On Monday (9th August), the Guardian published an article on ‘vulnerability support hubs’, a project which embeds NHS mental health professionals into counterterrorism police units as part of the controversial Prevent counter-extremism policy.
All the sources cited in the piece are involved in (and unsurprisingly supportive of) the scheme: police lead for Prevent Chief Constable Simon Cole, national coordinator of Prevent Chief Superintendent Nik Adams, and clinical lead Dr Nicki Fowler.
Oddly, no counterbalancing critics of the hubs are quoted. The paper did not even link to its own article from May this year, which was based on Medact’s report Racism, mental health and pre-crime policing: the ethics of Vulnerability Support Hubs. The evidence in that report, however, starkly contrasts with many of the claims made by Cole, Adams and Fowler.
Let’s start with the headline’s claim that “up to 70% of people referred to Prevent may have mental health issues”. In fact, Cole’s specific claim is that about 70% of Prevent cases “now have some measure of concern within them that needs assessing via vulnerability support hub.” What exactly does that mean?
The article tells us that although the hubs “were set up to deal with those with mental health issues”, they soon “adapted to deal with other vulnerabilities that could cause mental health distress”. In other words, in contrast to mainstream mental health services – where the bar to access support is very high – the hubs use sub-diagnostic thresholds.
Indeed, through an FOI request, we revealed that in its first year of operation only 26% of the Midlands-based hub’s referrals presented with a diagnosable mental illness. Others had complex needs, ranging from autism to substance misuse to housing problems. These issues have the potential to be significant challenges, but they should not be treated as risk factors for terrorism, handled by counterterrorism police, or pathologised as mental health issues. As the Royal College of Psychiatrists has warned, it is “important that the distinction between normality and pathology is not lost.”
In the article, the police claim that the hubs are often “the first state service to refer [people] for the help they may need”. Again, the data contradicts this: a high proportion of the people referred were in fact already in contact with mental health services.
And despite the rhetoric of support, internal documents show health workers are being asked to “monitor” patients. This is surveillance, not care.
Cole also notes that the hubs are “accused by some of unfairly targeting Muslim communities” but disputes this claim. The statistics, however, support this perception. Through our research, we found that a Muslim is at least 23 times more likely to be referred to the hubs for alleged ‘Islamism’ than a white British individual is for ‘Far Right extremism’.
Meanwhile, Adams states that police are not “trawling for mental health information” through the hubs. Yet documents we obtained showed clearly that easier access to health information was a key success of the scheme from the perspective of the police. For example, at the end of the pilot scheme, an evaluation document observed that by “significantly reducing the time it takes to get health information”, the project was “markedly saving police time and resources”.
Once you cut through the spin, the evidence about vulnerability support hubs raises serious ethical concerns. It is deeply concerning, and potentially coercive, that mental health assessments are being conducted in the presence of police. And health workers contributing to “combined” risk gradings, which collapse any separation between mental health conditions and terrorism concern, are likely acting beyond their remit.
In a letter to the Guardian responding to our report, counterterrorism police called Medact’s research “biased” and claimed that the hubs work is not about “the ‘securitisation’ of mental health provision but the ‘clinicalisation’ of preventive counter-terrorism work”. Either way around, we are in dangerous territory when the lines between security and care become blurred.
Counterterrorism policing’s ‘pre-crime’ security concerns are often spurious and racist, as shown by research we referenced in our report False Positives. They should not be improperly influencing medical treatment or psychiatric decision-making. People in mental distress should get the treatment they need in mainstream mental health services – which we know are chronically underfunded.
The hubs are completely non-transparent, as they are based within counterterrorism units. Yet the NHS has helped pay for them, despite the complete absence of any evidence that they are reducing terrorism, let alone improving health outcomes.
Instead, they are exacerbating stigma around poor mental health – especially amongst Muslims and migrants – linking it to terrorism without robust evidence. And they are very likely to be creating mistrust and deterring racialised groups from accessing healthcare. The hubs must be closed down and the harmful Prevent policy as a whole scrapped.
- Counterterrorism police can’t spin surveillance as care - August 12, 2021
- Racism, mental health and pre-crime policing: the ethics of Vulnerability Support Hubs - May 19, 2021
- Submission to the Special Rapporteur on freedom of religion or belief’s call for evidence on anti-Muslim hatred and discrimination - November 27, 2020