So far I have refrained from voicing my personal opinion on SIM/HIN because I am aware I am not qualified to make a statement. However, I will just write this and please keep in mind it is just my personal opinion and not the least professional/scientific etc. @StopSIMMH #StopSIM

SIM seems to be based on the assumption that individuals who are frequently seen by services for self harm, suicide ideology/attempts have had pleasant experiences from those services/environments. Thus this “pleasant outcome” needs to stop to eradicate the behavior.

Now, a lot of these individuals have experienced horrible stigma, discrimination and maltreatment by services at some point, on some level, because we know that even though mental health stigmatization has come a long way it is nowhere near resolved even within clinical settings.

If behaviorism were to work on the individuals SIM is targeting, we would have seen results a long time ago. These people have experienced less that ideal treatment at different points and thus should have had their self-harm/suicidal ideation and service presentation eradicated?

Drawing on the fact that SIM seems to think most of the individuals who are repeatedly seen in services should have a diagnosis of “BPD” surely we need to remember the evidence available.

CBT (partly based on behaviorism) in its simplest form as delivered by IAPT does very little for “BPD” with the majority of SU preferring opportunities to work through their trauma. Then why would this over-simplified radical behaviorism type of approach work?

Going back to some of my very first psych lessons years ago, I vividly remember being told that in terms of behaviorism, reinforcement is much more powerful in modifying behaviors than punishment. That would be A-level psychology level. So why are we opting for punishment?

I needed to voice this because the idea that someone could be refused mental AND physical health care at A&E because they are seen as being in this setting to gain attention as they have attended A&E many times for their mental health had kept me up for the last few nights.

I don’t even want to attempt to discuss what bringing the police into the treatment of individuals with a history of trauma entails or the complexity of what needs to be done for effective care and to stop people falling through the cracks in MH care. I will leave it on this.

If this behaviorism were to work on this SU group we wouldn’t even be having this conversation. These people have had enough punishments in behavioral terms already and nothing has changed. However I am a fan of science so pls sign the petition so we can have some science on this