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Harshana Sangtani & Amanda C de C Williams

A week ago today, the government’s long-delayed ‘Independent Review of Prevent’ was finally published. As anticipated, it is a whitewash which fails to engage with the wide array of evidence of the duty’s harms, or respond to criticisms of Prevent from human rights groups, civil society organisations and multiple UN Special Rapporteurs. 

Instead, William Shawcross calls for harsher enforcement, expansion of the duty within public services, and the introduction of Prevent into immigration and asylum services as well as job centres  – all while doubling down on the targeting of Muslim communities, calling for Prevent to refocus on “Islamist extremism”.

Prevent – what we know

Prevent is part of the government’s counter-terrorism strategy, with the stated aim of identifying “vulnerability to radicalisation”. In 2015, the Counter Terrorism and Security Act introduced the Prevent duty into many public spaces – including  schools, universities, local authorities and healthcare services. This made the UK the only country in the world where healthcare bodies are legally obliged to respond to “the ideological challenge of terrorism”. 

People aren’t referred to Prevent because they have committed a crime: rather, they have simply been suspected of ‘susceptibility’ to radicalisation. Through the duty, health workers are expected to make a speculative assessment, largely reliant on trusting one’s “instinct”.  Such assessments lead to racial profiling, reliant on the redefinition of what behaviour or beliefs should cause concern. Consequently, and in conjunction with endemic Islamophobia across the UK, the harm caused by Prevent has fallen more heavily on Muslim people than on any other section of the population. 

The review process

Since its outset, the review process itself has been a whitewashing of the harms inflicted by the policy. Lord Carlile, Chairman of the Lloyd’s of London Enforcement Board, was initially appointed as independent reviewer for Prevent. However, various organisations, including Rights & Security International, openly objected to his appointment in response to his history of support for the Prevent strategy, revealing a clear inability to carry out a fair and unbiased review. Following public outrage, Lord Carlile stepped down two years later only to be replaced by William Shawcross, who has openly and consistently expressed Islamophobic sentiment. 

Shawcross was director of the Henry Jackson Society, an organisation whose own co-founder Matthew Jamison wrote in 2017 that he was ashamed of his involvement, having never imagined it “would become a far-right, deeply anti-Muslim racist … propaganda outfit to smear other cultures, religions and ethnic groups”. What’s more, during his directorship, Shawcross himself outrightly stated: “Europe and Islam is one of the greatest, most terrifying problems of our future. I think all European countries have vastly, very quickly growing Islamic populations.”

By this point, the good faith of human rights and civil society organisations that this review would be able to critically examine Prevent was completely discarded, and a boycott of the review was announced by a coalition of 17 UK organisations. 

The review’s findings

Targeting Muslim communities 

The review, known as the “Shawcross report”, was first leaked to the Guardian in May 2022  The results were far from surprising for many who have been critical of the Prevent strategy from its inception. Many of the deeply worrying key components shared in the leak have ultimately been included in the published review. 

The review questions the increased representation of far-right extremism in recent referral data, and calls for a renewed focus on ‘Islamist extremism’, including in instances where individuals do not meet the ‘terrorism threshold’. Although the government does  not publish complete ethnicity and faith data of those referred to Prevent, Medact and many other organisations have researched and outlined the disproportionate rates of Prevent referrals for Muslim and racially minoritised communities. From our False Positives report, looking at Prevent referrals from NHS Trusts, we found that Muslims were eight times more likely to be referred to Prevent than non-muslims, and that Asians and British Asians were around four times more likely to be referred. The government has been quick to point to 2021, a year in which more referrals were made suspecting far-right extremism than Islamic extremism, as evidence that the policy is not discriminatory. At the same time however, they seem to be treating this shift as an aberration, and as justification that Prevent must ‘refocus’ on its original target.  It’s important to remember that Muslim communities have been the identified target of Prevent since its formulation: Home Office leaked documents from 2019 describe “Prevent audiences” explicitly as British Muslims, particularly males aged 15 – 39.

If we needed further confirmation that the Prevent strategy has ignored the widespread concern and criticism of its targeting of Muslim communities, and maintained its Islamophobic focus, the findings of the Independent review provide just that.

It should be noted that we are not interested in shifting the parameters of Prevent’s targets. We are not seeking to debate who Prevent should concern itself with. We wish to underline that the strategy is poorly evidenced, fundamentally discriminatory and actively harmful to health as it operates within healthcare and across society. We believe health workers should recognise the Islamophobia that has underpinned  the Prevent strategy from its inception, actively oppose the duty as a legitimate method to tackle extremism, and demand its complete overhaul.

The conflation of mental ill-health and vulnerability to radicalisation 

The review names the major overrepresentation of those with mental health conditions in Prevent referrals, but fails to engage at all with the harmful outcomes of this for patients. Instead, Shawcross simply concludes this as “a serious misallocation of resources” that “risks diverting attention from the threat itself.” 

Mental health assessment and application of even well-established diagnostic categories is always a subjective activity, and agreement among professionals can be low. The pre-crime, predictive assessments of ‘vulnerability’ to particular political views or activities on which Prevent relies, creates the space for individual ‘impressions’, ‘instinct’, and other supposed sources of wisdom that fundamentally draw from racial stereotypes, anti-Muslim prejudice, and abelism. 

The Royal College of Psychiatrists has addressed the troubling, unsubstantiated link between mental health and terrorism in its report Counter-Terrorism and Psychiatry, concluding that a lack of a clear pattern or diagnosis means that “there should therefore be no assumption that an individual who carries out an act of terror is suffering mental ill health, nor that someone with poor mental health is likely to carry out a terrorist act”.  

Importantly, the lived experiences of those with mental health issues indicate that they are far more likely to face institutional and societal violence and neglect than to be the ones inflicting harm on others (Brick by Brick by Cradle Community, p82–83). The ambiguous, psychological dimension of the ‘mixed, unstable or unclear’ category of Prevent referral leaves plenty of room for ableism and mental health stigma to intensify, posing serious risk to those with pre-existing mental health conditions. 

Shawcross has correctly identified counter-terrorism policing shouldn’t fill the gaps in mental health services, but says nothing about the stigmatisation, pathologisation and racist attitudes that cause this conflation in the first place.

Outright failure to engage with the harms of Prevent in health care

Research from our False Positives report found evidence that Prevent referrals can damage the physical and mental health of the individuals concerned, as well as their families, in a variety of direct and indirect ways (see Chapter 5 and Chapter 6 case studies). 

From case studies, we found that Prevent referrals of people already being treated for pre-existing mental health conditions damaged therapeutic relationships between health practitioners and patients, setting back recovery, interrupting care, causing patients to disengage, and limiting the support health services can provide due to erosion of trust. Case study evidence has also suggested Prevent referrals can in fact trigger mental health problems, including in individuals with no prior reported history of psychiatric illness. 

Given the racialised disproportionality of Prevent referrals, as identified in our research, and new calls to ‘refocus’ Prevent on ‘Islamist extremism’, these negative effects are likely to be impacting the health and mental health of Muslim communities more than others.

Prevent introduces a fundamental conflict for health workers between the duty and their professional duties of care and confidentiality with patients – blurring the distinction between safeguarding and public protection, and introducing institutional pressure to comply. Many (if not most) referrals are made on the basis of very little evidence, and without seeking patient consent as a result. 

In the review, Shawcross also attempts to position health workers – and all public sector workers obligated to comply with the statutory duty – as ‘unsung’ implementers, to be ‘praised’ for carrying out the policy. As a health community, we reject this position. The patient–health-worker relationship is an integral part of providing care, made fraught by the introduction of new obligations by the Prevent duty. The inappropriate breaching of confidentiality erodes trust, compromises the therapeutic practitioner-patient relationship, and discourages health-seeking behaviour. It also puts practitioners squarely in breach of their professional obligations, GMC guidance and the law.  

Taking action as a health community 

Medact’s 2020 False Positives report made it clear that the Prevent strategy carries a high false positive rate and there is limited evidence that it is effective in reducing the risk of terrorism. We have evidence that the training itself relies on racial and religious bias, that referrals have been shown to negatively impact on health and that it demands health workers prioritise policing over patients.

The Shawcross review follows an observable expansion in securitisation policies in healthcare and indicates to us that we must act fast to prevent further securitisation of our healthcare system. In her article exploring the PCSC Bill’s implications for medical practice in the UK, Sarah Lasoye explains how the Serious Violence Duty that forms part of the bill would ‘enable the police to override data protections, undermine confidentiality and erode public trust in health services by requiring health workers to share confidential patient information’. 

Instead of welcoming such a policy without resistance, we saw groups such as the BMA, GMC and BACP openly acknowledge its dangers. In fact, the BMA released a parliamentary brief outlining these dangers on behalf of the concerns expressed by healthcare workers and students across the UK and, as a result, the health sector was made exempt from the Serious Violence Duty.

We know, therefore, that mobilisation against issues of patient safety is possible and successful. The implementation of the Prevent strategy in healthcare warrants the same level of response. 

As a healthcare student , I would like to see the future of medical practice centre justice, understanding and trust and reject policies that do not reflect this. That is why I oppose the Prevent duty in healthcare, and you should too.

—Harshana Sangtani, medical student (she/they)

As an academic and clinical psychologist involved in training the next generation of clinical psychologists, I am deeply concerned about the misrepresentation of police and security agendas as mental health care, and about the way in which mental health services are being compromised by the demands of Prevent. Healthcare workers, their professional bodies and their unions, need to resist complicity in these policies and institutions; to challenge the redefinitions of mental illness and criminal activity by the police and security services; and to work towards the repeal of Prevent.

—Amanda C de C Williams, Professor of Clinical Health Psychology & Consultant Clinical Psychologist (she/her)

To stand up for the rights of both patients and health workers: