{"id":48303,"date":"2020-08-13T21:51:42","date_gmt":"2020-08-13T20:51:42","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48303"},"modified":"2020-08-28T16:46:04","modified_gmt":"2020-08-28T15:46:04","slug":"shazad-amin-the-prevent-policy-has-no-place-in-modern-healthcare","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/13\/shazad-amin-the-prevent-policy-has-no-place-in-modern-healthcare\/","title":{"rendered":"Shazad Amin: The Prevent policy has no place in modern healthcare"},"content":{"rendered":"

Prevent is part of the UK Government\u2019s counter-terrorism strategy, and in 2015 it imposed a statutory duty for public sector employees to have <\/span>\u201cdue regard to the need to prevent people from being drawn into terrorism.<\/span><\/i>\u201d [<\/span>1] People identified as being “at risk” are referred to a local Channel panel, where they can be assessed for Channel “support.” In 2018-19, 564 individuals were referred under the Prevent strategy via the Health sector, 10% of all referrals. [<\/span>2]\u00a0\u00a0<\/span><\/p>\n

While few would disagree with its aims, Prevent is controversial. A major new report by MEDACT has raised concerns about the application of Prevent in healthcare. The report \u201c<\/span>False Positives \u2013 the Prevent counter-extremism policy in healthcare<\/span><\/a>\u201d concluded that the Prevent policy in healthcare should be repealed, and highlighted a number of concerns including that Prevent referrals were disproportionately targeting Muslim and ethnic minority populations, that there was \u201cracial bias\u201d in official training materials, and that found evidence that Prevent referrals were damaging to people\u2019s mental health and to therapeutic relationships.\u00a0 \u00a0\u00a0<\/span><\/p>\n

Government counter-terrorism policy has for many years viewed the whole Muslim community in the UK through a securitised lens, i.e. as a potential terror threat. Government guidance from 2007 stated that Prevent funding eligibility for local authorities would be focused on those with \u201c<\/span>sizeable Muslim communities<\/span><\/i>\u201d, adding \u201c<\/span>the<\/span><\/i> key measure of success will be demonstrable changes in attitudes among Muslims …<\/span><\/i>” [3]<\/p>\n

Proponents of Prevent suggest it is about safeguarding vulnerable people. However this reverses the normative view of safeguarding, i.e. protecting the patient from society, whereas here it is protecting society from the patient. Adrian James, President of the Royal College of Psychiatrists, has stated \u201c<\/span>I also have a duty to safeguard the public\u2014just like any other doctor. But I\u2019m really unsure about whether the use of Prevent really can be considered safeguarding.<\/span><\/i>\u201d [<\/span>4] A report in 2018 evaluated the role of Prevent safeguarding in the NHS and found that 47% of healthcare professionals disagreed that \u201c<\/span>Prevent is a genuine safeguarding procedure<\/span><\/i>\u201d and only 48% agreed that the \u201c<\/span>Prevent duty belongs in healthcare<\/span><\/i>\u201d.<\/span> [5]<\/p>\n

Another concern is that it is primarily a surveillance programme. Following the 2017 terrorist attacks in Manchester, the then Home Secretary Amber Rudd revealed on BBC Question Time <\/span>\u201cWe get the intelligence much more from the Prevent strategy, which engages with local community groups, not through the police.<\/span><\/i>\u201d [<\/span>6] Infact Prevent embeds surveillance structures into Muslim communities at different levels, often covertly. [<\/span>7] \u00a0<\/b>Heath-Kelly and Strausz also found NHS staff were split as to whether Prevent was a form of surveillance, with 33% stating it was not, and 24% stating it was. [<\/span>5]<\/p>\n

This is important when considering the wider context of increasing Islamophobia in society. Home Office data records that nearly half of all religiously motivated hate crime is targeted towards Muslims. [<\/span>9]\u00a0 A Comres Poll of the general public in 2018 revealed that nearly half of people surveyed thought that religious discrimination towards Muslims was more than against people of other faiths, and that 43% of respondents would be \u201c<\/span>Concerned if a mosque was built in my neighbourhood<\/span><\/i>\u201d. [<\/span>10]\u00a0 Analysis of the British press revealed 21 negative references to Muslims for every single neutral or positive reference; <\/span>often such references were to Muslims being involved with violence, conflict, and terrorism. [11]<\/span><\/p>\n

NHS staff are not immune to being influenced by such prejudicial attitudes towards Muslims. The Prevent strategy normalises such attitudes under the guise of safeguarding. Hence unsurprisingly data has shown that a Muslim is between eight and 40 times more likely than a non-Muslim to be referred under Prevent. [<\/span>12,13]<\/p>\n

What is worse is that Prevent has no significant evidence base or independent peer-reviewed process underpinning it. [<\/span>14] There is a paucity of research as to whether Channel Support interventions work, with the little evidence available suggesting they do not. [<\/span>15] Only approximately 10% of Prevent referrals eventually receive Channel support, suggesting a high number of stigmatising “false” referrals.<\/span><\/p>\n

In addition only <\/span>4% of NHS Trusts<\/span><\/a> gave a full disclosure of their Prevent referrals with a staggering 38% of NHS Trusts refusing to disclose any data, with evidence that many used advice from NHS England to refuse Freedom of Information requests. Such data should be in the public domain, and subject to independent scrutiny.\u00a0<\/span><\/p>\n

Supporters of Prevent often point to the pending Independent Review of Prevent as evidence that the Government is listening to such criticisms. However <\/span>the proposed <\/span>Counter-Terrorism and Sentencing Bill 2019\u201321 (amending the current\u00a0 Counter-Terrorism and Border Security Act 2019) seeks to remove any time constraints on when such a review needs to be completed (previously it was within 18 months of the Bill being passed) and also to remove the previous statutory duty upon the Secretary of State in Section 20 (10) of the current Act to \u201crespond to each recommendation made as part of the independent review\u201d. [<\/span>16] If the Bill is passed, then such an Independent Review could theoretically take several years to complete and whatever it concludes, the Government has no duty to respond to it in any case.\u00a0<\/span><\/p>\n

Prevent is a classic example of policy based evidence, not evidence based policy. It is unacceptable that whilst many ethnic minority and Muslim health professionals have given the ultimate sacrifice tackling the covid-19 pandemic that such a structurally racist and Islamophobic policy continues to be pursued. In the era of Black Lives Matter, the medical profession, and especially Muslim and ethnic minority doctors, should have enough courage to call out Prevent. It should have no place in modern healthcare.<\/span><\/p>\n

Shazad Amin, <\/b>Consultant Psychiatrist (retired) and CEO of MEND<\/span><\/em><\/p>\n

Declaration of interest<\/strong>: SA is CEO of MEND (Muslim Engagement and Development), an advocacy organisation that has been publicly critical of Prevent.<\/span><\/p>\n

References:<\/b><\/p>\n

    \n
  1. HM Government (2015) <\/span>Prevent Duty Guidance: For England and Wales<\/span><\/i>. The Stationery Office, London<\/span><\/li>\n
  2. Home Office (2019) <\/span>Individuals referred to and supported through the Prevent Programme, April 2017 to March 2018<\/span><\/i>. Statistical bulletin 32\/19.\u00a0 The Stationery Office, London<\/span><\/li>\n
  3. Department for Communities and Local Government (DCLG) (2007) <\/span>Preventing violent extremism pathfinder fund: guidance note for government offices and local authorities in England<\/span><\/i>. Department of Communities and Local Government, London<\/span><\/li>\n
  4. James, A. (2018) I’m a Doctor, Not a Counter-Terrorism Operative. Let Me Do My Job. <\/span>The Guardian. <\/span><\/i>www.theguardian.com\/commentisfree\/2018\/mar\/21\/doctor-counter-terrorism-mental-health-patients-radicalisation-prevent<\/a> (Accessed 31st December 2019)<\/span><\/li>\n
  5. Heath-Kelly, C., Strausz, E. (2018) Counter-terrorism in the NHS: Evaluating Prevent Safeguarding Duty in the NHS. University of Warwick, Coventry.<\/span><\/li>\n
  6. Press Association (2017) Amber Rudd denies cuts to police were factor in Manchester atrocity. <\/span>The Guardian<\/span><\/i>. <\/span>https:\/\/www.theguardian.com\/uk-news\/2017\/may\/25\/amber-rudd-denies-cuts-to-police-were-factor-in-manchester-atrocity<\/span><\/a> (Accessed 31st December 2019)<\/span><\/li>\n
  7. Qurashi, F. (2018). The Prevent strategy and the UK \u2018war on terror\u2019: embedding infrastructures of surveillance in Muslim communities.\u00a0<\/span>Palgrave Communications<\/span><\/i>,\u00a0<\/span>4<\/span><\/i>(1), 17.<\/span><\/li>\n
  8. Younis, T., & Jadhav, S. (2019). Islamophobia in the National Health Service: an ethnography of institutional racism in PREVENT’s counter\u2010radicalisation policy.\u00a0<\/span>Sociology of Health & Illness<\/span><\/i>.<\/span><\/li>\n
  9. Home Office, October 2019 Hate crime, England and Wales, 2018\/19\u201d. <\/span>https:\/\/www.gov.uk\/government\/statistics\/hate-crime-england-and-wales-2018-to-2019<\/a><\/li>\n
  10. ComRes. 2018. MEND Islamophobia Poll October 2018. https:\/\/www. comresglobal.com\/polls\/mend-islamophobia-poll-october-2018\/\u00a0<\/span><\/li>\n
  11. Baker, P, Gabrielatos, C. and McEnery, T. (2013) <\/span>Discourse analysis and media attitudes: the representation of Islam in the British Press<\/span><\/i>. Cambridge: University Press, 2013.<\/span><\/li>\n
  12. Medact. False positives: Prevent counter-extremism policy in healthcare.\u00a0<\/span>www.medact.org\/2020\/resources\/reports\/false-positives-the-prevent-counter-extremism-policy-in-healthcare<\/a><\/span><\/li>\n
  13. Versi, M. (2017) The latest Prevent figures show why the strategy needs an independent review. The Guardian<\/i>. <\/span>https:\/\/www.theguardian.com\/commentisfree\/2017\/nov\/10\/prevent-strategy-statistics-independent-review-home-office-muslims<\/a>\u00a0<\/span><\/li>\n
  14. Mythen, G., Walklate, S., & Peatfield, E. J. (2017). Assembling and deconstructing radicalisation in PREVENT: A case of policy-based evidence making?.\u00a0<\/span>Critical Social Policy<\/span><\/i>,\u00a0<\/span>37<\/span><\/i>(2), 180-201.<\/span><\/li>\n
  15. Hamilton, F (2018) Most progammes to stop radicalisation are failing. <\/span>The Times<\/span><\/i>. <\/span>www.thetimes.co.uk\/article\/most-programmes-to-stop-radicalisation-are-failing-0bwh9pbtd<\/a>\u00a0 (Accessed 31st December 2019)<\/span><\/li>\n
  16. “Counter-Terrorism and Sentencing Bill 2019-21,” Legislation.gov.uk, accessed 13<\/span>th<\/span> July 2020, <\/span>https:\/\/services.parliament.uk\/bills\/2019-21\/counterterrorismandsentencing.html<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Prevent is part of the UK Government\u2019s counter-terrorism strategy, and in 2015 it imposed a statutory duty for public sector employees to have \u201cdue regard to the need to prevent […]<\/p>\n

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