England, despite the lack of quality research into its impact on mental heath service-users.

But concerted campaign pressure by the StopSIM coalition has now led to NHS England’s national clinical director for mental health, Tim Kendall, writing to mental health trusts, calling on them to review their use of the scheme.

The coalition said yesterday (Wednesday) that, although it was “reassured” that some action was being taken, NHS England needed to co-ordinate an immediate independent investigation into the use of SIM-type schemes.

In his letter, Kendall admits that the SIM model was chosen as part of an NHS Innovation Accelerator programme in 2018, but he insists that NHS England “is not formally endorsing or promoting” the spread of the SIM scheme.

But the coalition said yesterday that the SIM model had been endorsed by several key NHS figures and pointed to evidence that NHS England had encouraged its widespread rollout.

In a lengthy, detailed and evidenced statement, it said it believed that NHS England had a “statutory duty” to carry out a “more robust and centrally coordinated investigation in view of the severity of concerns regarding SIM”.

It said: “We are reassured that NHS England have acknowledged our concerns and are planning to take actions in response.

“We agree, a review is essential in order to address concerns and in order to take robust actions as appropriate.

“However, we remain concerned that this response does not appropriately reflect the urgency and magnitude of the issues we have highlighted.”

It added: “Due to the severity of risk posed to service users under SIM, we consider a centrally coordinated investigation of urgent importance.”

It also repeated its call for NHS England to “halt the rollout and delivery of SIM with immediate effect”.

The National Survivor User Network (NSUN), which has backed the coalition’s campaign, welcomed the statements by NHS England and other bodies in response to the campaigning by the coalition.

But NSUN said there were questions over how the SIM schemes had been commissioned, and allowed to spread across the NHS in England, and who was responsible for these decisions.

Akiko Hart, NSUN’s chief executive, said: “SIM did not appear in a vacuum.

“Its adoption and scaling point to lazy and opaque commissioning processes, a focus on what is useful for services instead of what might be helpful for service-users and patients, and a normalisation of toxic cultures which harm and neglect people in distress seeking support.”

In his letter, Kendall points to concerns raised by the coalition about how SIM schemes involve police officers in the case management of people with complex mental health needs, the lack of research data on the impact of the scheme on patients, and whether SIM breaches treatment guidelines for personality disorder and self-harm care.

He also tells mental health trusts that concerns have been raised about the legal basis for sharing patient records under the scheme, and “the human rights and equalities implications” of the SIM approach.

He says in the letter that he is asking trusts to review their use of SIM “in light of the lack of evidence base for the interventions provided by this model and the concerns raised by patient groups about how it is being implemented”.

In a letter sent this week to the StopSIM coalition, Claire Murdoch, NHS England’s national mental health director, says trusts are being asked to examine whether the scheme breaches guidelines for personality disorder and self-harm care, and if it compromises “patient safety or human rights”.

She says in the letter that NHS England guidance states that such services “must have a compassionate, trauma-informed ethos and reject punitive approaches to care” and should be co-produced with people with a diagnosis of personality disorder.

Last month, Disability News Service (DNS) reported how the organisation that supports SIM schemes – the High Intensity Network (HIN) – said it was already working with 23 of 57 mental health trusts in England.

Paul Jennings, HIN’s director and the founder of SIM and himself a former police officer with experience of using mental health services, admitted to DNS last month that there was a need for an independent review of the programme.

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