Still criminalising distress: police involvement in care has not been “eradicated”

One year on from publishing our Criminalising Distress report, we wanted to share an update on some follow-up advocacy and research work – including new evidence illustrating the disturbing (but sadly not surprising) fact that the criminalisation of distress goes on.

Background

Our 2024 report followed the scandal over SIM (Serenity Integrated Mentoring), a scheme through which police officers were embedded into community mental health teams at around half the NHS mental health trusts in England. The project was conducted by members of the Medact Research Network, with former members of the StopSIM Coalition – the grassroots network which led the campaign to oppose SIM – serving as a steering committee.

As reported by the British Medical Journal, the research we published in April 2024 found evidence of ongoing punitive, exclusionary and discriminatory practices in mental health trusts. This was despite NHS England saying in March 2023, as a result of StopSIM’s campaign, that these practices should be “eradicated”. Our findings also reinforced previous evidence showing that contact with police is often very harmful to patients: potentially invoking fear and shame, compounding distress, destroying trust and risking re-traumatisation.

Follow-up

After publishing our findings, Medact wrote to NHS England, alongside Mind, NSUN and WISH, highlighting the fact that despite the disappearance of models explicitly named ‘SIM’ as a result of the scandal, there remain multiple examples of similar schemes using different names. The letter therefore called on NHS England to:

1. apologise to the StopSIM Coalition for its poor handling of their involvement in reviewing SIM 
2. publish the joint StopSIM policy with clear criteria for the Care Quality Commission to inspect mental health trusts for punitive, exclusionary and discriminatory practices
3. launch an independent inquiry into ongoing practices of this kind. 

However, given the role NHS England itself played in fostering and rolling out SIM, we should not hold our breath – especially because the organisation is now set to be abolished in October 2026. 

New evidence

Earlier this year, we also got the results of a new round of freedom of information requests in. There were a few trusts whose responses sounded like potentially good news.¹ Among these:

• Surrey and Borders Partnership NHS Foundation Trust stated that it has not replaced the Surrey High Intensity Partnership Programme (SHIPP) and that “no contact with Surrey Police is facilitated by the Trust”
• Leicestershire Partnership NHS Trust stated that although the police-led PAVE (Pro Active Vulnerability Engagement) scheme is still operational “there are now no mental health practitioners or consultant psychiatrists working in the team”.
• Rotherham, Doncaster and South Humber NHS Foundation Trust stated that its High Intensity Care Team “no longer works jointly with South Yorkshire Police and Officers have no direct contact in the support of people presenting with mental health difficulties, nor do they have any routine association with the High Intensity Care Team”.

However, several other trusts’ responses were concerning.² Among these:

• South West Yorkshire Partnership NHS Foundation Trust, despite replacing SIM with the ARC (Alternative Response to Crisis) scheme and then scrapping that too, stated that police continue to be involved in “collaborative care planning meetings”.
• Gloucestershire Health and Care NHS Foundation Trust stated that its Frequent Engagement Response Network (“FERN”) team is still operational and includes “a police officer dedicated to supporting us for one day a week” who “visits people under FERN”.³
• Mersey Care NHS Foundation Trust, as part of its Mental Health Triage and Response Service, stated that it has an allocated High Intensity User Officer from Cheshire police’s Complex Mental Health Demand Team who attends meetings about “high intensity users” and “supports in discussion for individual cases”. The trust also confirmed that it may facilitate police contact with patients, may offer “the advice and guidance of mental health professionals” to police considering prosecuting patients, and shares some patient data with police.
• Lancashire and South Cumbria NHS Foundation Trust stated that it “would only support arranging meetings” between patients and police “if there was a clinical need”, implying police involvement is still conceptualised as part of healthcare.
• Cheshire and Wirral Partnership NHS Foundation Trust stated that in relation to patients “with complex needs who frequently attend A&E” and are “known to the Police”, the latter “could” be involved “as a partner in care planning.” 

These responses make it clear that – despite NHS England’s call for police involvement in care to be “eradicated”, this has not happened. The criminalisation of distress goes on. 

Not only does the continuation of such schemes speak to an absence of regulatory mechanisms and accountability, the fact that SIM was ever rolled out in the first place is a symptom of much deeper problems which have neither been acknowledged nor addressed.

Notes

1. Other bodies appear to be in the process of reviewing policies: North East Ambulance Service, whose Frequent Caller Procedure refers to “collaborative working with the police”, potentially obtaining a “behaviour contract or anti social behaviour order”, and even referring frequent callers “to the police for possible prosecution” when “the behaviour of the Frequent Caller does not improve”, told us the policy had not changed but there were “plans to review [it] in the near future.” Similarly, the Yorkshire Ambulance Service, whose Frequent Caller Identity and Management procedure also referred to potential use of “a behavioural contact” or “progression towards a civil/criminal behaviour order” or referral to the police “for possible prosecution” stated that its policy is “currently under review”.
2. East Midlands Ambulance Service stated that it had “renewed and updated” its Frequent Caller Policy, which previously included the stipulation that if “calls are at a level where they are disrupting the smooth running [of the ambulance service]…they are discussed with the Crime and Security team which may result in local police being contacted”. However, while this language has been removed, the flow chart in the policy still indicates that patients may be referred to police.
3. The trust added that FERN is “something we are really proud of” and provided an example of a young woman with a history of self injury whose FERN plan was said to be “so effective that her police contact has been zero for the past 7 months and at it’s [sic] height there were as many as 27 incidents in a month.”