Over the last couple of weeks, service users, survivors, people with lived experience of mental distress and allies have been working hard to draw attention to the rollout across NHS Trusts of the High Intensity Network’s (HIN) intervention, “Serenity Integrated Mentoring” (SIM), a programme for what they term “High Intensity Users” (most of whom have a label of a ‘Personality Disorder’) of crisis and emergency healthcare services. The programme is framed around reducing demand on services and cutting costs, and involves the police as interventionists in crisis care.
There is no sound evidence base for the intervention, little oversight of service user outcomes not relating to cost, demand and staff time, and no involvement of service users or ‘experts by experience’ in the development of the model or feedback on experiences of being under it. Police presence in crisis care reinforces the criminalisation of distress, and uses the threat of punitive legal action to coerce people into no longer “demonstrating intensive patterns of demand” rather than acknowledging and addressing underlying issues, unmet need, and the need for compassionate responses to mental health crises. Knowing that forced police contact may now be a part of the response you receive if you “repeatedly” reach out for help when deeply distressed presents another barrier to seeking support, 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.
So far the Coalition has released an initial Consensus Statement, which you can read below, and a specific Coalition Statement regarding the evidence base for HIN/SIM, which you can read on their website (you can also sign up to the mailing list via this website). You can find the Twitter page here and the Instagram page here.
StopSIM Coalition Consensus Statement relating to The High Intensity Network (HIN) and Serenity Integrating Mentoring (SIM), 21/04/21
“We are a coalition of mental health service users and allies who have grave concerns about the rapid, widespread rollout of the High Intensity Network’s ‘Serenity Integrated Mentoring’ (SIM) intervention across NHS England. The intervention is designed for people who have not committed a crime, but are in contact with mental health services, are frequently at high risk of suicide and self harm and are deemed “high intensity users” of emergency services. Key intervention components include a co-ordinated withholding of potentially life saving treatment by multiple agencies (A&E, mental health, ambulance and police services) and, using SIM’s own words, the “coercive” approach of a police officer as an interventionist.
We call on NHS England to:
- Halt the rollout and delivery of SIM with immediate effect, as well as interventions operating under a different name, which are associated with the High Intensity Network (HIN).
- Conduct an independent review and evaluation of SIM in regards to its evidence base, safety, legality, ethics, governance and acceptability to service users.
- Respond to this statement within 7 days to communicate the actions taken by NHS England. Communications should be directed to email@example.com.
Our concerns about SIM relate to its evidence, legality (including GDPR, Human Rights and Safeguarding), aims, governance and ethics. Interventions or service models operating using SIM principles may be known by alternative names, however, for brevity, this statement equally applies to those services, interventions and models.
This is a preliminary consensus statement. We have been researching SIM and the HIN for a number of weeks in preparation for the release of a detailed and referenced statement. However, we are releasing this brief statement since becoming aware that, due to the hard and concerted effort of service users, survivors and allies over many weeks – and in some instances, years – that high level conversations have been prompted. We felt it was critical to make our position public as soon as possible. A longer version of this statement, with citations, is shortly forthcoming.
We expect to be involved in any high level conversations concerning the High Intensity Network and SIM as a coalition of service users and allies. We can be contacted by email at firstname.lastname@example.org or via Twitter DM: @StopSIMMH. We will be publishing further updates on our Twitter account.
In solidarity with survivors, service users and allies who have worked tirelessly to shine a light on injustice,
The #StopSim Coalition
Sir Simon Stevens, CEO – NHS England Lord David Prior, Chair – NHS England, Claire Murdoch, National Mental Health Director – NHS England, Martin Hewitt, Chair – National Police Chiefs’ Council, Sir Tom Winsor, Her Majesty’s Inspectorate of Constabulary and Fire and Rescue Service.”