UK counterterror mental health project raises ethical concerns

A six-year-old is among thousands suspected of ‘extremism’ to have been assessed in hubs set up by counterterrorism police, medical charity says.

London, United Kingdom – Thousands of people in the United Kingdom suspected of “extremism” – including a six-year-old – have had mental health assessments, often in the presence of police, as part of a scheme that blurs the line between “security and care”, a medical charity has claimed.

Medact released its findings on Wednesday and called for the “secretive” programme set up by counterterrorism police, in which mental health professionals work alongside police officers, to be scrapped due to ethical concerns.

The so-called Vulnerability Support Hubs were launched in southern, central and northern England as part of a pilot programme in 2016 and have since become an established part of the UK’s counterterrorism framework.

Almost 4,000 people were assessed between 2016 and 2020, Medact said.

Many arrived at the hubs having been referred as part of the government’s controversial counterterrorism strategy, Prevent.

Medact warned the assessment hubs project had effectively deployed “medicine as a security device” and has disproportionately targeted minority communities, particularly Muslims, since it began.

Medact, which made a series of Freedom of Information (FOI) requests regarding the scheme, said “counterterrorism policing’s often spurious and highly racialised pre-crime security concerns” had routinely influenced the medical treatment received by patients.

The charity said that assessments being conducted with police present could “potentially [cause] clinicians to vary their normal medical practice”.

It added that people had been detained under the Mental Health Act in cases where officers appeared to have pressured healthcare professionals, and reported instances where patients’ privacy rights were eroded, as police had greater access to their healthcare information.

“Improving mental health outcomes for patients is not the priority,” Medact said.

“Rather, the hubs’ main purpose emerges implicitly as helping police to mitigate the perceived risk posed by the individuals referred. These people, it bears repeating, often do not have mental health conditions and have not committed a crime, but have been referred on the basis of suspicion alone.”

‘Ethically dubious’

Medact said many who had been assessed were young adults and children, the youngest of whom was six.

Its findings also revealed that Muslims were at least 23 times more likely to be referred to a hub for “Islamism” than a white British person was for “far-right extremism”.

In some case studies Medact reviewed, medical professionals were encouraged to monitor more closely the medication regimes of patients who had converted to Islam or were deemed to be “acting in an odd manner”.

“[The] monitoring of patients referred for ‘Islamic ideology’ risks pathologising normative Muslim practices,” said Shazad Amin, a consultant psychiatrist and the deputy chair of MEND, a group which seeks to tackle Islamophobia.

“The disproportionate rates of Muslim children being referred is also concerning – we need clarity on the reasons for this to ensure that judgements based on Islamophobia are not being made.”

Medact’s report concluded that healthcare staff often worked beyond their remits, such as by collaborating with police to engage in “‘deradicalisation’ work of dubious scientific validity”.

“This report shows that within Vulnerability Support Hubs, doctors may be working beyond their competence in helping to assess patients as a terrorism risk, which conflicts with guidance in good medical practice,” said Amin.

Hil Aked, a co-author of the report and Medact’s research manager, said: “This project claims to be about care, but it’s actually about helping police circumvent confidentiality, while co-opting health workers into activities beyond their remit, including surveillance and criminalisation.”

Aked said the project had combined “mental health stigma with Islamophobia” and accused counterterrorism police of attempting to keep it “secret because it’s so ethically dubious”.

“But they’re now rolling it out nationwide despite a complete lack of independent evaluation,” he added, before urging the UK health community to “call for an end to the scheme.”

Amanda C de C Williams, professor of Clinical Health Psychology at University College London, also voiced concern over the scheme.

“The Vulnerability Support Hubs, as with the Prevent programme overall, appear to act on collective beliefs among police and security services, informed by stereotypes and suspicion, all of which disregard the mental health needs of the individuals gathered up in the net,” she said.

“It is a travesty of health practice that NHS staff are helping in these processes, the likely result of which is harm to the individuals referred, and widespread suspicion of mental health services by targeted communities.”

Police defend programme

When the project began, police said it was aimed at trying to learn more about a possible link between “mental health conditions and vulnerability to radicalisation”.

It was also planned to divert potential “terrorism” suspects away from crime.

The pilot was jointly funded by counterterrorism police, the NHS and the Home Office.

Nik Adams, the national coordinator for Prevent, dismissed Medact’s claims that the hubs are “secretive”, as he described instead a “partnership between policing and health specialists”.

The programme helps officers with “identifying and understanding the complex individual needs that are driving harmful behaviour and vulnerability to radicalisation”, Adams told Al Jazeera.

“This helps us … stop those who are vulnerable from criminalising themselves, or suffering serious harm,” he said.

“When an individual’s needs do not appear relevant to a terrorism-related risk, they are simply referred to other mental health or support services with appropriate recommendations for their care.”

Adams added that the staff involved respect ethical and clinical standards.

A UK government spokesperson did not directly address Al Jazeera’s questions concerning the hubs, but said the NHS had an “an important role to play in preventing vulnerable people from being drawn into terrorism”.

“Healthcare practitioners recognise Prevent as part of their safeguarding duties,” the spokesperson said.

“A key part of Prevent is to enable front-line staff to recognise and safeguard individuals at risk from all types of radicalisation, referring them to pathways for appropriate support.

“Mental health conditions may contribute to a person’s wider vulnerabilities, though the relationship between mental health and radicalisation is complex.”