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Counterterrorism in the NHS: Evaluating Prevent Duty Safeguarding by Midlands Healthcare Providers

Principle Investigator: Dr Charlotte Heath-Kelly

Co-Investigator: Dr Erzsébet Strausz

Introduction

The Prevent Duty is a component of the Counter-Terrorism and Security Act 2015. It requires healthcare providers to train their staff about the signs of radicalisation and how to report patients/staff to safeguarding teams. The inclusion of counterterrorism safeguarding within healthcare in Britain is novel, worldwide. Our pilot study explored how Midlands healthcare providers undertake their safeguarding responsibilities under the Prevent Duty, given that such procedures have not previously been attempted. This was a sociological study of Prevent Duty implementation by safeguarding teams in Midlands providers, designed to evaluate the methods and outcomes of embedding counterterrorism safeguarding within broader safeguarding mechanisms.

Our project was funded by a Wellcome Trust Seed Award in the Humanities and Social Sciences. The methodology included 17 expert interviews with NHS safeguarding experts and Prevent Leads, Channel Panel members, a Forensic Lead in a Prevent Mental Health Hub, two Police Prevent Leads, and medics publishing on the Prevent Duty. Six NHS trusts and CCG's participated in our study. We also distributed a questionnaire to 329 NHS staff about the Prevent training they received, and their understanding of the signs of radcialisation.

Findings:

Our full project report can be downloaded here.

From our interviews with experts, literature reviews and questionnaire with NHS staff, we found that:

• The positioning of the Prevent Duty as a safeguarding measure is ambiguous. Safeguarding professionals alerted us that they are operating in a ‘grey area’ with Prevent, and that significant differences exist between Prevent Duty safeguarding and normal safeguarding.

• Our survey revealed that NHS staff are comfortable with the Prevent training provided and feel confident to detect radicalisation.

• However, our survey also revealed that NHS staff strongly identified hate speech, the possession of radical Islamic/Anarchist philosophy, and anger at foreign policy as indicators of radicalisation. Prevent training modules do not identify these factors. Staff would make Prevent queries to the safeguarding team if they noted these behaviours, which could be an inappropriate use of the safeguarding team’s time

• Our survey revealed that staff attitudes were polarised regarding whether Prevent is a form of safeguarding. Only 47% of respondents agree that Prevent is a genuine safeguarding procedure, and 48% agree that Prevent belongs in healthcare

• NHS staff have very mixed opinions about whether Prevent is a form of surveillance, with only 1 in 3 respondents confident that it is not surveillance. However this did not affect a high level of confidence in individual Trusts/CCG’s to make sensible and appropriate decisions about Prevent referrals.

• 4 Mental Health Trusts (of 54 in England) currently include radicalisation criteria in their Comprehensive Risk Assessments for all service users.

Conclusions and Recommendations:

• We will contact the Health Select Committee to advise them of the gap separating the Care Act 2014 and Prevent Duty safeguarding. We will raise the comments of safeguarding experts with them, regarding the expectation that they work in a legal grey area between the provisions of the Care Act and the Counterterrorism and Security Act.

• The line between mental illness and radicalisation is becoming increasingly blurred by initiatives like ‘Prevent in Place’, radicalisation screening practices in individual Mental Health Trusts, and the 2017 Prevent Guidance for Mental Health Trusts. The Prevent Duty should not act as a fast-track pathway to mental health care, or other social services, as this creates incentives for well-meaning practitioners to misuse Prevent to access services.

• Similarly, mental health trusts should not integrate radicalisation criteria into Comprehensive Risk Assessments performed on all service users. The Royal College of Psychiatrists Position Statement PS04/16 highlights concerns about the evidence base underwriting links between mental ill health and the likelihood of committing a terrorist act. Applying radicalisation screening to all service users risks inappropriately stigmatising the mentally ill.

• When making a referral to the safeguarding team, NHS staff respond to the call for ‘intuitive reporting’ in WRAP by drawing from popular culture to understand radicalisation. At the time the study was completed, images of ISIS flags and beheadings were prominent in the minds of participants. Safeguarding teams should be aware that these images will disappear from the media upon the defeat of ISIS, with unclear consequences for future Prevent referrals.

• WRAP trainers should directly instruct staff to beware of unconscious bias when making Prevent referrals. Currently there is a risk that popular culture stereotypes will influence staff perception of radicalisation.


 

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Project Report

Available for download here

News and Media

Institute of Race Relations coverage of the project findings (19th April 2018).

National Healthcare Executive coverage of the project findings (19th March 2018).

I'm a Doctor, not a Counter-Terrorism Operative. Let me do my job. (Adrian James responds to the project report, in the Guardian).

Report finds some NHS Mental Health Trusts screen all Patients for Radicalisation (The Guardian, 19th March 2018)

Is there any place for counterterrorism in the NHS?
(The British Medical Journal)

New Counter-Terror Rules Give GP's Bizarre Incentives to Refer Mental Health Patients as Radicalisation Threat (The Conversation, 13/12/2017)