BASW responds to concerns about the High Intensity Network’s ‘Serenity Integrated Mentoring’ (SIM)

The BASW England Mental Health Group has discussed deep concerns about the High Intensity Network and SIM raised by practitioners and particularly by people with lived experience of using mental health services

Serenity Integrated Monitoring is an approach to coordinating multi-professional and multiagency responses - including health and the police - to ‘demand …caused by a small number of ‘high intensity users’ who struggle with complex trauma and behavioural disorders’, according to the High Intensity Network website. 

Developed over the last decade, in 2016 SIM was adopted by NHS England for scaling up. More recently, SIM projects have been connected through the Network.

The BASW England Mental Health Group has discussed deep concerns about the High Intensity Network and SIM raised by practitioners and particularly by people with lived experience of using mental health services and created this statement.

We welcome the work of the ‘StopSIM’ Coalition, thank them for raising the profile of concerns about these interventions and bringing them to our attention.

The concerns regarding the SIM model of practice raised include: 

  • Despite claims of a focus on quality, SIM prioritises cost reduction and financial savings from people receiving less contact with emergency services rather than being driven by the impact on service users in the short and long term.
  • That in order to achieve those reductions in cost, people in acute distress, and experiencing or acting on thoughts of self-harm or suicide are dissuaded from accessing the support and interventions they find helpful. 
  • The apparent lack of co-production in the design and delivery of these services, that is despite the High Intensity Network stating that ‘we are experts of our own care’ in their three core principles. 
  • That the evidence base for this approach is limited at best. Outcomes for many services adopting this model appear to be based on the reduction in contact with emergency services and the associated cost reduction. 
  • That the model may increase the risk of harm for some people who feel they are not allowed to access services in a crisis and /or unwelcome if they do 

We would add to this list our concern that there is no reference in the model to ensuring people entitled to support and/or assessment under the Care Act can access this.

This should be the basis of preventive and contingency community support services alongside health and other sectors services. We are concerned that the SIM model may perversely prevent that from being offered or followed through ap

BASW supports the call from the StopSIM Coalition to 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. 

With regards to the involvement of Social Workers in the delivery of such services, we would ask that colleagues be mindful of the BASW code of ethics.

Social work is based on respect for the inherent worth and dignity of all people as expressed in the United Nations Universal Declaration of Human Rights (1948) and other related UN declarations on rights and the conventions derived from those declarations. 

1.     Upholding and promoting human dignity and well-being:  Social workers should respect, uphold and defend each person’s physical, psychological, emotional and spiritual integrity and well-being. They should work towards promoting the best interests of individuals and groups in society and the avoidance of harm. 

2.     Respecting the right to self-determination: Social workers should respect, promote and support people’s dignity and right to make their own choices and decisions, irrespective of their values and life choices, provided this does not threaten the rights, safety and legitimate interests of others. 

3.     Promoting the right to participation: Social workers should promote the full involvement and participation of people using their services in ways that enable them to be empowered in all aspects of decisions and actions affecting their lives. 

4.     Treating each person as a whole:  Social workers should be concerned with the whole person, within the family, community, societal and natural environments, and should seek to recognise all aspects of a person’s life. 

5.     Identifying and developing strengths: Social workers should focus on the strengths of all individuals, groups and communities and thus promote their empowerment. 

How social workers can raise concerns

Should Social Workers find themselves in a difficult position with regards local service models and policies running counter to our professional code of ethics, we would encourage you to raise those concerns through your organisation’s processes and/or through BASW’s professional officers. Please use this form to get in touch with BASW. 

Mary Buckman and Anna Grainger, Co-Chairs, BASW England Mental Health Group