The High Intensity Network (HIN) and associated ‘Serenity Integrated Mentoring’ (SIM) model of care has been increasingly widely promoted by NHS England since 2016. According to HIN’s website, the issue that the SIM model seeks to address is the “intensive demand on police, ambulance, A&E departments, and mental health crisis teams” from “a small number of ‘high-intensity users’ who struggle with complex trauma and behavioural disorders”. This group of service users are people who have not committed a crime but are frequently at high risk of suicide and self-harm.
In response, the HIN/SIM model promotes an intensified form of multi-agency working between the police, and emergency and NHS mental health services. This involves joint working between mental health professionals and police officers, with police access to medical records and involvement in planning and multi-professional intervention with this group of service users. As critics of HIN/SIM have noted, this involves a “blurring of boundaries between therapeutic (health services) responses and coercive (police service) responses”. Furthermore, many of the intervention strategies promoted within HIN/SIM involve punitive behavioural approaches that may intensify harms and distress for those with histories of complex trauma.
In response the #StopSIM Coalition, a campaigning network of mental health service users and allies, has formed to challenge the HIN/SIM model. The Coalition has identified and highlighted a range of significant issues including:
- Human rights concerns, in particular SIM strategies that may legitimise withholding of potentially lifesaving treatment from service users by agencies including A&E, mental health, ambulance and police services.
- Lack of meaningful service user involvement in the design, monitoring and implementation of HIN/SIM.
- Data protection concerns with regard to police access to service users’ medical records.
The Social Work Action Network (SWAN) shares the significant concerns about HIN/SIM raised by the #StopSIM Coalition and outlined above. SWAN fully supports the aims of the #StopSIM Coalition which are to:
- Halt the rollout and delivery of SIM with immediate effect, as well as interventions operating under a different name, which are associated with HIN.
- Conduct an independent review and evaluation of SIM in regards to its evidence base, safety, legality, ethics, governance and acceptability to service users.
For SWAN, initiatives such as HIN/SIM represent a top-down ‘fix’ to reduce user demand on mental health and other services in the context of over a decade of swingeing austerity cuts that have severely restricted availability of and access to what remains of supportive forms of mental health provision. We argue that what is needed are not increasingly coercive interventions and gatekeeping of limited services, but significant investment in community-based and user-led forms of social and therapeutic support to address the needs of those experiencing distress related to histories of trauma (and any other form of mental distress).
For more information and to support the #StopSIM Coalition: stopsim.co.uk
Social Work Action Network (SWAN) Steering Committee
24th May 2021