Police are still being used as part of “punitive, exclusionary and discriminatory” NHS schemes in England that criminalise mental distress, an 18-month investigation has found.
The Criminalising Distress report calls for an end to all such practices and the immediate removal of police from NHS mental health services.
The report, written by the global health charity Medact and supported by disabled activists, focuses on the “national scandal” of the Serenity Integrated Mentoring (SIM) scheme, which was only halted through a campaign by the StopSIM Coalition that exposed it as discriminatory, coercive and punitive.
The coalition’s campaign eventually persuaded NHS England (NHSE) to order local reviews by mental health trusts of how SIM had been implemented, and to admit it was wrong to endorse SIM without applying “sufficient scrutiny” and accept that this had harmed service-users.
Former members of the StopSIM coalition of service-users and allies acted as a steering committee for the Criminalising Distress project.
Hat, one of those former StopSIM members, and a survivor, researcher, activist and artist, told an online launch of the report that the coalition had eventually been forced to disband to prioritize their own health.
The coalition had worked with NHSE for 15 months on a new policy statement, only for NHSE to renege last year on a promise to publish it, and refuse to apologise or commit to change.
Hat said the hardest part of the decision to disband “was knowing that the fight to end SIM and the harmful and abusive systems and structures which allowed it to spread continued so widely, and knowing that the fight to eradicate all of that needed to continue”.
But they said that, despite StopSIM being disbanded, the survivor activism against SIM-like schemes continued.
Hat said that even though an apology would not have rectified “the real harms that continue to happen, it still felt like a huge injustice that that was never recognized, along with anyone taking accountability and responsibility for the failure and the harms”.
They also spoke about Oxevision, the system used to monitor mental health inpatients in their own bedrooms through a camera and infra-red sensor, which campaigners have described as “intrusive and dehumanizing and retraumatizing”.
They told the meeting: “We’ve spoken to people who’ve spent entire admissions sleeping on the bathroom floor, in communal areas, in the garden, just anywhere to avoid the camera.”
Hat said that Oxevision and similar surveillance systems were “being used to punish and criminalise patients”.
They pointed to similarities to SIM, with “patients and survivors” being left to “do the jobs of lawyers and detectives” and investigate what was happening, with a lack of accountability within the health system.
They said that services were “jumping on new technologies and ideas as if these can fill the gaps and failings that are created by a broken and chronically-underfunded system with deeply entrenched harms and violence”.
The SIM scheme focused on users of mental health services – often those at high risk of suicide and self-harm – who were seen as “high intensity users” of emergency services and a “troublesome burden on cash-strapped services”, with police officers embedded into community mental health teams.
But the Medact report exposes how the scheme grew and spread across England despite the false claims of its success made “aggressively” by its founder, police sergeant Paul Jennings.
The report concludes that, even though schemes named “SIM” have disappeared, there are “multiple” similar schemes that continue to criminalise distress, often led by the police.
These schemes are based on coercion and denial of potentially life-saving support, leaving some service-users to live in fear of arrest or even prosecution when in mental health crisis.
The report calls for an independent inquiry into ongoing SIM-like schemes, as well as a move towards a non-coercive, “robust and sustainable”, rights-based system of community support.
But it also says there is a need for interventions that “pre-empt crises occurring, by addressing the social determinants of mental health such as poverty, housing and employment”.
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.
NHSE, the NHS Innovation Accelerator, the Academic Health Science Network (now known as the Health Innovation Network) and the National Police Chiefs’ Council have all failed so far to apologise for the harm caused by SIM or the failures that led to its widespread introduction.
But the report also says that, due to the NHS culture of “blame-shifting and unaccountability, combined with its hierarchical leadership structures”, frontline staff who have spoken out against criminalisation have been punished, while there has been “no evidence of accountability” within the police.
The report also says that the NHS Innovation Accelerator has continued to push “dubious” new schemes such as Oxevision.
Research by the grassroots campaign group Stop Oxevision has confirmed that the technology is “regularly used without patients’ consent or sometimes even knowledge”, the report says.
Dr Jay Watts, a disabled activist and consultant clinical psychologist, told the report’s online launch that people she had spoken to who had been on SIM had experienced a “neglect of care” and then “kind of get attacked” and become a “scapegoat”.
She said there was “a lack of complex trauma knowledge, a lack of therapy, a lack of all the things that we know are affecting this group”, and they are viewed by the NHS as “a kind of a sucker of resources, in some dreadful way, who need to be punished”.
She said it was vital that those in need of support know they are “worthy of decent, really good care, and that’s so important to say when the system is still against you”.
And she said it was vital people looked after themselves and also “use our social power, whatever it might be”.
The Medact report concludes that SIM “was an example of a wider problem”.
It says: “Lack of compassion, failure to respect confidentiality, coercive practices, exclusion, denial of care, criminalisation and outright abuse are all far too common.
“Nor can we hope to truly eradicate SIM-like practices while the NHS’s culture of blame-shifting and unaccountability at the top remains intact and whistleblowing frontline staff continue to be punished.
“This same culture meant that the medical establishment waved through SIM, and it was left to people with lived experience of prior harm and injustice in the mental health system to challenge the programme.”
Patients, it says, “continue to be criminalised, neglected and used as scapegoats for a grossly inadequate system in need of radical overhaul”.
Dr Hil Aked, research and policy manager at Medact and lead author of the report, said: “The continuation and rebranding of SIM under different names shows that accountability for this harmful set of practices is still being evaded.
“The government, NHS England and individual NHS trusts must recognise that people in mental distress deserve care and compassion, and should never be punished for being unwell.”
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