Questions over Prevent referrals by mental health trusts | Letters

In your report (Patients reported as terror risk for watching Arabic TV, 19 March), a forensic psychiatrist says, “I’m ashamed, it’s totally unscientific”. There are more pressing reasons than science for psychiatry to be ashamed of its engagement in this programme. Patient confidentiality has been a fundamental principle of medical care since Hippocrates. Nowhere is it more important than in psychiatry, where troubled people need to know that their concerns will be treated sympathetically and confidentially.

The reporting of people to authorities for what they think rather than what they do is surely contrary to all we value in our legal and civic tradition, while the naive hypocrisy of labelling a surveillance role as a safeguarding one fools nobody. It compromises psychiatry’s need to try to be as honest and transparent with patients as possible. We have long had to balance our primary duty to patients with our undoubted obligations to the society in which we operate. This has always been a highly complex and sensitive area with no easy answers. If not addressed openly and honestly, it risks a serious breakdown of trust. There are well-established principles for breaking medical confidentiality if there is clear evidence of dangerous criminal activity or direct risk to a third party. Prevent falls well outside these principles. Given some of the darker episodes in our history when we have colluded with repressive regimes, it is remarkable that psychiatry’s challenge to Prevent has not been more vociferous.
Tom Burns
Professor emeritus of social psychiatry, University of Oxford

The Guardian contributes to anti-Prevent mythology by reporting a pilot research study, Counter-terrorism in the NHS: Evaluating Prevent Duty Safeguarding in the NHS (by Drs Heath-Kelly and Erzsébet Strausz), which rests on shockingly shaky foundations. Among other things, the study suggests that the mentally ill are being unfairly stigmatised as terrorism risks by NHS mental health trusts which are themselves being turned by the counter-terrorist Prevent strategy into instruments of surveillance rather than safeguarding. Yet these sweeping allegations are based on interviews with only 17 NHS “experts”, two police officers, and safeguarding teams in six NHS trusts and clinical commissioning groups out of over 300, plus completed online questionnaires from an unrepresentative sample of 329 out of a total of 1.5 million NHS employees. This is not sound social science.
Steven Greer
Professor of human rights, University of Bristol Law School

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