The antithesis of care

Hilary Aked writes about the insidious role of Prevent, the government’s counter- extremism programme, in compromising mental health services

September 28, 2020 · 6 min read
‘Hospital’ by capturedbychelsea is licensed under CC BY-NC-ND 2.0

For an NHS psychiatrist working with schizophrenic patients, it’s not unusual to witness people suffering from severe paranoia. Fear of being watched by the state and persecuted by the police may well feature in such patients’ delusions. What is rarer is for someone receiving mental health care to see their fears come to life because their psychiatry team has reported them to Prevent, leading police to question them as a suspected potential terrorist.

Yet these are the kinds of scenarios that occur in the NHS today because of the insidious Prevent policy. Implemented soon after the 7/7 bombings of 2005, and long the most controversial strand of the UK government’s counter- terrorism strategy, the so-called Prevent ‘duty’ was made statutory by the Counter-Terrorism and Security Act 2015. A host of public institutions, including schools, hospitals and universities, have since been legally required to ‘have due regard to the need to prevent people being drawn into terrorism’.

Spotting the signs

In the NHS, what that means in practice is that around 85 per cent of staff are expected to be given Prevent training to help them spot the alleged ‘signs of radicalisation’. The problem, of course, is that there is no conveyor belt from holding radical views to committing acts of political violence. The 22 factors that it is claimed may increase ‘vulnerability’ to ‘radicalisation’ include traits as innocuous as ‘a desire for political, social or moral change’, ‘a desire for excitement and adventure’ and a ‘need for identity, meaning and belonging’.

It’s interesting to compare the inclusion of such widespread characteristics with how the current coronavirus pandemic has been handled. Despite ear, nose and throat specialists saying for two months that loss of taste and smell was a symptom of Covid-19, its official inclusion was delayed until its predictive value had been ascertained. No such stringency is exercised with the psychometric systems used to predict potential terrorist involvement.

Told they must be vigilant, how do health workers and other public sector employees operationalise and apply these blunt instruments without sweeping up virtually all their patients in the dragnet? Naturally, they are also given more specific clues about whom they should suspect. On a website called ‘Let’s Talk About It’, created by Bedfordshire Police and recommended by the National Counter Terrorism Security Office, the 22 factors are discussed in detail. ‘Feelings of grievance and injustice’, a page called ‘Spotting the signs’ explains, may arise from experiences of ‘racial or religious harassment’, or from ‘poverty’ or ‘disadvantage’. Already suspect, thanks to what scholar Arun Kundnani calls the ‘racial subtext to the entire discourse of counter- terrorism’, minorities – especially Muslims – are thus obliquely but unambiguously highlighted as potential terrorists in ways that are also deeply classed.


Make no mistake – psychiatrists are not simply referring to Prevent just any patients with mental health conditions who make vague threats of violence. It is black and brown people, and especially Muslims, who are overwhelmingly reported. Indeed, in the recent report False Positives: the Prevent counter-extremism policy in healthcare, published by the health charity Medact, where I work, we found that Muslims were reported to Prevent eight times more than non- Muslims, and Asians four times more than non-Asians.

As one psychiatrist told us, in a case involving a British-Pakistani Muslim man, the patient’s religious rhetoric, lacing his ‘bizarre but threatening statements’ had been a critical factor leading to his referral to Prevent. Non-Muslim white British patients making similar threats – while experiencing similar levels of psychosis – would not have generated such alarm or provoked such an interrogation.

Hidden harms

The racial and religious disproportionality of counter- extremism measures like Prevent was already well-known from areas such as education. But due to the confidentiality protocols governing medical professionals, we hear less about the impact of Prevent in healthcare. Its hidden harms, however, may be even more profound.

According to the (very limited) statistical information released by the Home Office, young people under the age of 20 constitute the majority of those reported to Prevent nationwide. Many of these referrals come from the education sector but the health sector’s ‘contribution’ has been steadily rising, today comprising around 10 per cent of the approximately 5,000- 7,000 annual referrals.

Our research found that patients referred from mental health departments and mental health specialist trusts are massively over-represented in Prevent referral figures. This means that the discriminatory treatment under Prevent faced by black and brown Muslims, especially young people, is further compounded for those experiencing difficulties with mental health.

We should not underestimate the traumatising and damaging effects that Prevent interrogation can have on people, especially young people from already marginalised groups who are vulnerable due to their mental state. In the case of the schizophrenic British-Pakistani patient, his psychiatrist reflected that the Prevent referral undoubtedly harmed the therapeutic relationship so fundamental to healing from conditions like his, and thus very likely set back his recovery.

In another case, a Muslim family lost trust in an entire NHS care team after a physiotherapist referred their severely ill son to Prevent despite the fact that he was unable to self-feed. In a third example, a GP told us about a Muslim teenage boy who had developed obsessive compulsive disorder (OCD) as a direct result, he believed, of the prolonged stress of weeks of entanglement in the Prevent process.

The government’s claim that people with mental health conditions may be more likely to be drawn into terrorism is not supported by robust evidence. Prevent mixes mental health stigma and racism in ways that harm not only individual patients and their families but also wider trust in confidential, non- discriminatory healthcare. As a hospice worker observed, appalled at being told to watch for signs of extremism among extremely frail patients at the end of their lives, the surveillance mentality of Prevent is the antithesis of care.

Ensuring that the resurgent UK racial justice movement includes repeal of Prevent as a central demand is vital. Don’t hold your breath for the long- delayed, government-commissioned independent review of Prevent to deliver the death blow this failed and harmful policy urgently needs.

Dr Hilary Aked is a writer and investigative researcher. This article originally appeared in issue #229 ‘No Return to Normal’. Subscribe today to get your copy and support fearless, independent media.


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