Post by Admin on Mar 20, 2023 21:38:13 GMT
StopSIM: Mental Illness Is Not A Crime
stopsim.co.uk/
We are a coalition of service users and allies campaigning for the High Intensity Network’s Serenity Integrated Mentoring (SIM) model to be halted immediately. We call on NHS England to publish the joint StopSIM national policy in full immediately. We believe that SIM is unlawful, unethical and unacceptable.
www.change.org/p/nhs-england-stopsim-halt-the-rollout-and-delivery-of-sim-and-conduct-an-independent-review
This petition was started by the StopSIM Coalition. We are a group of mental health service users, survivors and allies calling on NHS England to halt the development and rollout of ‘Serenity Integrated Mentoring’ (SIM), created by the ‘High Intensity Network (HIN), with immediate effect, and to conduct an independent review. We believe that SIM is an unacceptable step backwards in disability justice and has the effect of criminalising mental distress/illness.
SIM is a model of mental healthcare targeted towards some of the most mentally unwell individuals in our communities, who frequently come into contact with emergency services while in crisis. SIM refers to these individuals as “High Intensity Users” and claims that they place an “unnecessary financial burden” on the NHS.
Despite being at very high risk of self-harm or suicide, individuals under SIM have “crisis response plans” that prevent them from accessing potentially life-saving treatment from the usual places that people are able to seek support during a crisis. This includes: ambulance services, A&E, mental health crisis services, community mental health teams and the police.
Additionally, the SIM model is heavily reliant on the “coercive” powers of the police to enforce “behavioural responsibility” and “behavioural management” on “High Intensity Users”. “High Intensity Officers” are placed in mental health teams and have full access to the individual's medical records, with or without their consent. Messages such as: “We are responsible for the consequences of our actions and we need you to understand what the consequences of your actions will be if they continue” are “compassionately, but firmly reinforced over the course of several weeks/months.”
The focus of SIM is on reducing service demand (how frequently people come into contact with emergency services), not the patients’ well-being or experience. Indeed, we believe this program will have the effect of re-traumatising individuals. SIM does not use any outcome measures (data that measures the success of the programme) that are commonly used in community mental health services to assess changes in the individuals mental well-being.
We ask you to sign this petition, calling 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.
A full petition statement including references can be found on our website: www.stopsim.co.uk along with statements we have released about SIM. You can also follow @stopsimmh on Twitter and Instagram.
NSUN statement on NHSE’s failure to publish joint policy with StopSIM coalition
Posted on 20 March 2023
www.nsun.org.uk/news/nsun-statement-on-nhses-failure-to-publish-sim-policy/
The StopSIM coalition has been working with NHS England for 15 months on a joint policy around the Serenity Integrated Mentoring (SIM) model, and similar “high-intensity service use” models, setting out practices that must be eliminated in mental health care (and how this should be monitored) alongside an acknowledgment of and apology for the harm caused by the acceleration and endorsement of the SIM scheme.
On Friday 10th March, NHSE published a short letter to trusts instead of the full co-produced policy. We stand in solidarity with the coalition, who are now having to pause all activity for a minimum of a month due to the distress caused by NHSE’s decision not to publish the policy after months of intensive, unpaid labour, and fully support their call for NHSE to publish the joint policy in full immediately in the statement they released on Monday 13th March.
As the coalition say in their statement:
“We share in the anger, disappointment and fear that service users will feel following this announcement. NHS England’s failure to publish this policy is a significant betrayal of the seen and unseen labour put into the development of this work and the campaign against SIM more broadly…
We had hoped this work would signify changes in ways of working within NHS England and indicate the possibilities of future improvements in the involvement of lived experience groups within the institution. However, failure to publish the final policy sets a precedent for undervaluing lived experience contributions and failing to follow through on commitments, as well as demonstrating total disregard for the labour of lived experience involvement.”
Publishing this collaborative policy would have been a tangible step towards eradicating punitive practices and the criminalisation of distress in mental health care, as well as a demonstration that NHSE is willing to work in partnership with survivors and service users, and we are deeply disappointed by NHSE’s last-minute decision to backtrack on its publication. This betrayal further embeds distrust in “co-production” work within the mental health system which comes from decades of the co-option and erasure of survivor and service-user led work.
NSUN calls on NHS England to publish the full co-authored policy immediately. We agree with the coalition that “unless the full policy is published and the public are able to scrutinise how trusts respond, we do not believe that all trusts will make the necessary changes outlined above… Crucially, failure to publish leaves services users without access to a policy that could help protect them from SIM and SIM-like approaches, and without acknowledgement of the harm that’s been caused to them.”
StopSIM have asked that in their absence, allies such as health, medical, and academic professionals sign an open letter to NHSE which is currently being organised – you can add your name by contacting Fiona by Twitter DM or by signing via the letter itself when it is published shortly – we will add the link to this page when it is live.
Scheme putting police in mental health teams must end, says NHS England
Critics of SIM monitoring system have raised fears that high-risk people are not receiving the care they need
www.theguardian.com/society/2023/mar/14/scheme-police-mental-health-teams-must-end-nhs-england
A controversial mental health monitoring system, which embedded police officers in clinical teams, must no longer be used in mental health services, NHS England has said.
In a letter seen by the Guardian, NHS England’s national clinical director for mental health, Prof Tim Kendall, gave the instruction about the serenity integrated mentoring (SIM) scheme and similar models.
The scheme, which began expanding across the UK six years ago, puts police into health teams to help manage patients who repeatedly call emergency services.
Critics say the system involves instructing A&E, ambulance, mental health services and police not to respond to calls from these people in case it “positively reinforces” high-risk behaviour.
Medical bodies and campaigners including the Centre for Mental Health and Rethink Mental Illness have said there are concerns that people experiencing acute distress, who are at high risk of self-harm, have not been receiving the medical help they need.
Lucy Schonegevel, the associate director for policy and practice at Rethink Mental Illness, said: “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.”
NHS England has worked with the StopSIM coalition, a group campaigning to halt the use of SIM in the NHS, to produce a report on the effects of the system.
NHS England said it had no plans to publish the report, but StopSIM called for it to be published “in full immediately”.
The coalition 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.”
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.”
StopSIM has concerns that it is now down to the individual trusts and integrated care boards to end the use of SIM or other similar practices.
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.”
Kendall said in his letter: “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.”
He added: “Ongoing engagement with people with lived experience will be critical as we do this work, alongside government and policing partners.”
NHS England’s StopSIM ‘betrayal’ is ‘ticking time bomb’ on co-production
By John Pring on 16th March 2023
Category: Human Rights
www.disabilitynewsservice.com/nhs-englands-stopsim-betrayal-is-ticking-time-bomb-on-co-production/
NHS England has been warned that its actions could “plunge co-production into crisis”, after it went back on a promise to publish a mental health policy that disabled campaigners had been working on for 15 months.
Grassroots groups and disabled activists spoke out this week after the decision of NHS England to prevent the release of a document drawn up with detailed input from members of the StopSIM coalition, who had worked “tirelessly” – without payment – on the policy.
The coalition had been working on the “rigorous and detailed” policy with NHS England (NHSE) after exposing the dangers posed by the multi-agency Serenity Integrated Mentoring (SIM) scheme.
Prevent: Health workers resist UK’s ‘counter terrorism’ strategy that weaponizes public services
Public sector workers in the UK have a statutory duty under the ‘Prevent’ strategy to report ‘signs of radicalization’. The program is notorious for targeting Muslims and uses key services like healthcare to implement discriminatory ‘counter-terror’ tactics
March 11, 2023 by Tanupriya Singh
peoplesdispatch.org/2023/03/11/prevent-health-workers-resist-uks-counter-terrorism-strategy-that-weaponizes-public-services/
In the two decades since the UK government unveiled its ‘counter terrorism’ strategy ‘Prevent’, campaigners and human rights organizations have consistently documented its impact on racialized and otherwise marginalized communities, and the ways in which public services—including healthcare—have been weaponized in this process.
A part of the government’s broader counter-terrorism strategy called CONTEST, Prevent’s stated objective is to “prevent people from being drawn into terrorism.” First implemented in the aftermath of the 2005 London bombings, Prevent was amended in 2011 to deal with “all forms of terrorism and with non-violent extremism.” Extremism was vaguely defined as “vocal or active opposition to fundamental British values.”
While on paper Prevent’s ambit was expanded beyond ‘Islamist’ extremism, research shows that the program has continued to disproportionately target Muslims, with 73% of the Muslim population in England and Wales living in “Prevent Priority Areas.”
“From the outset, Prevent’s impetus has been to focus on Muslim communities in the UK. Documents that were leaked early on in the strategy’s life span also show that it was an inherent part of the project to focus on British Asian males between the ages of around 15 to their mid-30s,” Sarah Lasoye, poet, writer, and the Peace and Security Campaign lead at Medact, a health justice campaigning organization in the UK, told Peoples Dispatch.
In 2015, the UK passed the Counter-Terrorism and Security Act that created a statutory duty for public sector workers, including social workers, school staff, and health workers, to give “due regard to the need to prevent people from being drawn into terrorism” and to report potential “signs of radicalization.” This resulted in children as young as three and four years old being referred to “deradicalization” programs.
From “pre-crime” to criminalization
“Prevent operates in this ‘pre-crime’ space, so its intention, in the government’s own terms, is to identify ‘susceptibility’ or ‘vulnerability’ to radicalization—it is all in this space of potential,” Lasoye said. “Human rights organizations and even UN special rapporteurs have noted that nobody who has been referred to Prevent and diverted away from care or whatever service that initially acts as an in [or entry point] to a stream of government counter-terror security agencies has committed a crime.”
Meanwhile, the secretive Extremism Risk Guidance 22+ (ERG22+) tool, developed by the government to train public sector workers to detect ‘radicalization’, has been found to rely on unproven and insufficient evidence. Medact’s own research found racial bias in Prevent training materials, and noted that health workers are being instructed to use their “instinct” in the absence of “reliable predictive criteria.”
Based on data from nine National Health Service (NHS) Trusts, Medact found that Asians were reported to Prevent four times more than non-Asians. Muslim people were referred to Prevent eight times more than non-Muslims, in data from six trusts.
A key component of Prevent is Channel, a highly secretive “multi-agency program which identifies and supports at-risk individuals” and is led by the police. According to Medact, at least 90–95% of all Prevent referrals are deemed to not warrant further—or “Channel”—intervention by the police themselves. Medact calls these cases “false positives.”
“Ultimately, a policy that is operating based on a person’s ‘instinct’ is going to be susceptible to their own views and understanding of who is a threat and who is likely to commit an act of violent crime,” Lasoye said. This is compounded by widespread Islamophobia in the UK, and the differing and outright discriminatory thresholds of “suspicious” behavior outlined in Prevent training, which are “geared towards treating Muslim communities with more suspicion.”
Not only are “health workers being roped into treating their patients with suspicion, instead of prioritizing their care,” Lasoye added, Prevent ultimately also acts as a deterrent to seeking care for people “who are already dealing with problems accessing public services, people who have been treated poorly by health practitioners, and, broadly, communities who have faced racialized violence or negligence from health workers,” given that health workers now have a statutory duty.
Medact’s research has also shown that Prevent referrals can inflict both indirect and direct damage to the physical and mental health of not only the people who have been targeted by the strategy, but also their families and wider communities.
“A lot of health workers who unknowingly thought that maybe their patient would receive the care they need through Prevent have often never heard from those patients again. So we do not know if they received the care they needed or what impact the Prevent referral had on their life,” Lasoye said.
One of the risk factors or criteria associated with signs of radicalization in the ERG22+ is “mental health issues.” People with mental health conditions are disproportionately represented in Prevent referrals, as the government has continued to push an unproven link between mental health and terrorism, all of which is also rooted in ableism and stigma.
Not only is violent policing generally being deployed as a response to mental health crises, in the case of the UK, the police have also actively impinged upon mental health services to enforce counter-terror strategies.
Based on an analysis of the secretive “Vulnerability Support Hubs” run by the counter-terrorism police, Medact found that racialized Muslims were at least 23 times more likely to be referred to a mental health hub for ‘Islamism’ compared to a white British individual for ‘far-right extremism.’
Moreover, “counter-terrorism’s turn to mental health” has also led to a “securitization of care,” which has not only meant increasing influence of police over mental health services and treatment, but also a growing risk of the complicity of NHS workers in the criminalization and surveillance of people, not to mention blatant violations of the duty of confidentiality in healthcare.
What has made the government’s use of schools and health care workers to implement Prevent particularly insidious is the fact that for so many vulnerable people, these public services form a basic or primary point of contact with the state. Not only that, as Lasoye emphasized, these are “trusted” sites and, as such, have been very useful for the government as sites for the introduction of harmful policies like Prevent.
The Police, Crime, Sentencing, and Courts Act of 2022 had attempted to enforce a “Serious Violence Duty,” under which health workers would be required to share their patient’s confidential information with the police. While the law was ultimately passed, health workers in the NHS were ultimately exempt from the duty thanks to the mobilizing efforts of groups like Medact.
Rejecting securitization, centering care
In mid-February, the government’s widely-boycotted “independent” review of Prevent by William Shawcross was published. Condemned as a “whitewash,” the Shawcross report ultimately doubled-down on some of Prevent’s most harmful aspects, calling for harsher enforcement and a renewed emphasis on “Islamist extremism.”
Not only that, Shawcross called for the expansion of Prevent to asylum and immigration services as well as job centers.
“Who are the people who are accessing these services? It is racialized people, it is working class people, it is people who have always been on the underside of the state’s ‘hard’ security policies,” Lasoye said. “The expansion of Prevent into these services that are also incredibly vital to people will act as a deterrent to seeking these services for fear of being brought into yet another stream of government security and criminalizing policies.”
She further added, “From our perspective, criminalization is not at all a functional or effective response to what is often, if not always, a situation of unmet needs—be it social, political, or economic. As such, a truly public health approach to resolving these issues, to reduce acts of violent harm, would meet people’s needs.”
“We are in an incredibly difficult time, given people’s economic situation and cuts to public services that have been ongoing for decades. People are really struggling, and then we see an exacerbation of issues that are criminalized by the government, and a strengthening of the narrative that the only way to deal with this is to criminalize people and undertake punitive action.”
“Medact and the health workers that we work with are opposed to this kind of response. Instead, we are focusing on an approach with the intention to prioritize and center the health of everyone involved, and try to have some transformational change.”
Lasoye said, “The health perspective holds a lot of weight politically, and not necessarily in an elitist sense of ‘we should listen to doctors more than anyone else,’ but because it allows people to see the importance of everybody’s wellbeing, and what would it look like if we as a society decided to center everyone’s wellbeing. How would we care for each other not only on a big, economic level but also interpersonally?”
Distress and dissent within and beyond healthcare
Posted on 14 March 2023 by Rhiannon Osborne
www.nsun.org.uk/distress-and-dissent-within-and-beyond-healthcare/
I am a final year medical student, due to start work as a junior doctor in August. For me, the strikes by nurses, ambulance workers, and now junior doctors have been a source of active hope, mobilised people around me, and created possibilities for rethinking how we understand health itself. Instead of the colonial capitalist idea that health is your individual responsibility, determined by your behaviour or genetics, strikes at the intersection with health (which all strikes are) help us to understand how the extractive economy and the exploitation it relies on becomes embodied as ill-health.
Throughout my training I have seen the mental health impacts of long hours, unmanageable workloads, low pay and staff shortages on healthcare workers. According to NHS practitioner health, almost one quarter of sick leave for nurses is due to anxiety, stress, depression, or other psychiatric illness. Suicidality amongst nurses, in particular female nurses, is estimated to be around 23% higher than the national average. Even before the pandemic, doctors were citing workplace stress, low pay, lack of support and staff shortages as causes of mental health issues. Three in four NHS Trusts say more nurses are visiting mental health services because of stress, debt, and poverty.
The work-related mental distress of healthcare workers is caused and compounded by the underfunding and marketisation of the NHS, itself part of austerity and the privatisation of all public services across the UK. Not only are healthcare workers suffering the mental health consequences of austerity, we are also seeing it destroy the health of patients. Over 330,000 excess deaths were linked to austerity between 2012 and 2019. In clinics and mutual aid organising, I have seen people devastated physically and mentally by financial stress, unable to afford heating and food, and frequently further traumatised by loan sharks. Recent work by Medact highlights how across the entire economy, including the health and care sector, outsourcing, the gig economy, precarious work, differences in pay and unpaid work, and inadequate sick pay compound to create mental and physical health inequalities. Everything we need to be healthy – housing, food, a liveable income, rest, clean air, community, a stable climate – is governed in the interests of capital rather than health.
The mental health catastrophe created by this rising inequality, corporate greed, and the decimation of public services is being fought not just by the health unions but by everyone else on strike.
The UK’s latest intensification of inequality and economic precarity is also compounding existing mental health inequalities. The environmental injustice of pollution has been shown to create mental distress amongst poor and racialised communities, who are then the most affected by other health crises such as austerity and COVID-19. Systematic discrimination against disabled people in the workplace means they are more likely to already be in precarious work. Poverty, debt and predatory loans disproportionately impact racialised communities in the UK, one of the many reasons why the rise in suicide driven by the cost of living crisis is hitting racialised communities the hardest. And, as living conditions worsen, so does violent scapegoating of marginalised communities. We are witnessing the horrific mental health impact of rising hate-crime and discrimination towards trans people, and the intensification of the hostile environment, deportation and detention.
The uneven mental health impact of the cost of living crisis is no surprise. The extractive economy relies on devaluing the lives of poor people, racialised people, disabled people, women, LGBTQIA+ people, migrants and anyone else whose health is deliberately harmed for the sake of capital, in order to justify and hide the premature death it creates. Françoise Vergès in A Decolonial Feminism describes how “wear and tear on the body…is inseparable from an economy which divides bodies between those who have a right to good health and to relax, and those whose health does not matter and who do not have a right to rest”. Despite this, individualistic health narrative tells us that our biology or behaviour is the cause of mental distress, not the systems of sickness which create or exacerbate it.
As healthcare workers, we are asked to accept (and in many cases, actively enforce) this economy, or simply attempt to patch up the consequences. This inability to deal with the root causes of mental distress and other health issues was a large contributor to my own mental health struggles as a medical student. Dr Sanah Ahsan asks – “Services may (just about) be keeping people alive, but how ethical is that when we’re doing nothing to change unlivable conditions?”. It often feels like, at best, we are sending people back out into the fire with a few bandages on their burns.
At worst, and in particular for those who are migrants, disabled, and racialised, healthcare workers can cause a lot more mental distress. Under the mental health system, patients, in particular those from poor and racialised backgrounds, face punitive coercion, detention and criminalisation in the name of ‘care’. The ‘do no harm’ narrative disguises how medicine has, throughout history and today, been used as a tool of violence, and has always been deeply intertwined with police, prisons and borders. Health workers’ engagement with the politics of mental distress must also mean engaging with abolitionist medicine. Patient-led abolitionist campaigns against carceral mental health systems are leading the way, and some health workers, such as the Docs not Cops movement, are incorporating abolition into their organising.
As well as this, organising at the intersection of health and labour must challenge not only the mental health impacts of exploitative work, but the very idea that work and health are synonymous. When health is seen only as the capacity to work and be productive to capital, medicine is focussed on returning people to work (even when work makes you sick), and people who cannot work are treated as a ‘burden’. Both Labour and the Tories are currently emphasising ‘returning people to work’ whilst disabled people already face horrific physical and mental distress by being forced to work, constantly disbelieved and denied disability payments.
Strikes by healthcare workers can open up the space to question an economy which creates sickness, deprives people of the care they need to heal, and punishes those it deems ‘unhealthy’. They present an opportunity to fight collectively across unions, highlighting how workplace exploitation, low pay and precarity create mental distress. Through shared political analysis of the causes of mental distress, and dismantling hierarchies, solidarity across movements can reclaim health as a theoretical and practical organising tool for social justice. By linking the strikes of healthcare workers to all strikes, and to the health of all people, we can work to abolish conditions designed to create sickness.
Punished for being mentally ill
File on 4
File on 4 hears from people suffering from acute mental illness who have faced criminalisation, rather than care and compassion.
www.bbc.co.uk/programmes/m001k0qx
stopsim.co.uk/
We are a coalition of service users and allies campaigning for the High Intensity Network’s Serenity Integrated Mentoring (SIM) model to be halted immediately. We call on NHS England to publish the joint StopSIM national policy in full immediately. We believe that SIM is unlawful, unethical and unacceptable.
www.change.org/p/nhs-england-stopsim-halt-the-rollout-and-delivery-of-sim-and-conduct-an-independent-review
This petition was started by the StopSIM Coalition. We are a group of mental health service users, survivors and allies calling on NHS England to halt the development and rollout of ‘Serenity Integrated Mentoring’ (SIM), created by the ‘High Intensity Network (HIN), with immediate effect, and to conduct an independent review. We believe that SIM is an unacceptable step backwards in disability justice and has the effect of criminalising mental distress/illness.
SIM is a model of mental healthcare targeted towards some of the most mentally unwell individuals in our communities, who frequently come into contact with emergency services while in crisis. SIM refers to these individuals as “High Intensity Users” and claims that they place an “unnecessary financial burden” on the NHS.
Despite being at very high risk of self-harm or suicide, individuals under SIM have “crisis response plans” that prevent them from accessing potentially life-saving treatment from the usual places that people are able to seek support during a crisis. This includes: ambulance services, A&E, mental health crisis services, community mental health teams and the police.
Additionally, the SIM model is heavily reliant on the “coercive” powers of the police to enforce “behavioural responsibility” and “behavioural management” on “High Intensity Users”. “High Intensity Officers” are placed in mental health teams and have full access to the individual's medical records, with or without their consent. Messages such as: “We are responsible for the consequences of our actions and we need you to understand what the consequences of your actions will be if they continue” are “compassionately, but firmly reinforced over the course of several weeks/months.”
The focus of SIM is on reducing service demand (how frequently people come into contact with emergency services), not the patients’ well-being or experience. Indeed, we believe this program will have the effect of re-traumatising individuals. SIM does not use any outcome measures (data that measures the success of the programme) that are commonly used in community mental health services to assess changes in the individuals mental well-being.
We ask you to sign this petition, calling 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.
A full petition statement including references can be found on our website: www.stopsim.co.uk along with statements we have released about SIM. You can also follow @stopsimmh on Twitter and Instagram.
NSUN statement on NHSE’s failure to publish joint policy with StopSIM coalition
Posted on 20 March 2023
www.nsun.org.uk/news/nsun-statement-on-nhses-failure-to-publish-sim-policy/
The StopSIM coalition has been working with NHS England for 15 months on a joint policy around the Serenity Integrated Mentoring (SIM) model, and similar “high-intensity service use” models, setting out practices that must be eliminated in mental health care (and how this should be monitored) alongside an acknowledgment of and apology for the harm caused by the acceleration and endorsement of the SIM scheme.
On Friday 10th March, NHSE published a short letter to trusts instead of the full co-produced policy. We stand in solidarity with the coalition, who are now having to pause all activity for a minimum of a month due to the distress caused by NHSE’s decision not to publish the policy after months of intensive, unpaid labour, and fully support their call for NHSE to publish the joint policy in full immediately in the statement they released on Monday 13th March.
As the coalition say in their statement:
“We share in the anger, disappointment and fear that service users will feel following this announcement. NHS England’s failure to publish this policy is a significant betrayal of the seen and unseen labour put into the development of this work and the campaign against SIM more broadly…
We had hoped this work would signify changes in ways of working within NHS England and indicate the possibilities of future improvements in the involvement of lived experience groups within the institution. However, failure to publish the final policy sets a precedent for undervaluing lived experience contributions and failing to follow through on commitments, as well as demonstrating total disregard for the labour of lived experience involvement.”
Publishing this collaborative policy would have been a tangible step towards eradicating punitive practices and the criminalisation of distress in mental health care, as well as a demonstration that NHSE is willing to work in partnership with survivors and service users, and we are deeply disappointed by NHSE’s last-minute decision to backtrack on its publication. This betrayal further embeds distrust in “co-production” work within the mental health system which comes from decades of the co-option and erasure of survivor and service-user led work.
NSUN calls on NHS England to publish the full co-authored policy immediately. We agree with the coalition that “unless the full policy is published and the public are able to scrutinise how trusts respond, we do not believe that all trusts will make the necessary changes outlined above… Crucially, failure to publish leaves services users without access to a policy that could help protect them from SIM and SIM-like approaches, and without acknowledgement of the harm that’s been caused to them.”
StopSIM have asked that in their absence, allies such as health, medical, and academic professionals sign an open letter to NHSE which is currently being organised – you can add your name by contacting Fiona by Twitter DM or by signing via the letter itself when it is published shortly – we will add the link to this page when it is live.
Scheme putting police in mental health teams must end, says NHS England
Critics of SIM monitoring system have raised fears that high-risk people are not receiving the care they need
www.theguardian.com/society/2023/mar/14/scheme-police-mental-health-teams-must-end-nhs-england
A controversial mental health monitoring system, which embedded police officers in clinical teams, must no longer be used in mental health services, NHS England has said.
In a letter seen by the Guardian, NHS England’s national clinical director for mental health, Prof Tim Kendall, gave the instruction about the serenity integrated mentoring (SIM) scheme and similar models.
The scheme, which began expanding across the UK six years ago, puts police into health teams to help manage patients who repeatedly call emergency services.
Critics say the system involves instructing A&E, ambulance, mental health services and police not to respond to calls from these people in case it “positively reinforces” high-risk behaviour.
Medical bodies and campaigners including the Centre for Mental Health and Rethink Mental Illness have said there are concerns that people experiencing acute distress, who are at high risk of self-harm, have not been receiving the medical help they need.
Lucy Schonegevel, the associate director for policy and practice at Rethink Mental Illness, said: “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.”
NHS England has worked with the StopSIM coalition, a group campaigning to halt the use of SIM in the NHS, to produce a report on the effects of the system.
NHS England said it had no plans to publish the report, but StopSIM called for it to be published “in full immediately”.
The coalition 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.”
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.”
StopSIM has concerns that it is now down to the individual trusts and integrated care boards to end the use of SIM or other similar practices.
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.”
Kendall said in his letter: “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.”
He added: “Ongoing engagement with people with lived experience will be critical as we do this work, alongside government and policing partners.”
NHS England’s StopSIM ‘betrayal’ is ‘ticking time bomb’ on co-production
By John Pring on 16th March 2023
Category: Human Rights
www.disabilitynewsservice.com/nhs-englands-stopsim-betrayal-is-ticking-time-bomb-on-co-production/
NHS England has been warned that its actions could “plunge co-production into crisis”, after it went back on a promise to publish a mental health policy that disabled campaigners had been working on for 15 months.
Grassroots groups and disabled activists spoke out this week after the decision of NHS England to prevent the release of a document drawn up with detailed input from members of the StopSIM coalition, who had worked “tirelessly” – without payment – on the policy.
The coalition had been working on the “rigorous and detailed” policy with NHS England (NHSE) after exposing the dangers posed by the multi-agency Serenity Integrated Mentoring (SIM) scheme.
Prevent: Health workers resist UK’s ‘counter terrorism’ strategy that weaponizes public services
Public sector workers in the UK have a statutory duty under the ‘Prevent’ strategy to report ‘signs of radicalization’. The program is notorious for targeting Muslims and uses key services like healthcare to implement discriminatory ‘counter-terror’ tactics
March 11, 2023 by Tanupriya Singh
peoplesdispatch.org/2023/03/11/prevent-health-workers-resist-uks-counter-terrorism-strategy-that-weaponizes-public-services/
In the two decades since the UK government unveiled its ‘counter terrorism’ strategy ‘Prevent’, campaigners and human rights organizations have consistently documented its impact on racialized and otherwise marginalized communities, and the ways in which public services—including healthcare—have been weaponized in this process.
A part of the government’s broader counter-terrorism strategy called CONTEST, Prevent’s stated objective is to “prevent people from being drawn into terrorism.” First implemented in the aftermath of the 2005 London bombings, Prevent was amended in 2011 to deal with “all forms of terrorism and with non-violent extremism.” Extremism was vaguely defined as “vocal or active opposition to fundamental British values.”
While on paper Prevent’s ambit was expanded beyond ‘Islamist’ extremism, research shows that the program has continued to disproportionately target Muslims, with 73% of the Muslim population in England and Wales living in “Prevent Priority Areas.”
“From the outset, Prevent’s impetus has been to focus on Muslim communities in the UK. Documents that were leaked early on in the strategy’s life span also show that it was an inherent part of the project to focus on British Asian males between the ages of around 15 to their mid-30s,” Sarah Lasoye, poet, writer, and the Peace and Security Campaign lead at Medact, a health justice campaigning organization in the UK, told Peoples Dispatch.
In 2015, the UK passed the Counter-Terrorism and Security Act that created a statutory duty for public sector workers, including social workers, school staff, and health workers, to give “due regard to the need to prevent people from being drawn into terrorism” and to report potential “signs of radicalization.” This resulted in children as young as three and four years old being referred to “deradicalization” programs.
From “pre-crime” to criminalization
“Prevent operates in this ‘pre-crime’ space, so its intention, in the government’s own terms, is to identify ‘susceptibility’ or ‘vulnerability’ to radicalization—it is all in this space of potential,” Lasoye said. “Human rights organizations and even UN special rapporteurs have noted that nobody who has been referred to Prevent and diverted away from care or whatever service that initially acts as an in [or entry point] to a stream of government counter-terror security agencies has committed a crime.”
Meanwhile, the secretive Extremism Risk Guidance 22+ (ERG22+) tool, developed by the government to train public sector workers to detect ‘radicalization’, has been found to rely on unproven and insufficient evidence. Medact’s own research found racial bias in Prevent training materials, and noted that health workers are being instructed to use their “instinct” in the absence of “reliable predictive criteria.”
Based on data from nine National Health Service (NHS) Trusts, Medact found that Asians were reported to Prevent four times more than non-Asians. Muslim people were referred to Prevent eight times more than non-Muslims, in data from six trusts.
A key component of Prevent is Channel, a highly secretive “multi-agency program which identifies and supports at-risk individuals” and is led by the police. According to Medact, at least 90–95% of all Prevent referrals are deemed to not warrant further—or “Channel”—intervention by the police themselves. Medact calls these cases “false positives.”
“Ultimately, a policy that is operating based on a person’s ‘instinct’ is going to be susceptible to their own views and understanding of who is a threat and who is likely to commit an act of violent crime,” Lasoye said. This is compounded by widespread Islamophobia in the UK, and the differing and outright discriminatory thresholds of “suspicious” behavior outlined in Prevent training, which are “geared towards treating Muslim communities with more suspicion.”
Not only are “health workers being roped into treating their patients with suspicion, instead of prioritizing their care,” Lasoye added, Prevent ultimately also acts as a deterrent to seeking care for people “who are already dealing with problems accessing public services, people who have been treated poorly by health practitioners, and, broadly, communities who have faced racialized violence or negligence from health workers,” given that health workers now have a statutory duty.
Medact’s research has also shown that Prevent referrals can inflict both indirect and direct damage to the physical and mental health of not only the people who have been targeted by the strategy, but also their families and wider communities.
“A lot of health workers who unknowingly thought that maybe their patient would receive the care they need through Prevent have often never heard from those patients again. So we do not know if they received the care they needed or what impact the Prevent referral had on their life,” Lasoye said.
One of the risk factors or criteria associated with signs of radicalization in the ERG22+ is “mental health issues.” People with mental health conditions are disproportionately represented in Prevent referrals, as the government has continued to push an unproven link between mental health and terrorism, all of which is also rooted in ableism and stigma.
Not only is violent policing generally being deployed as a response to mental health crises, in the case of the UK, the police have also actively impinged upon mental health services to enforce counter-terror strategies.
Based on an analysis of the secretive “Vulnerability Support Hubs” run by the counter-terrorism police, Medact found that racialized Muslims were at least 23 times more likely to be referred to a mental health hub for ‘Islamism’ compared to a white British individual for ‘far-right extremism.’
Moreover, “counter-terrorism’s turn to mental health” has also led to a “securitization of care,” which has not only meant increasing influence of police over mental health services and treatment, but also a growing risk of the complicity of NHS workers in the criminalization and surveillance of people, not to mention blatant violations of the duty of confidentiality in healthcare.
What has made the government’s use of schools and health care workers to implement Prevent particularly insidious is the fact that for so many vulnerable people, these public services form a basic or primary point of contact with the state. Not only that, as Lasoye emphasized, these are “trusted” sites and, as such, have been very useful for the government as sites for the introduction of harmful policies like Prevent.
The Police, Crime, Sentencing, and Courts Act of 2022 had attempted to enforce a “Serious Violence Duty,” under which health workers would be required to share their patient’s confidential information with the police. While the law was ultimately passed, health workers in the NHS were ultimately exempt from the duty thanks to the mobilizing efforts of groups like Medact.
Rejecting securitization, centering care
In mid-February, the government’s widely-boycotted “independent” review of Prevent by William Shawcross was published. Condemned as a “whitewash,” the Shawcross report ultimately doubled-down on some of Prevent’s most harmful aspects, calling for harsher enforcement and a renewed emphasis on “Islamist extremism.”
Not only that, Shawcross called for the expansion of Prevent to asylum and immigration services as well as job centers.
“Who are the people who are accessing these services? It is racialized people, it is working class people, it is people who have always been on the underside of the state’s ‘hard’ security policies,” Lasoye said. “The expansion of Prevent into these services that are also incredibly vital to people will act as a deterrent to seeking these services for fear of being brought into yet another stream of government security and criminalizing policies.”
She further added, “From our perspective, criminalization is not at all a functional or effective response to what is often, if not always, a situation of unmet needs—be it social, political, or economic. As such, a truly public health approach to resolving these issues, to reduce acts of violent harm, would meet people’s needs.”
“We are in an incredibly difficult time, given people’s economic situation and cuts to public services that have been ongoing for decades. People are really struggling, and then we see an exacerbation of issues that are criminalized by the government, and a strengthening of the narrative that the only way to deal with this is to criminalize people and undertake punitive action.”
“Medact and the health workers that we work with are opposed to this kind of response. Instead, we are focusing on an approach with the intention to prioritize and center the health of everyone involved, and try to have some transformational change.”
Lasoye said, “The health perspective holds a lot of weight politically, and not necessarily in an elitist sense of ‘we should listen to doctors more than anyone else,’ but because it allows people to see the importance of everybody’s wellbeing, and what would it look like if we as a society decided to center everyone’s wellbeing. How would we care for each other not only on a big, economic level but also interpersonally?”
Distress and dissent within and beyond healthcare
Posted on 14 March 2023 by Rhiannon Osborne
www.nsun.org.uk/distress-and-dissent-within-and-beyond-healthcare/
I am a final year medical student, due to start work as a junior doctor in August. For me, the strikes by nurses, ambulance workers, and now junior doctors have been a source of active hope, mobilised people around me, and created possibilities for rethinking how we understand health itself. Instead of the colonial capitalist idea that health is your individual responsibility, determined by your behaviour or genetics, strikes at the intersection with health (which all strikes are) help us to understand how the extractive economy and the exploitation it relies on becomes embodied as ill-health.
Throughout my training I have seen the mental health impacts of long hours, unmanageable workloads, low pay and staff shortages on healthcare workers. According to NHS practitioner health, almost one quarter of sick leave for nurses is due to anxiety, stress, depression, or other psychiatric illness. Suicidality amongst nurses, in particular female nurses, is estimated to be around 23% higher than the national average. Even before the pandemic, doctors were citing workplace stress, low pay, lack of support and staff shortages as causes of mental health issues. Three in four NHS Trusts say more nurses are visiting mental health services because of stress, debt, and poverty.
The work-related mental distress of healthcare workers is caused and compounded by the underfunding and marketisation of the NHS, itself part of austerity and the privatisation of all public services across the UK. Not only are healthcare workers suffering the mental health consequences of austerity, we are also seeing it destroy the health of patients. Over 330,000 excess deaths were linked to austerity between 2012 and 2019. In clinics and mutual aid organising, I have seen people devastated physically and mentally by financial stress, unable to afford heating and food, and frequently further traumatised by loan sharks. Recent work by Medact highlights how across the entire economy, including the health and care sector, outsourcing, the gig economy, precarious work, differences in pay and unpaid work, and inadequate sick pay compound to create mental and physical health inequalities. Everything we need to be healthy – housing, food, a liveable income, rest, clean air, community, a stable climate – is governed in the interests of capital rather than health.
The mental health catastrophe created by this rising inequality, corporate greed, and the decimation of public services is being fought not just by the health unions but by everyone else on strike.
The UK’s latest intensification of inequality and economic precarity is also compounding existing mental health inequalities. The environmental injustice of pollution has been shown to create mental distress amongst poor and racialised communities, who are then the most affected by other health crises such as austerity and COVID-19. Systematic discrimination against disabled people in the workplace means they are more likely to already be in precarious work. Poverty, debt and predatory loans disproportionately impact racialised communities in the UK, one of the many reasons why the rise in suicide driven by the cost of living crisis is hitting racialised communities the hardest. And, as living conditions worsen, so does violent scapegoating of marginalised communities. We are witnessing the horrific mental health impact of rising hate-crime and discrimination towards trans people, and the intensification of the hostile environment, deportation and detention.
The uneven mental health impact of the cost of living crisis is no surprise. The extractive economy relies on devaluing the lives of poor people, racialised people, disabled people, women, LGBTQIA+ people, migrants and anyone else whose health is deliberately harmed for the sake of capital, in order to justify and hide the premature death it creates. Françoise Vergès in A Decolonial Feminism describes how “wear and tear on the body…is inseparable from an economy which divides bodies between those who have a right to good health and to relax, and those whose health does not matter and who do not have a right to rest”. Despite this, individualistic health narrative tells us that our biology or behaviour is the cause of mental distress, not the systems of sickness which create or exacerbate it.
As healthcare workers, we are asked to accept (and in many cases, actively enforce) this economy, or simply attempt to patch up the consequences. This inability to deal with the root causes of mental distress and other health issues was a large contributor to my own mental health struggles as a medical student. Dr Sanah Ahsan asks – “Services may (just about) be keeping people alive, but how ethical is that when we’re doing nothing to change unlivable conditions?”. It often feels like, at best, we are sending people back out into the fire with a few bandages on their burns.
At worst, and in particular for those who are migrants, disabled, and racialised, healthcare workers can cause a lot more mental distress. Under the mental health system, patients, in particular those from poor and racialised backgrounds, face punitive coercion, detention and criminalisation in the name of ‘care’. The ‘do no harm’ narrative disguises how medicine has, throughout history and today, been used as a tool of violence, and has always been deeply intertwined with police, prisons and borders. Health workers’ engagement with the politics of mental distress must also mean engaging with abolitionist medicine. Patient-led abolitionist campaigns against carceral mental health systems are leading the way, and some health workers, such as the Docs not Cops movement, are incorporating abolition into their organising.
As well as this, organising at the intersection of health and labour must challenge not only the mental health impacts of exploitative work, but the very idea that work and health are synonymous. When health is seen only as the capacity to work and be productive to capital, medicine is focussed on returning people to work (even when work makes you sick), and people who cannot work are treated as a ‘burden’. Both Labour and the Tories are currently emphasising ‘returning people to work’ whilst disabled people already face horrific physical and mental distress by being forced to work, constantly disbelieved and denied disability payments.
Strikes by healthcare workers can open up the space to question an economy which creates sickness, deprives people of the care they need to heal, and punishes those it deems ‘unhealthy’. They present an opportunity to fight collectively across unions, highlighting how workplace exploitation, low pay and precarity create mental distress. Through shared political analysis of the causes of mental distress, and dismantling hierarchies, solidarity across movements can reclaim health as a theoretical and practical organising tool for social justice. By linking the strikes of healthcare workers to all strikes, and to the health of all people, we can work to abolish conditions designed to create sickness.
Punished for being mentally ill
File on 4
File on 4 hears from people suffering from acute mental illness who have faced criminalisation, rather than care and compassion.
www.bbc.co.uk/programmes/m001k0qx