Counter terror rules incentivise GPs to refer patients to Prevent

Doctor's surgery

Academics Charlotte Heath-Kelly and Erzsebet Strausz say counter-terror rules give GPs bizarre incentives to refer mental health patients as a radicalisation threat.

Mental Health Trusts in England are now to play a vital role in processing the huge number of citizens referred under the government’s counter-terrorism strategy, known as Prevent.

A new policy announced in November by the Home Office means urgent psychiatric care will now be provided by Mental Health Trusts to those people with psychological problems who are referred to Prevent. But this will remove them from a pipeline of support under a programme called Channel, aimed at those suspected of radicalising.

No one could possibly object to the provision of mental health care to those in need. But on deeper inspection, the integration of Mental Health Trusts within the Prevent strategy reveals profound confusion within counter-terrorism policies.

And the move could give health professionals perverse incentives to actually refer patients with mental health needs to Prevent – because they think it might get them help quicker.

Debates in the media about the new policy have so far focused on the small percentage of Prevent referrals which end up receiving specialist Channel support – 5% of the 7,631 people referred between April 2015 and March 2016 – and the disproportionate number of Islamist-related referrals.

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The government’s figures on outcomes for those referred to Prevent show that 36% of people were deemed unworthy of further action, meaning they were not at risk of radicalisation. A further 50% of referrals received help from “other services” – not de-radicalisation ones – which included education, health and social care.

But if in 50% of cases, radicalisation can be prevented by fast-tracked access to education, healthcare and social support, the government should not be cutting funding for these very services.

The government’s logic suggests that strong social services can prevent radicalisation. So surely the reduction in availability of services, through government austerity cuts, is likely to increase the risk of radicalisation. Reversing austerity would therefore reduce the number of people at risk of radicalisation.

Relying on mental health

The NHS has been responsible for preventing terrorism since 2011, when Department of Health policy framed Prevent as a safeguarding measure. Since then, great efforts have been afoot to train every GP, nurse, dentist and X-ray technician to spot the “signs” of radicalisation.

The government is now increasingly committed to using mental health practitioners to deal with Prevent cases and in November the Home Office launched a new e-learning package about radicalisation for those working in the mental health sector.

The NHS will now not only make Prevent referrals about patients – it will also receive Prevent cases and provide these people with mental health support.

Think carefully about what a standard referral to Prevent will mean under these new rules. A person requiring mental health support causes concern to someone, but rather than being referred directly to the NHS for help they are placed on the Prevent pathway.

They then pass through all the stages of the Prevent referral path, including specialist police background checks, before their case is scrutinised by the local authority Channel panel. Only at that point does the team decide that the individual has a health need, rather than requiring de-radicalisation.

Rather than provide adequate mental health care for all who need it, British society is more comfortable assuming that some vulnerable people are potential terrorists. Only when a specialist team declares that de-radicalisation is not required does the potential for healthcare then reopen.

This is a consequence of the Prevent duty itself. Since 2015, when reporting under the Prevent duty became mandatory, the number of people referred has rocketed. Where the system could once expect 500 or 1,000 referrals a year, it received 7,631 in 2015-16.

Once a person is referred to Channel they will be put in the charge of a Channel mentor who usually has experience of youth work or religious expertise. But it can take up to 18 months for the Home Office to approve a new mentor, and our conversations with some of them for our research suggest that there aren’t enough across the country to provide for 7,631 people per year.

During this long approval process, existing mentors remain exceptionally busy. This goes someway to explain why mental health and social care services have been asked to step in and deal with Prevent referrals.

Bizarre incentives

If access to social care, healthcare and education steers someone away from extremism, then it is sensible to assume the removal of those services must increase vulnerability.

But merging social care with counter-terrorism safeguarding also creates a bizarre incentive for GPs to make inappropriate referrals to Prevent, so that their patients can gain access to the housing, psychiatry and social care which patients are otherwise denied because of government cuts.

During interviews for our study of Prevent in the NHS a GP expressly told us that:

“One of my patients, single man, was made homeless. He had no chance whatsoever of getting housing. He was referred to Prevent because when he turned up at the housing centre saying ‘I want to kill Muslims and Africans …’ So, he got referred straightaway to Prevent. He was housed in a couple of days. There are times where I’ve actually thought to myself, ‘you’ve got housing issues, maybe I should say you’re a danger to society, you’re at risk of radicalising’.”

When austerity removes the safety net people rely upon for mental health services and housing, social care professionals will find other ways of obtaining services for those in need – even if it involves stigmatising them through the Prevent programme.

While Prevent has long been confused about the line between security risk and social care need, this dynamic has been made infinitely more problematic by economic austerity.

This article first appeared on The Conversation website.

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SOURCEThe Conversation
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