Should we intervene with 650,000 or 20,000 or 3000 individuals to prevent terrorist incidents, or is it all about foreign policy?

The fact that effects follow causes is not usually opposed by reasonable academics, public sector workers and supporters of enlightened democratic society. However when it comes to what someone thinks, feels, experiences or does before they progress to carry out a terrorist act seemingly some of the above think that cause and effect is not real. For them it cannot be true because any phenomena preceding a terror offence cannot exist because a pre-criminal space cannot exist. Are they suggesting that all terrorist acts are a bolt out of the blue that cannot be stopped by any intervention?

Maybe they believe in cause and effect, but simply think that no pre-criminal Islamist or Right wing fascist causes can exist because no terrorist crimes exist because all moral norms are relative. I have some sympathy with the idea that we can have a range of tolerable norms which enrich our world with diversity and flexibility. However the idea that gratuitous political violence against civilians can ever be judged as anything other than an extreme form of crime is not an idea that I think should be acceptable in our society. Some may feel understandable guilt about our country's actions or inactions which lead to more violent harm than good. However if all you do is point to and campaign against these failing foreign policies as contributors to terrorism, then ask yourself why you would not campaign to persuade individuals from carrying out actions or inactions which also lead to more terrorist violence than good.

I guess most reasonable folk agree that freedom of speech and free association of political groups are essential in a democracy that progresses towards peaceful disagreement rather than violent conflict. However does this mean we should facilitate all speech and political groups to spread any idea? Is open debate and democracy so magical that it can cure all society's ills and crimes? Was Bertrand Russell wrong to ' no platform' Oswald Mosley? Like him Should we no platform, or interfere further in the speech and association of the 3000 people actively monitored by security services as potential terrorists? Should we no platform or interfere further in the free speech of the larger group of 20,000 judged to represent a residual risk? Should we interfere in the free speech and associations​ of 650,000 UK citizens at risk of struggling to resolve disagreements without being violent?

650,000 is still a small proportion of 65 million, but it sounds like a dystopian number to intervene with and control in order to prevent terrorist incidents. However,  if we continue to ignore that some people are more likely to be politically violent than others are we keeping the path clear and frictionless for individuals to speed along a journey from extreme pre-criminal ideas to extreme criminal acts? I don't want to live in an Orwellian Stasi state, but is it not time that reasonable academics, public sector workers and supporters of an enlightened democratic society stopped looking the other way and started to acknowledge potential benefits of Prevent? Without transparency, empirical scrutiny and legal safeguards PREVENT poses problematic​ authoritarian dangers, but bombs in Manchester & stabbing in Borough Market are also dystopian nightmares that cannot be ignored.

An AngloSlavic memorial to European Unity in Erdington?



Tereza Buskova & the Bohemian Procession on Erdington High St June 11th

A few years back I wrote quite a lot of long rambling and tacky loose ideas about my wife’s art. I continued to support her battles to produce art for a living, but after a while I learnt that my ideas didn’t necessarily do her any favours. I kept pointing out that the art world seemed to be overfull with smug boring attempts to illustrate misunderstood philosophy accompanied by incoherent texts that revealed just how misunderstood those concepts were.

An Erdington volunteer clipping St Barnabas Church with a Czech & a Slovak behind a fence

The powerful results of the EU referendum and public performance part of her Clipping the Church artwork that took place 12 days earlier have uninhibited me enough to get reckless and talk about her art again.  The problems differentiating between New Labour & the hug a hoody Conservative party rendered me nihilistically all or no party for most of my adulthood. However when an email from the labour party asked me for help on June 23^rd I felt obliged to man phones, mostly to make up for the fact that despite living in the UK for 17 years my Czech wife and architect of clipping the church in Erdington did not have the suffrage for the question about whether or not her country of residence should remain in economic and political union with her homeland.

Rt Hon Gisela Stuart MP intrigues me. Like my wife she grew up in a country ravaged by both German national socialism and Russian communism. Like my wife she immigrated to the UK and created an Anglo-European family. Unlike my wife she did not see how the EU might have helped to keep the former Soviet Bloc democratic and friendlier with the UK than Russia. Unlike my wife she did not see how leaving the EU could harm other immigrants including those born East of Berlin like her. The thing is before the referendum campaign I had held a couple of talks with Gisela, including one Birmingham Salon BMI panel discussion on the NHS and migration. She made a good impression and as my constituency MP I must admit that I both voted for and still trust her to make reasonable representations for my constituency in parliament.

St Barnabas Vicar Freda

12 days before the UK chose to reject union with my wife’s homeland, amongst others, my wife revived the British tradition of Clipping the Church. This Christianised blatantly pagan act of local parishioners holding hands together around the local church was a stunning event to participate in and witness. She added a Bohemian wedding procession involving a carriage of baked goods headed up by one hundred Birmingham based Poles, Czechs and Slovaks, most of whom came in the demonised waves of migration since their home countries’ ascendancy to the EU. Erdington high street was lit up with celebration and Anglo-Slavic unity.  Local tory councillors held hands with the local Labour MP. Those hundred Eastern (or central) Europeans ‘came over here and’ held hands with one hundred Brummies.  This event had been planned for two years, so the timing with the referendum was a curiously pertinent coincidence.

Czech & Slovak participants in Clipping

Now I noticed that the photos of the event looked like both a memorial and celebration of unity. On 24^th June 2016 when we learnt that the same Birmingham community had rejected the EU it felt more like a memorial, but that event was not an EU event. It would have happened whether or not Cameron had gambled his career and many more. So the question is do we trust Gisela? Do we trust the 52%? Will the 48% and the EU British communities still hold their hands? Will the unity and mutual celebration evident at Clipping the Church of June 11^th be possible post-BREXIT? The simple joy of walking, holding hands and eating together seemed to bring many people a sense of cohesion and happiness. Is that gone forever, or did the EU have less to do with it than it seems?

The simple joy of clipping

Farage looks like a dangerous man to me. Will we see the rise of ugly Nationalism in the UK catalysed by a jingoistic Brexiteering Johnson? Was clipping the church a memorial to peace and unity within Britain and Europe?

An AngloSlavic memorial to European Unity in Erdington June 11th 2016?

Thursday 21 July 2016, 6.30-8pm Motherhood, maternal and art – discussion Eastside Projects, 86 Heath Mill Lane, Birmingham. B9 4AR
£4/2/free to ESP

Over the 20th century the representation of maternal in art has drastically changed from devotional and idealised to challenging traditional ideas of motherhood, exploring multifaceted categories of maternal subjectivity, including plurality of voices. A discussion at Eastside Projects will explore the representation of maternal in art, including different models of family and motherhood. The event will also investigate the position of a woman-mother-artist. The discussion will be followed by the screening of Clipping the Church.

Speculating on the benefits & harms of PREVENT

If only Andy Burnham could have queried the potential harms of PREVENT as sensibly and calmly as Professor Poole in his latest blog. Burnham instead opted for crass comparisons with internment. Professor Poole politely said that I had strong views on PREVENT, although I think I just have strong views about not throwing out babies with their bathwater. Strong is also arguably code for emotionally blinkered or unbalanced, but how else should we refer to unpopular defenders of PREVENT. To not jump on the Burnhamian bandwagon is surely a sign of failing to look a gift horse in the mouth.

Beyond modelling how people should disagree with decency the greatest success of Professor Poole's latest blog was an encouragement to try to measure and spell out the possible harms caused by psychiatrists making referrals to CHANNEL panels in comparison to other scenarios that encourage breach of patient confidentiality. This kind of reflective scrutiny of PREVENT is something that I consider to be essential to minimise harms and increase efficacy. In the spirit of ongoing scrutiny I noticed a few things that peaked my interest.

Firstly it is important to reflect on the fact that a CHANNEL referral does not need to involve a breach of confidentiality. Some people with ambivalence about being drawn into terrorism could theoretically fully support a psychiatrist referring them to a panel of experts who might be able to help them more effectively than a doctor.

Professor Poole asserts that PREVENT appears some way between reporting to the police historical child sexual offending disclosures  and unlawful engagement of patients in terminations of pregnancy in Northern Ireland, with the latter being judged to be more harmful to patients with little to no expected benefits. My take on this is that PREVENT sits some way before reporting historical child abuse and gets nowhere close to criminalising termination of  pregnancy, but then again these are all arguably apples and pears. However Professor Poole's examples refer to criminal offences that have been perpetrated so any disclosures drag the patient into the criminal justice arena either as a victim or as perpetrator. Instead PREVENT alone out of the three scenarios  offers people the chance to avoid the criminal justice system entirely. Is a report to the police about a crime that has been committed really comparable to asking local experts to consider offering support to someone who might commit a crime?

The processes of referrals and interventions should reasonably be considered to potentially cause harm, but we can not assume this, make crass comparisons to internment or believe everything we hear about the inevitability of harms. This is why I would discourage a politicised cross party review, but instead support regular routine independent adequately expert transparent review that aims to improve quality, reduce harms and maybe even increase efficiency. Some might think cross party means politically neutralised, but I think that is naïve especially when it involves people who must chase popularity to win votes. I think such transparent safeguards could alleviate concerns held by psychiatrists about a strategy which is in law less restrictive than the Mental Health Act 1983.

This itself is a big enough ask, given that PREVENT's leads in the Office for Security & Counter Terrorism are often reported to have spent their careers being covert in MI6, so perhaps it is taking time for the leaders of PREVENT to get used to more public facing responses to concerns of those involved in the strategy. Until PREVENT becomes more open and transparent at its core everything that we write on this remains speculative, as does our respective concern or support.

PREVENT & Psychiatry

On 24th May 2016 Chief Constable Simon Cole was gently grilled in Khrushchev's shoes for sharing his observations that many people referred to CHANNEL panels appear to have mental health problems. This seems to be conflated with lurid tabloid headlines which suggest that people with schizophrenia or other mental illnesses are all violent and should be locked away. Whilst I share disgust with many newspaper headlines, the Guardian article where the Chief Constable shared his ideas was not lurid. It may have been scientifically light weight, but the Guardian is not a peer reviewed psychiatric journal.

If people referred to CHANNEL panels are selected due to concerns that they may be inclined to commit serious violent crime, then it may be reasonable to predict that they share some characteristics with offenders, of whom we know suffer greater morbidity from psychiatric conditions including substance misuse conditions. To ignore this burden does not quench the rantings of tabloid columnists and editors, it just contributes to the suffering of detained offenders. If we cast doubt on the Chief Constable's observations too rashly, do we not risk the same harm to people vulnerable to being drawn into a particular type of serious violent crime?

On the same day that the Chief Constable was grilled for encouraging support for the vulnerable I took part in a public debate at the Central Library of Birmingham about the PREVENT strategy more broadly (a youtube upload is promised). I proposed that unintended harms and paradoxical potential to cause terrorism warrant robust safeguards, which in my opinion need more than what is currently available. However, there seems to be an assumption that PREVENT will cause more harms than benefits. This does not make sense at a fundamental level. PREVENT is the gentler end of the UK counter terrorism strategy. If you help people to not become an offender, then the state is less inclined to harm them. Whilst the criminal justice system does not engage in unlawful harm, it is perfectly lawful to cause people suffering with punishment for crimes and use proportionate force which can include fatally shooting people in the midst of perpetrating a grievous act. If psychiatrists and other cuddly public servants do not take responsibility for offering people some chance to choose not to perpetrate a terrorist offence, possibly in Syria, then the alternatives are found in the PURSUIT limb of the counter terrorism strategy with outcomes such as arrest, conviction and even death.

It is reasonable to seek robust evidence to support the Chief Constable's observations and it would be essential for all PREVENT interventions to undergo robust monitoring, and any interventions should be as evidence based as possible. However, the absence of an evidence base for specialist interventions can only be changed by offering specific experimental interventions. It is also necessary to focus on the fact that CHANNEL panels are composed of professionals who could offer evidence based interventions for any need identified within their remit. So, if it so happens that people being referred to CHANNEL panels have more mental health problems than others, like most potential offenders, there is likely to be robust evidence available to offer them interventions for those needs, whether or not these efforts make them resilient enough to choose to refrain from committing a terrorist offence.

Stigma is awful, but to turn a blind eye to putative novel associations between lone actor violence and mental disorder does not help. Whilst I do not support moral transgression or offending, it is my opinion that this simply reinforces the double stigma experienced by offenders with mental disorder. Lets stay open minded and curious. Lets not spurn balanced broadsheet articles, we can encourage critical thinking and challenge assertions, but lets not fall into a trap when we stop listening because what we hear makes us uncomfortable. Lets save our more robust criticisms for the real purveyors of prejudice.

National Happiness, Immortality & Freedom Service.

BIRMINGHAM SALON BIRMINGHAM MEDICAL INSTITUTE EXTRAORDINARY MEETING WITH SHADOW MINISTER FOR MENTAL HEALTH LUCIANA BERGER MP

National Happiness, Immortality & Freedom Service.

Are the UK’s mental health needs just too much for the National Health Service?

Birmingham Chamber of Commerce,
75 Harborne Rd, Birmingham B15 3DH

1825-2000hrs Thursday  12th May 2016

Panel of special guests to be announced

In January 2016 the Prime Minister announced that he ‘pledges a revolution in mental health treatment’. In February 2016 the President of the Royal College of Psychiatry advised that ‘the NHS in England… committed to the biggest transformation of mental health care across the NHS in a generation, pledging to help more than a million extra people and investing more than a billion pounds a year by 2020/21.’ To enable this revolution to take place a ‘Mental Health Taskforce, set up by NHS England in March 2015, had responsibility for creating and publishing a new five-year all-age national strategy for mental health in England to 2020, aligned to the Five Year Forward View (FYFV)’. The question for us tonight is could this revolution ever be enough to address what our guest Luciana Berger MP referred to as a ‘perfect storm’?

In 2015 she informed Guardian Journalist Mary O’Hara that “It feels like a perfect storm at the moment. There are so many issues where we were supposed to go forwards but actually went backwards. The waiting times to access help early on are too long around the country – if you get a referral at all” Indeed the NHS England Five Year Forward plan seems to have goals which tie us in pretty impossible gordian knots.

In paragraph one the plan emphasised that the NHS currently exists in a world consumed by ‘global recession and austerity’ which perhaps explains why the first aim is to try to focus on happiness and wellbeing. Is there a hope that we can prevent costly ill health by all of us achieving an immortal state of bliss due to low sugar diets, no smoking, no alcohol, exercise and mindfulness?

Much linguistic dexterity about funding and efficiency savings is offered, but you do not have to be a health economist to understand that if there is less money coming in there will eventually be less care going out. Much is made of legally enshrined definitions of quality as ‘patient safety, clinical effectiveness and patient experience’.  Quality is the goal, but if the money goes to wellbeing, happiness and preventing ill health like psychosis, how do you fund safe and excellent experiences for those who already have psychosis? 

In these forthcoming five years how will the optimistic strive for quality accommodate those other competing demands particular to mental health which seem to pitch freedom against immortality. Alongside austerity the number of people detained subject to the Mental Health Act 1983 has also been growing with the CQC informing us that ‘there were over 50,000 uses of the Mental Health Act in 2012/13 – the highest number ever recorded.’  This deprivation of liberty is significant and last year’s newly published Code of Practice tries to tackle that head on by naming ‘patients rights & autonomy’ as its first chapters. Hopes to reverse the increasing trend of costly and distressing detention with increased freedom and wellbeing can rub up against aims for safety and the understandable severe distress caused by the tragedies of suicide and homicide. With every coroners hearing and homicide inquiry can come calls to increase scrutiny of people with constant observations and deny them leave from hospitals. Indeed if health professionals don’t deprive people of their liberty enough and someone dies they may now be more likely to lose their own liberty like David Sellu who was found guilty of manslaughter by gross negligence in 2013.

So in this brave new world, how can the NHS Mental Health Services meet the UK’s mental health needs? Perhaps the panellists and your questions will help us to see a few glimmers of light that could help us to cut these Gordian knots.

As Geoff Berner once said "thank you, but no thank you"

Last night John Ware`s BBC radio 4 report on CHANNEL broadcast. It was interesting and important, but his treatment of Dr Mashuq Ally disturbed me. Ware gave the impression that it was a coup for a CHANNEL panel chair to come out of the shadows, but I learnt otherwise in 2013 when he popped along to the Victoria pub to speak openly to the Brummy public at a Birmingham Salon. He also seemed to cast anxieties about Dr Ally`s circumspect response to so called trojan horse allegations. I then discovered an even more curious linked article in Standpoint magazine and felt moved to respond.

As a Birmingham based atheist Jew I would like to respond with the words of Jewish Canadian singer Geoff Berner `thank you, but no thank you`. Jews are a reducing minority in Brum and I increasingly share the worry that it is too acceptable to be callous about the right to life of Jews in the Middle East as a consequence of the suffering of Palestinians.

However on this occasion I think your focus on Waqar Ahmed and Mashuq Ally is at the least unhelpful and at the most misleading. I listened to your radio programme and I am left struggling to understand your concern about Dr Mashuq Ally`s willingness to scrutinise so called trojan horse allegations whilst this is currently taking place in a legal forum. I went to a predominantly white christian Birmingham secondary school and was called a jew boy there too, what does that mean? Racist slurs in Birmingham are something that I commonly heard, this was just one of many. I do not fully understand Waqar Ahmed's potentially clumsy comment about IS, but it hardly seems unforgivable. He is strongly advocating a two state solution and this kind of voice is needed.

In your rush to highlight problematic callousness to Jews including those in Birmingham and the Middle East I would kindly ask you to show greater judgement in your questioning, thank you, but on this occasion, no thank you.

Lets ban everything disgusting! From Psychiatric Hospitals

The profiteers of alcohol, tobacco, fat, sugar & sedentary life disgust me. Regular ritualised smoke breaks look like dangerous sources of encouragement to become dependent on tobacco. Premature deaths of patients in psychiatric hospitals are immensely disturbing. I share aspirations thatpatients will stop lining their lungs with tar and the pockets of profiteerswith pennies.

In fact I would like to eradicate unhealthy food, sleeping during the day, sitting around watching TV, failing to get an education, failing to work, reading tabloids and consuming psychoactive substances. I think all that might create utopian Mental Health Centres of excellence, if we agreed to never offer anyone the opportunity of discharge into the real world. If we disproportionately ban things from our hospitals we detach our services from society.

I was going to look into the references claiming that the vanguard of smoking bans reduced violence, discouraged cannabis use, increased therapy, liberated nurses and improved respiratory functioning. I expected that champions of research and evidence based medicine would only state these grand claims if they were supported by robust peer reviewed large epidemiological studies. Regrettably I couldn’t find any weighty data to offer sound foundations for the flighty idea that banning tobacco can improve the quality of therapeutic interventions and bring peace to violent wards.

More significantly it seems inconsistent to have a Mental Health Act that safeguards people from excessive restrictive practices by psychiatric services only to restrict the freedom to make such a mundane choice that is rarely likely to be sufficiently attributable to the nature or degree of any mental disorder. Don’t ritualise smoke breaks and do offer people something better to do than smoke, but don’t take out your disgust at tobacco peddlers on the 58,000 people detained on the grounds of their mental health.

Next week this will be scrutinised at a Maudsley Debate. Speak now or forever don't inhale.