Published on 21 August 2022
Internal documents reveal misgivings about the scheme within health trusts
Reports Jack Barton, for Liberty Investigates, and Mark Townsend, Home Affairs Editor at the Observer. Edited by Eleanor Rose, Liberty Investigates editor.
Police forces and healthcare providers in different parts of the country are using or planning to resurrect a deeply controversial programme that critics say denies medical care to people having mental health crises.
The plans are detailed in documents obtained by the Observer and Liberty Investigates, and come a year after the private firm running the programme took down its website following outcry from campaigners.
The Serenity Integrated Mentoring (SIM) scheme, which sees police embedded in clinical teams to help manage patients who persistently call emergency services, was designed by former police officer Paul Jennings, a fellow on NHS England’s National Innovation Accelerator (NIA) from 2017 to 2020.
His firm, the High Intensity Network (HIN), claimed sending emergency services to respond to repeated calls from people in crisis “positively reinforce[s]” high-risk behaviour.
SIM began expanding across the UK five years ago with response plans drawn up for particular patients and shared with emergency services.
Critics say these plans instructed A&E, ambulance, mental health services and police not to treat these people, many of whom they claim are at high risk of self-harm.
Documents, released under information laws and seen by the Observer and Liberty Investigates show HIN told the NIA the scheme could save up to £80 million over three years by tackling “particularly high users of health care and police time”.
£80m
The amount of money the NHS's National Innovation Accelerator (NIA) was told the scheme could save
According to HIN’s estimates, the firm coordinated more than 40 teams to manage the care of 500 patients before StopSIM – a group of patients and allies – published concerns last year about the rollout, which had apparently taken place without the knowledge of Tim Kendall, NHS England’s national clinical director for mental health.
In response, Kendall wrote last In May 2021 that SIM appeared to have “no evidence base”. He asked NHS mental health trusts to submit reviews of the service, and HIN appears to have taken its website down.
Kendall’s report has not yet been published, but responses to his review – obtained by FOI – reveal misgivings about the scheme within trusts. One noted it “seemed to be focused on money saved or staff hours saved,” and there was “no reasonable way to defend SIM/HIN”.
Newly released documents show the scheme is still being used. In response to FOI requests, three trusts and four police forces said they still had patients on SIM.
One, Devon Partnership Trust, revealed it was still piloting SIM this year, and has several patients on it. South West Yorkshire Trust confirmed it had moved its SIM patients onto a new programme which also sees police officers accompany mental health practitioners to visit patients, though a spokesperson said the model differed from SIM and is based on consent and patient feedback.
Gloucestershire NHS Trust said it had stopped using SIM, but invested in a Complex Emotional Needs service which, a spokesperson said, “brings together health, police and voluntary care services and has supported people to realise positive change in their quality of life”.
Doncaster, Rotherham and South Humber Foundation Trust said in response to a FOI request that its SIM programme would be “rebranded”. When approached for comment, however, a spokesperson said SIM had been replaced with a new service that “differs significantly from SIM”.
They said the scheme took a trauma-informed approach while police involvement was to help communication between teams, not contribute to care plans.
“NHS trusts must consider and respond to people’s concerns – this does not equate to simply relaunching SIM under a different guise”
Campaigners raised concerns. Alexa Knight, associate director for policy and practice at Rethink Mental Illness, said the continued use of SIM and SIM-like schemes “flies in the face of the legitimate concerns of campaigners with lived experience who raised the alarm on the serious flaws of this programme, which risks denying people access to life-saving treatment”.
“Now we need assurances that mental health trusts have stopped using SIM or will do so urgently,” said Knight, “NHS trusts must consider and respond to people’s concerns – this does not equate to simply relaunching SIM under a different guise.”
The StopSIM campaign told the Observer and Liberty Investigates they are working with NHS England on a policy designed to ensure key concerns about denial of treatment are addressed. They plan to publish in the coming weeks.
Kendall, NHS England’s national clinical director for mental health, said: “Any approach that seeks to punish, coerce, or withhold care from patients who are experiencing distress is deeply unethical.
“The NHS is grateful to StopSIM coalition for highlighting these concerns which we immediately acted on – we will publish our full response to the campaign in the coming weeks.”
A version of this story was published by the Observer.