Police involvement in mental health teams must end, NHS says

The SIM model has been heavily criticised for its approach to mentally vulnerable patients

15th March 2023 about a 4 minute read
“Serious concerns have been raised highlighting that this may result in the potential withholding of life-saving treatment to people in crisis and that the model has not been sufficiently evaluated.” Lucy Schonegevel, associate director for policy and practice, Rethink Mental Illness

The controversial serenity integrating mentoring (SIM) should no longer be used in NHS mental health services, NHS England has said.

A letter from NHS England’s national clinical director for mental health, Prof Tim Kendall, said that use of the model, which embeds police officers in clinical teams, must end.

Kendall’s letter cites three elements of the model in particular that he wants to stop:

  • Police involvement in the delivery of therapeutic interventions in planned, non-emergency, community mental health care
  • The use of sanctions (criminal or otherwise), withholding care and otherwise punitive approaches
  • Discriminatory practices and attitudes towards patients who express self-harm behaviours, suicidality and/or those who are deemed “high intensity users”

In July 2021, Kendall wrote to NHS mental health trusts to commission local reviews of SIM. The decision to end SIM follows a review of all the material submitted.

In the letter, Kendall says he is grateful to the campaigning coalition StopSIM for highlighting concerns about the model and for “giving these concerns a platform via their campaign and also for the time they have put into assessing the model and making constructive proposals for change.”

Kendall adds that the work of StopSIM and the subsequent review “has taught us valuable lessons about the vital importance of engagement with lived experience in the design, delivery and evaluation of service models at national and local level, and the risks involved if this is overlooked.”

The SIM scheme has been in operation across the country for six years. It involves putting police officers into health teams to help manage patients who repeatedly call emergency services.

Model not ‘sufficiently evaluated’

Critics say that it has involved instructing A&E, ambulance, mental health services and police not to respond to calls from these patients because doing so would reinforce high-risk behaviour. Those campaigning against SIM include the Centre for Mental Health and Rethink Mental Illness.

Lucy Schonegevel, the associate director for policy and practice at Rethink Mental Illness, told the Guardian: “Serious concerns have been raised highlighting that this may result in the potential withholding of life-saving treatment to people in crisis and that the model has not been sufficiently evaluated.”

Responding to the letter from Kendall, StopSIM said: “Over the past 15 months, we have worked with NHS England, as well as a range of other stakeholders, to produce a rigorous and detailed policy that supports many of the concerns highlighted by service users and activists during the StopSIM campaign.”

Although NHS England has worked with StopSIM to write a report on the impact of the SIM model, it has decided not to publish it. Andy Bell, the interim chief executive for the Centre for Mental Health, said: “I am deeply disappointed that the full report that was co-produced with the StopSIM coalition will not be published; we strongly call on NHS England to publish that document honouring the co-production that went into it.”

Kendall’s letter states: “NHS England will continue to review the key principles for ensuring people in crisis get the right support at the right time as we agree a framework for joint working between police and mental health services over coming months. Ongoing engagement with people with lived experience will be critical as we do this work, alongside government and policing partners.”

The letter adds that NHS England will engage with the “small minority of trusts” using any of the three elements causing concern to make sure they are eradicated and that “work is underway to engage with experts by experience locally to co-design alternative services.” It will also work to make sure that “patients who have previously been under SIM or similar services now receive a care review to make sure that they are receiving care in line with NICE recommendations relevant to their condition(s)”.

Bell said: “The important thing in many ways is that SIM and everything similar is no longer part of mental health practice – it’s crucial that in every part of the country that support for all people in acute distress is safe, compassionate and effective.”

FCC Insight

We welcome this decision by NHS England. The StopSIM coalition has done valuable work in highlighting the dangers of the model, which has risked harming those experiencing severe mental illness, and we are pleased to see that NHS England has taken those concerns seriously. We hope that all mental health trusts will adopt a patient-centred model that prioritises providing compassionate care for those in mental health crisis.