Barry Gale

Yes I would agree with MOST of that Steve. What I don't agree with is the importance of the claim that "SIM promotes the withholding of potentially life-saving treatment." As proof of this claim StopSIM and its supporters point to a single passage which plainly says that the co-produced crisis response plan (CRP) gives ED staff the confidence to refuse to do blood tests, x-rays etc at the demand of the HIU which the ED staff suspect are not needed. This confidence comes from the fact that the behaviour observed has been predicted in the CRP and the HIU has pre-authorised the ED staff to withhold such tests if the circumstances match. What StopSIM supporters do is to ring fence a specific block of this text, which they interpret in isolation (ie out of context) as SIM either ordering or authorising the ED staff to refuse to treat someone who clearly requires it and may 'potentially' die without it. However, the sentences immediately adjacent (which are deliberately excluded from the highlight) make it abundantly clear that this is NOT the case. The treatment is NOT needed to save life, and the patient was co-producer of the authorisation (ie the CRP). The interpretation given by StopSIM supporters, that ED staff are looking for the slightest excuse to refuse to give life-saving treatment to someone who clearly needs it, just because that person is mentally ill and vexatious and the injury might have been deliberately self-inflicted, is manifestly preposterous. (I have heard of malicious ED staff refusing to stitch a self-inflicted cut - WITHOUT any authorisation from a SIM team! - but nothing anywhere near life-threatening.) They would lay themselves open to prosecution for criminal negligence if they did what StopSIM is suggesting. Even if the authorisation came from the CE of the NHS, this would provide no defence in court because the immediate circumstances, and the patient's right to life (ECHR Article 2), would emphatically over-ride it. Otherwise, I agree with everything you say about the failings of our beloved NHS - for which SIM cannot be blamed. I don't think SIM is perfect, either as intended or as implemented. But I do think it was well-intentioned, and it has been unjustly maligned by people who had an ax to grind and others who jumped on the bandwagon to avoid being unpopular and/or to divert attention away from their own harmful practices (eg Royal College of Psychiatrists).

I have no experience of HIN/SIM other than what I've read, which is the ideal version rather than what is implemented. I am a former carer with no professional training. My comments on the above : A, Such a multi-agency panel does not look out of place to me. As I understand, the MAP is not creating your HIN care plan then retrospectively inviting you to "co-produce" it. It is merely deciding who, from among those who have been nominated, to offer the HIN/SIM service to - ie do you meet the threshold criteria? could you benefit from it? They don't need to interview all candidates, only those short-listed, so to speak. The 'individualised crisis response plan' is then produced with you if you agree, or without you if you refuse - because it is better to have an imperfect crisis response plan than none at all. B. The essential nature of policing IS coercion. As I wrote above, the police have a duty to uphold the law - to encourage people to obey the law, especially to warn those who are on a course of action which will result in them breaking the law. Therefore it is entirely appropriate (and refreshingly honest) for them to describe their function as "coercive," In a SIM programme the police are not offering to provide mental health care or 'treatment' (which is what StopSIM claims that SIM is doing), they are offering to show you how to make better decisions so that you can avoid committing a crime and being prosecuted. (If a financial adviser gave a mentally ill person advice about managing their finances better, would they be providing mental health care or treatment?) C. I don't see where you are getting the quote from. It doesn't appear on these slides. No I don't find this statement chilling. Nor is it necessary to interpret it as you have done, as being concerned solely about the place of death. You are imposing your own meaning onto words which do not justify it. It a fact that people suffering mental distress react badly to being arrested and locked up in a police cell, and may commit suicide as a result. It is entirely appropriate to want to minimise such deaths by reducing the numbers of people taken to a police cell, which is achieved by reducing the behaviours which lead to the arrest. D. You appear to be attributing this quote to HIN/SIM. However the slide attributes it to an unidentified mental health manager during an informal discussion at a conference. It is not stated whether this person has any connection with HIN/SIM. Just because someone quotes what someone else said does not mean that they endorse the statement or the language used. (The response is clearly being used as a selling point to other managers.) The anomaly of the phrase 'accidental suicide' is already noted on the slide by placing it in quotation marks. The writer is aware this is an oxymoron. E. Yes it would be good to see the document you are paraphrasing here. Or that for any of the "loads" of example you mention. It does seem anomalous that a programme that makes a significant claim about its effectiveness would immediately after it make another statement which disproves the claim. Either the writer was utterly stupid, or the note has been misunderstood in some way. F. If the only problem with HIN/SIM is the language or the use of data, then I don't understand why there is an urgent need for scrutiny and regulation. Such "concerns" justify a Public Inquiry according to StopSIM. Are these "concerns" actually causing mental or physical or financial harm to anyone? Or is it all a "storm in a teacup"? Incidentally, StopSIM does not balk at saying things which are not true. EG claiming that SIM promotes the withholding of potentially life-saving care, and criminalises people for experiencing mental distress. G. Having previously praised "excellent care co-ordination" in MARMAP, which included Gloucestershire Police, it now seems inconsistent that you criticise police involvement through SIM. The tragic deaths of Olaseni Lewis in London and Sheku Bayoh in Scotland, and the more recent case of the 17 year old learning-disabled girl who was hit 30 times with a baton then tasered, all suggest that the police need a better understanding of and a better response to mental crises, rather than to be sidelined as you appear to be suggesting.

More allegations. Still no investigation. The title is misleading, making it appear that HIN has been shut down by powers above. But there is no evidence of it having been found guilty of anything. The text suggests that it is voluntarily shutting down, probably because of the hostility not only from StopSIM but also from professional organisations like RCP. The statement gives the impression that any review or investigation is a foregone conclusion, and that RCP members played a key role in unearthing this public scandal. Hypocrisy and opportunism.

Yes it would be more helpful if HIN directors were willing to engage in discussion. However from my own experience on twitter and facebook I can understand their decision not to do so. When people are attacking you via social media as StopSIM is attacking HIN/SIM then defending yourself is not wise. The more you defend yourself, the more belligerent your critics become. If you don't want to apologise unreservedly, then it is best for all if you just keep quiet and disengage. In my own unwise encounters I continued defending myself, resulting in abuse, accusations that I was really Paul Jennings(!), and being blocked so that others in the thread could continue bad-mouthing me behind my back. Paul Jennings answered questions from the Association of Clinical Psychologists (ACP-UK) which nevertheless retained "significant concerns" about issues which were not thoroughly explored in the interview. I asked ACP whether any of its concerns pre-dated contact with it from StopSIM - to date it has not replied. If a professional organisation like ACP cannot acknowledge that Sgt Jennings' answers have adequately countered most of its concerns, and that those concerns did not exist prior to contact from the popular SU-led campaign StopSIM, then it is not surprising that he is reluctant to engage more widely. https://acpuk.org.uk/rapid-response-concerns-about-the-high-intensity-network-hin-and-serenity-integrated-mentoring-sim-2/

Yes we do need open and honest discussion about what SIM/HIN actually does, rather than a heavily publicised attack consisting mostly of 'concerns' about what it 'might' be doing, some of which border on being malicious and libellous. The hostility of the attack against HIN - with many professional organisations also now distancing themselves from it and expressing new-found 'concerns' which never bothered them before - has resulted in the HIN directors avoiding engagement and taking their website offline. Hostility and deliberate misrepresentation does not provide an environment in which there can be 'open and honest discussion'. It is one thing to investigate formal complaints by those who have experienced SIM or its variants first hand, and another to address 'concerns' expressed by people with no experience of SIM who (like you) are alarmed by the allegations they are reading. The former requires a formal, independent investigation and possibly suspension of all SIM-related activities pending official approval (which is what StopSIM appears to be asking for - the clue is in the name), while the latter could be satisfied by a press conference. The latter can be service-user led, but the former needs to be led by people who are unbiased by any personal or popular views, have the confidence of the public and the authority to compel the answers and information requested, who know their way around the system, know what they are looking for and what is reasonable practice within the NHS or the Police Service. In answer to your concerns : 1. SIM arose out of concern about impact on services rather than concern about the welfare of individual service users. It was not devised as a form of therapy but as a strategy to reduce the detrimental impact which some service users are having on emergency services. It is not a replacement for the Assertive Outreach Nurse. Like 'street triage' the prime objective is to improve the effective use of resources rather than to improve the choice. satisfaction and ultimate well-being of service users. As such I don't think it needs to be 'patient-led' nor 'patient-focussed' - although I expect it can benefit from feedback provided by current or potential users of its own service. Nevertheless to my understanding SIM does aim to benefit both services and service users by taking a pro-active approach towards potentially criminal behaviour. It aims to influence the service user (yes using some measure of 'coercion' by warning about potential consequences of continued anti-social behaviour) to form better habits of self management, and engage with the appropriate chronic services on offer, rather than seek help from acute services which cannot provide what the SU needs. (There is a question here of whether they have been offered suitable chronic services.) The police and criminal justice systems have a duty to protect society against individuals (whether or not their behaviour can be excused by mental illness), rather than to do what is best for the individual offender. 2. It seems to me that the nature of the incidents - potentially criminal but possibly excusable by mental illness - means that both mental health and police services must necessarily be involved, The involvement of the police in mental health is inherent in the Mental Health Act 1983, eg by virtue of s 136. If someone is causing a public disturbance by threatening to jump from a motorway or railway bridge, or is repeatedly calling for an ambulance when one is not needed, or has reported their spouse for domestic abuse when none has taken place, or is being threatening and abusive at an A&E department, then it is the police who are qualified to respond to such situations. They are obliged to investigate, to warn about potential consequences if the offence is repeated, direct the person to appropriate support or advice, and as a last resort to consider prosecution (if the circumstances would normally warrant it) regardless of the person having a diagnosis of mental illness. It is not for them to judge that mental illness is an adequate defence, that is for the CPS or the courts to decide in all the circumstances. On the other hand SIM does give the service user the option of co-creating a crisis response plan tailored to their own needs. Doesn't that meet your requirement of being 'patient-focussed' with the service user choosing how they would like to be treated? 3. It also seems to me that the serious nature of the above incidents usually does justify data sharing, without consent, arising from a duty to protect not only the service user but also the public, the people who provide services, and the service-resources. Data is routinely shared with the police and other services in Adult and Child Protection Case Conferences, which are somewhat similar. These take place merely because of 'concerns' whether or not the Vulnerable Adult or Child wants 'protection'. As the 'suspected abuser' in an APCC, I was shocked at how readily information which I had provided in confidence (along with rumours and 'concerns') was shared behind my back and subsequently discussed at Conferences from which I and my mother (the presumed victim) were excluded. To the extent that I felt completely isolated and victimised myself, and powerless to 'stop' a chain of events which resulted in my elderly mother's death 3 years later, after being later locked up in hospital for 2 years. So if you want to complain about data sharing without consent, and harmful services which operate on the basis of what they think is best for you rather than how you would like your own life to turn out, then I suggest that you really ought to compare what happens across Health & Social Care Partnerships, and in the Forensic Mental Health and Criminal Justice Systems, and not focus exclusively on small fry like SIM. As though that is the only source of evil in society.

I have engaged in several discussions on twitter and facebook with supporters of StopSIM and with the person who appears to be the spokesperson (LD) for the StopSIM Coalition (which is anonymous). While there is some valid criticism of the lack of genuine co-production with service users in the development of the programme, and lack of independent evaluation of the programme (which I think cannot be blamed on HIN), the most alarming criticisms such as "withholding potentially life-saving treatment" and the "coercive" nature of the programme appear to be blatant misrepresentations. The very tagliine of StopSIM ("Mental illness is not a crime") is itself a blatant misrepresentation, chosen to stir up opposition to SIM, because mental illness is not stated to be a crime anywhere in the SIM/HIN source documents. (I suggest that the real issues is whether having a mental illness absolves a person completely from responsibility for their own actions - which raises the question of what kind of 'legal equality' can exist between those with and those without a mental disability under the UNCRPD.) Although many service users are raising concerns about SIM, they are basing their concerns on their own negative experience of contact with the police outside of any SIM programme, or on newspaper reports of people being convicted for their anti-social behaviour presumably resulting from mental illness. It is such bad experiences and convictions which the SIM programme aims to reduce (among other goals) by co-producing crisis response plans with the service user (as outlined in your blog) and by training police officers to respond more knowledgeably to those in mental health crises. I have not yet encountered anyone who is or was mentored in a SIM or related programme. One AMHP told me about a service user she knows well who is on a local SIM programme and is very satisfied with her experience of it. The spokesperson LD refuses to confirm whether the Coalition has made any contact with current or former mentees of the programme - refuses even to provide a number of mentees who have given evidence to the Coalition - on the excuse that the disclosure of this number will somehow jeopardise the privacy or safety of those who might (or might not) have complained to the Coalition. Ruth Hunt in her article in the Morning Star claims to have had contact with 2 verified mentees ('Jan' and 'Ali') but in view of LD's refusal to confirm contact with any mentees, I am somewhat sceptical about this. The majority of professional organisations echo the concerns raised by StopSIM although they have not expressed any concerns over the years until StopSIM gained popularity. They are often 'appalled' by the 'insensitive' terminology used by HIN/SIM (such as "attention-seeking") and by candid comments apparently from SIM mentors (such as "I dislike her less now") and by the behavioural model behind the programme (has behaviourism been totally discredited?). ... So my view is that the programme appears to be a positive step forward and is not "unsafe" as claimed. Undoubtedly independent evaluation is overdue (as the founders acknowledge and called for back in 2015) and far more attention could be given to feedback from actual mentees of the programme (rather than to 'concerns' raised by those with no experience of the programme). I was impressed by an early comment for a non-SIM service user : "... treatments that are demonstrably working & well liked by SUs should not be earmarked for closure using lack of research evidence as justification. When we all tell you its saving & changing our lives, don't employ an 'independent' firm to tell us we're wrong." ."