Why is Serenity Integrated Mentoring (SIM) destroying the outcomes of vulnerable people?

Content warning: A triggering discussion with mentions of abuse, self-harm, suicide, systemic abuse. 

I'm taking a break from my usual topics today to bring your attention to a harmful programme being used by 23 out of 52 NHS trusts in the UK. Please stick with me until the end and I will try to explain why you should sign a petition and write to your local MP.

Serenity Integrated Mentoring (SIM) is a scheme developed by Sgt Paul Jennings (ex police in Hampshire constabulary). It is worth mentioning that Jennings' limited company (HIN) is in the private sector. SIM allows emergency services/crisis services to turn so called 'frequent flyers' away; even if these people are actively harming and suicidal. Let's run through a scenario of how someone could be flagged, put on the SIM list, and what this would mean for them: 

For the last few years I haven't been coping well with life. I was abused throughout my childhood and grew up living in fear. When I finally found a way to leave my abusive home, it was through moving in with a partner. Here I experienced sexual abuse and domestic violence. I began self-harming. Healthy coping mechanisms were never modeled to me in childhood, so I become extremely overwhelmed by even small stressors. The self-harm was a way of coping. On my dark days I feel empty, I feel hopeless, and I think that everyone I love will leave me. But, I don't want to hurt people by taking my own life, so I go to get help from mental health professionals. They tell me that I should just stop self-harming, that I should use better coping techniques, but waiting lists for the treatment that will teach me those skills are years long. I am sent home with a harsh word and no support. Over the next few years I frequently turn up to A&E begging for someone to help me. Each time they tell me to stop what I'm doing and offer a limited service (usually involving 1 or 2 home visits before immediate discharge). They grow increasingly sick of me as they are not trained to help me. One day they tell me that due to my frequent contact they will no longer be allowing me to come to A&E or use crisis services. They have given up on me, just like everyone else in my life has. Despite my increasingly self damaging self-harm and suicide attempts, I am told that I am an 'attention seeker' that I am 'wasting public funds' - finally they have confirmed what I have always known - nobody cares if I live or die. 

These are common life experiences (and emotions) of people with complex needs and personality disorders. This leads onto the topic of who is being affected by these barbaric practices: 

• Heavily traumatised women with complex PTSD

• Survivors of repeated rape, incest and other abuses

• Those diagnosed with a personality disorder are more likely to be listed

• Those who grew up in poverty

• Those who are homeless and/or involved in sex work

• BAME and/or LGBTQ+ people

The only 'support' (as HIN describes it) that those on the SIM list are offered, is to be assigned a police officer who discusses management of their 'behaviour'. Police officers are there to enforce the law and shouldn't be used to coerce people into not seeking psychological support. In many cases the trauma that people have experienced has involved the criminal justice system, especially in the case of BAME and LGBTQ+ people. 

Personality disorders are described as severe and enduring mental health conditions. In fact Emotionally Unstable Personality/Borderline Personality Disorder has the highest mortality rate of any mental health condition (excluding eating disorders for physical health reasons). 10% of people living with BPD will complete suicide, compared to 0.0112% within the general population. By rolling out SIM the NHS is choosing to minimise these statistics and create their own reality, in which they ignore the suffering and potential risks of those with complex needs. It is widely known that personality disorders don't simply clear up on their own. It takes years of intense therapies such as DBT. Without these interventions outcomes are deeply concerning. These people are consistently presenting to crisis services, because society and the system has failed them. We also know that severe mental health conditions, if not treated, will worsen and increase the likelihood of poverty and homlessness, vulnerability to further abuse, and substance misuse.

For anyone who understands mental health, it is clear to see that SIM is an unethical scheme not fit for purpose and is actively causing lethal harm. There have also been no trials made public that support its use in improving outcomes for any patient groups. It also comes with an extremely dangerous idea bubbling just under the surface. 'People presenting in this manner are not mentally ill and do not need treatment. This is the way forward for treating people with complex trauma.'  Having worked in the mental system for many years and having been a service user myself for even longer, I know that ideas like this spread like wildfire. Part of my current role involves looking at the treatment people with complex needs experience. Our service user led team has been fighting the stigma and trying to improve attitudes among healthcare professionals. The NHS trust that commissioned us, actively using SIM, is massively undermining all the work that we are doing. It is moving away from a people first model and onto a business first model. Read: Saving money over lives - siphoning money out of the NHS and into the wealthy pockets of private business owners.

There is currently no independent enquiry or investigation taking place. Some trusts have promised an internal investigation, but 'marking your own' work is not sufficient when we are talking about the lives of severely traumatised individuals. As of last week HIN appears to have removed their website for unknown reasons.

Please sign the petition for a halt to SIM and an independent enquiry to be launched. I've included a link to more information and on this page you click to sign the petition. https://stopsim.co.uk/

Let's end the systematic neglect and abuse of those living with complex mental health needs. 

BPD & Daily Life: Physical Health

Can Borderline Personality Disorder have an effect on your physical health? Short answer: yes! In fact if you have BPD you almost certainly realised this long ago. Poorly managed mental health is often detrimental to our bodies. Depressive or low moods may lead to us not being able to eat balanced meals, do exercise and take care of our personal hygiene. 

I remember one very hot summer I hid under my duvet, with no water, no showers, and a box or two of pizza for the most part of a week. I think in the end my housemate intervened by bringing bottles of water to me. All I could think of at the time was how I couldn’t face another 20 years of existence. Looking back on it I was emotionally exhausted from learning to ‘mask’ my symptoms, trying desperately to keep up with uni work, and learning to live away from home. I had a lot on my plate and it simply caused me to freeze up. 

These days I have learned to manage my burnout in a healthier way, despite it still hitting me hard at times. I am much more in control of my symptoms, but my physical health has suffered over the years. Let’s talk about a few of the problems people living with BPD encounter: 

• Weight - In my experience this one is very common. This could be either being overweight or underweight. There are lots of contributing factors here: medications that cause increased appetite (or the opposite), lack of motivation to exercise, emotional overeating and even not having the mental stability to cook a healthy meal. It is also vital to mention that those with BPD often have a comorbid eating disorder that can go hand in hand with poor self-esteem and feeling out of control.

• Underlying health conditions - Because people with BPD face a lot of stigma from healthcare professionals and therefore are more reluctant to seek help, things can get missed. Repeated invalidation from services is enough to re-traumatise us and make us avoid getting help from our GPs. Alternatively the BPD diagnosis becomes a distraction and often symptoms of other illnesses are contributed to mental health. I recall one story of a girl with BPD who was going to her GP for months, presenting with chest pains and feeling clammy. The GP put it down to anxiety and did no further investigation. It was only after she had a heart attack in her early twenties, that they realised she had a heart condition. This isn’t an isolated event, I’ve heard many stories like this from friends and other BPD content creators.

• Liver/kidney damage - This is something I’ve heard less about, but if you take a couple of things into consideration it makes sense. Firstly liver damage can be caused by excessive alcohol use. We know that many people with BPD also struggle with substance misuse and impulse control problems. Secondly, we know that overdoses of certain medications can also damage the liver. So we can safely assume that acting on our impulsive urges can cause us some pretty serious physical problems. With regard to kidney damage, I used to work with a woman who developed this through refusing to drink much water due to her low mood. 

• Digestion issues - this one is quite personal to me, but if you’ve read the ACEs study (seriously go research this, it’ll blow your mind) you can see how this could happen. I’ve had on and off stomach problems for most of my adult life, and I’ve suffered a lot of pain in my abdomen. I kept going to the hospital in agony; a roaring burning pain in my stomach that would have me on the floor screaming. No one could ever work out what the problem was - mainly due to the very long waiting times at my A&E. The pain would subside and I would be sent home. Eventually the doctors decided to do some investigating and it turned out that I had developed a stomach ulcer. There are many reasons why someone can get a stomach ulcer, but mine was put down to constant stress. Not really a situation I can fix when I live in a perpetual state of anxiety. I take medication for it and it is better managed now, but I have to be careful of what I eat and drink and take my meds wherever I go. 

• Dental problems - I wasn’t planning to write about this, but as I was thinking I realised how much of an issue this one is. I have been lucky. Countless nights of passing out without brushing my teeth and days where I simply couldn’t get the energy together, haven’t really caused me problems. I’m 29 without a single filling and have never had major work done in my adult life, despite not going to the dentist for a decade at one point. Others aren’t so lucky. It is a known fact that some antipsychotic medications can cause dental problems and weaken teeth. I know a few people who have rotted their teeth beyond repair thanks to not cleaning them, smoking cigarettes and avoiding the dentist. There have even been studies correlating poor dental hygiene with heart disease. 

As you can see, living with BPD and other mental health conditions can take a huge toll on your physical wellbeing. Remember when you are in treatment to talk about your physical health concerns and needs. You’re going to need help with it and you deserve to be looked after holistically.