“There should be no conflation of mental ill health and terrorism,” says NHS guidance on how the Prevent duty should be administered. I wholeheartedly agree, and I’m highly concerned by the report from Warwick University that suggests the very opposite is happening.
A number of mental health trusts in England seem to be applying radicalisation screening to each and every one of their patients. This sends out a strongly stigmatising message. It implies that people with mental illness are a group apart. In the words of the report’s authors this “inappropriately positions” those with mental illnesses as a community from which terrorism originates.
Would all patients in a general hospital ever be subject to blanket screening without their consent or knowledge?
It needs to be understood that radicalisation is not a mental illness
Prevent, which stems from the Counter-Terrorism and Security Act 2015, requires providers of health services to consider how they should report patients, as well as their colleagues, when concerns regarding radicalisation are suspected.
As a psychiatrist, the care, treatment and safety of my patients is at the centre of what I do. As well as having a duty to safeguard our patients, I also have a duty to safeguard the public – just like any other doctor. But I’m really unsure about whether the use of Prevent really can be considered safeguarding. And I’m not alone: more than half of the NHS staff surveyed in the Warwick University report were unsure whether Prevent belongs in healthcare.
For context, it should be noted that the UK is the only country in the world where a duty to report signs of radicalisation is expected of a healthcare system.
I recognise the importance of counter-terrorism measures. Terrorism causes enormous human suffering, and in itself can lead to psychiatric consequences. Yet I and other psychiatrists have serious concerns about the implementation of Prevent, which we voiced while the strategy was being developed. Many of these concerns have now been borne out.
Yes, mental illness itself can make individuals susceptible to negative influences, and they can become victims of violence and exploitation. This is something I see all too often as a forensic psychiatrist – addressing this is a major part of my work.
However, it needs to be understood that radicalisation is not a mental illness. Individuals hold a wide spectrum of beliefs: when these are extreme it should not lead to an immediate connection with mental disorder.
The finding that Prevent referrals are encouraged, even if they are “checking, just in case” is deeply worrying. The report shows that referrals are being made due to patients possessing unpleasant opinions, or reading religious philosophy. This is “a rationale more familiar to surveillance”, as the report concludes, and it illustrates the difficulties myself and colleagues need to grapple with when considering a Prevent referral.
As a psychiatrist, I take many steps with my colleagues and the patients we work with to minimise risks where possible, but it has not been shown that we can predict rare events like terrorist attacks. Surely time and resources would be better spent elsewhere, rather than requiring public sector staff to dedicate considerable hours to forecasting such occurrences.
The automatic screening of patients with mental illness must be ended.
In an age where failing to show support for mental wellbeing is becoming almost unthinkable, I cannot see how we can allow such stigmatising and discriminatory treatment towards those with mental illnesses to be continued.
To help my patients – who often suffer from complex, debilitating mental illnesses – it is vital to build up trusting, open, patient-doctor relationships. This will be really difficult if patients feel they are under suspicion by virtue of their illness, and at risk of being subsumed into a process dominated by the criminal justice system just for seeking psychiatric help.
More evidence needs to be published regarding any perceived benefit from Prevent for patients – and they must always be fully informed about what the processes really mean. Consent for referrals needs to be open and transparent.
Every day I see the consequences of when people struggling to get support for their mental illness – this can be life-changing for the people involved and those around them. People with mental illness must feel free to engage fully with mental health professionals, without raising further concerns over supposed radicalisation.
Rather than preventing terrorist attacks, I fear that Prevent measures, at present, do little more than prevent people seeking support for serious illness.
• Dr Adrian James is registrar of the Royal College of Psychiatrists and forensic psychiatrist at Devon Partnership NHS Trust