Thread by @Skourkos1

(CW) For the last two weeks my timeline has been almost exclusively filled with messages about Serenity Integrated Mentoring #highintensitynetwork the work of @StopSIMMH and the campaign to #StopSIM. Here is why 1/21

In my work I study the embedding of patient and public involvement across health research. I do so as a mental health service user/survivor researcher, which means I bring my relationship with mental distress/mh services to my work. 2/21

In this capacity I attend meetings with Trust managers, senior clinicians &academics, where, now, references to co-production elicit enthusiastic nods; where people increasingly highlight the importance of reaching out to diverse & underserved communities 3/21

And now I wonder how many of those same managers & clinical academics have endorsed SIM, an intervention which introduces police officers in NHS services & includes threatening service users with prosecution if they continue calling for help. 4/21

At those meetings, people reiterate the importance of service integration and discuss how to best facilitate the spread of innovation at scale 5/21

And I know that SIM has won awards for fostering service integration, that it has been enthusiastically taken up & showcased as an example of successful adoption of innovation across NHS Trusts 6/21

The creators of SIM acknowledge that healthcare workers are overwhelmed with demand for services, that caseloads are unsustainable & service users unsupported. 7/21

but they do not link this to the politics of austerity, to chronic underfunding combined with escalating social and health inequalities 8/21

Instead they claim that the problem lies with certain service users' disordered behaviours and the lack of strong decisive action to control them 9/21

Instead, they take the logic of responsibilisation to its deadly conclusion: integrate police officers into mental health services, force those service users who most need help to stop calling for help. 10/21

They redefine care as the withholding of care 11/21

They redefine boundary setting through the threat of prosecution 12/21

They redefine threatening people with prosecution as a psycho-social intervention: worse still, in their model for integrated services the ‘psycho-social’ becomes the domain of the police &healthcare workers are to be concerned with 'biomedical' matters only 13/21

They train overworked healthcare workers on how to silence those service users who complain too much and instruct them on how to dismiss grievances raised against them 14/21

They train overwhelmed workers to feel ok about withholding support including urgent medical treatment, and assure them that they will not be held responsible for the potentially lethal outcomes of their actions. 15/21

They provide elastic definitions of who is a 'high intensity service user' and promise that their methods (and clinical record sharing) can identify people who may be likely to engage in such behaviours to stop them before they begin 16/21

So this is why I only talk about SIM: because SIM is another deadly iteration of the hostile environment within the NHS, demonising service users as drain on taxpayers, criminalising distress, starting with 'easy pickings' to install policing as a psycho-social intervention 17/21

Because SIM relies on divide &rule: on averting workers' eyes from the conditions of their exploitation and pointing to an ever expanding marginalised group as the reason why their working conditions worsen 18/21

Because SIM is what happens when toxic pragmatism rules: when the politics of austerity are a horizon that can never be challenged, when policy imperatives (to reduce demand, to aim for efficiency savings) can never be questioned 19/21

Because I am still sitting at tables with clinical academics, managers & consultants hearing about service integration. And at those tables, the rules of civility which give me a place, demand that I can never ask: 'did you know?' nor 'did you endorse this?' 20/21

For how many of us is maintaining this violent civility the price of entry at such tables? #StopSIM 21/21