NHS trusts are still using harmful mental health practices, secret reviews show

Reviews carried out by NHS trusts across England into a mental health scheme branded unethical, unlawful and unsafe raised multiple concerns about its use, documents obtained by Disability News Service (DNS) have revealed.

The reviews also show that many of the trusts have continued with practices that campaigners have described as “harmful” and “inappropriate”.

The reviews were ordered last year after mounting concerns raised by disabled campaigners and allies about the use of the Serenity Integrated Mentoring (SIM) system, and its rollout across the NHS in England, despite the lack of quality research into its impact on service-users.

It appears that SIM was implemented in almost half of the mental health trusts across England.

The reviews suggest that although most – if not all – SIM schemes have now been abandoned, similar programmes are still widespread across NHS England.

Campaigning by the StopSIM coalition led to NHS England’s national clinical director for mental health, Tim Kendall, writing to mental health trusts last year to call on them to review their use of the SIM scheme.

Although those reviews appear to have been completed last autumn, NHS England (NHSE) repeatedly ignored attempts by DNS to obtain them under freedom of information laws.

NHSE has now finally released the reviews to DNS, and they reveal how many trusts appear to have accepted that the SIM system was flawed.

Several of the reviews suggest that many trusts accepted that the way SIM used police officers was inappropriate, and that procedures for ensuring patients’ consent to share their information among agencies was flawed.

But StopSIM is concerned that the changes made by trusts after the reviews “do not go nearly far enough”.

The coalition had described SIM last year as an “unacceptable step backwards in disability justice” which effectively criminalised mental distress.

It said that SIM and SIM-type schemes put pressure on users of mental health services – often those at high risk of suicide and self-harm – who had not committed a crime but were seen as “high intensity users” of emergency services.

Despite being at very high risk of self-harm or suicide, individuals under SIM could be prevented from accessing potentially life-saving treatment from ambulance services, accident and emergency departments, mental health crisis services, community mental health teams and the police.

SIM also gave police officers a key role in making clinical decisions when service-users were in crisis, and – said the coalition – was “heavily reliant” on their “coercive” powers to enforce “behavioural management”.

Most of the SIM schemes – and possibly all of them – have now been closed, according to the reviews, but it appears that many trusts have altered aspects of how they operated, before relaunching them under new names.

A StopSIM spokesperson said: “Although a number of trusts stated that they were making changes to the SIM model, such as changing the name and branding, in most areas these changes do not go nearly far enough.

“The majority of these trusts intend to continue with key harmful practices associated with SIM, including the inappropriate involvement of police in routine community mental health care, behavioural contracts and the use of sanctions for patients who self-harm or engage in suicidal behaviour.”

Many trusts tried to justify some of the controversial aspects of SIM and SIM-type schemes in their reviews.

One, in response to an NHSE question about whether the trust sought to “reduce use of care” through sanctions, appeared to accept that it had adopted a “conditional” approach to care, which “could be perceived” by service-users as “coercive”.

Another review by a trust spoke of changing the name of its scheme “because the SIM branding is harmful to patient perception of the model and to the organisations involved”.

Several schemes admitted that police officers were providing mental health support to service-users, with one stating that although officers do not “undertake scheduled healthcare… they are involved in ongoing support/discussions” with service-users.

Another review admitted that, although police officers were not “specifically involved in the Mental Care of the patient… it could be said that at times there was a blurring of roles”.

One trust from the north of England described how it turned down funding offered by NHSE to take part in the SIM scheme “due to concerns we had, along with our Police partners around the ethos and governance of the project”, and that “we did not want to involve the Police in anyone’s care and treatment unnecessarily”.

A trust in the north-west stated that it “did not implement the SIM model due to concerns raised by our police partners”.

And another review described how a meeting between two trusts had concluded that “the SIM approach and guidance about patient consent not being needed for information sharing between partner organisations… was flawed and was not an acceptable way forward”.

One email released by NHSE, from the London region’s mental health team at NHSE and NHS Improvement, spoke of the “lack of evidence” for the SIM approach.

One review from three London mental health trusts made a series of recommendations for future multi-agency working, including ensuring that any future schemes “should be co-produced with service user and carer representatives”, and stressing the need for “transparent processes for discussing, recording and reviewing the consent of the patient to share information”.

The reviews also include a paper from Isle of Wight NHS Trust, where the original SIM model was developed in 2015 but then abandoned in 2017 following concerns from Hampshire police “about the way some of the data had been recorded, and its accuracy”.

The trust stressed in its paper that its current arrangements “do not follow the SIM model, and do not include any of the features of SIM that have raised concerns”.

An NHSE spokesperson told DNS this week that any approach “that seeks to punish, coerce, or withhold care from patients who are experiencing distress is deeply unethical”.

He said: “The NHS is grateful to StopSIM coalition for highlighting these concerns and the full response will be published in the coming weeks, following significant input from a range of stakeholders.”

A StopSIM spokesperson added: “The disparity in feedback from trusts demonstrates the need for a national position to put an end to these coercive and punitive practices, and remind trusts of their responsibilities in line with the NHS constitution, NICE* guidelines and existing equality and human rights legislation.

“We hope our forthcoming position statement with NHS England will put an end to these practices and ensure that patients who have been, or still are being, harmed by SIM receive appropriate care.

“We are also working with regulatory and professional bodies to create this position statement, to ensure that SIM and the practices associated with this model do not re-emerge in the future.”

*National Institute for Health and Care Excellence

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