On 1st July 2015 the Counter Terrorism & Security Act created a requirement that UK medics and many other public servants give due consideration of their duty to prevent vulnerable people from being drawn into terrorism. On the 18th of September Sean O’Neill announced in The Times that links between mental health and extremism had been identified. He went on to highlight that National Health Service professionals were now employed full-time to support the PREVENT program.
The American Psychology Association’s failure to clarify opposition to involvement of psychologists in torture, mass detention of pro-democracy dissidents in the USSR, the invention of Dangerous & Severe Personality Disorder UK NHS hospital services in the first decade of the millennium, and the unexpectedly highs numbers of UK citizens detained subject to the 2007 adaptation of the Mental Health Act 1983 called Community Treatment Orders are notable forerunners of occasions when political pressure
to protect the public from harm placed the rights and freedoms of patients in
jeopardy.
Given that the Prime Minister is calling for a whole society approach to counter extremism we judged that it was healthy
to comprehensively debate the potential pitfalls that the new statutory PREVENT
duty may throw up for psychiatry. We did this with experts, psychiatrists and
ethicists at the Philosophy & Psychiatry Conference at the Royal College of
Psychiatrists on the 25th September 2015. We heard first hand from
Maajid Nawaz, Chairman & Co-Founder of Quilliam about the significant
traumatic life events and teenage growing pains that drew him to the brink of
violent extremism. His narrative was recognizable and included the kind of challenges that could have benefited from primary care services that should reasonably be expected to treat people for common medical conditions such as depression and anxiety.
This raised an important first challenge to
fears about PREVENT leading to some form of widespread Soviet style situation
where political dissidents are brain washed with CBT on the NHS. Let’s get
real, despite complex and fragmentary injections of extra treasury cash specifically
to try to Increase Access to Psychological Treatment, most General Practitioners are more likely to find that their patient’s will suffer for months or even years before being able to access these basic treatments. They
will not be swooped off by our diminishing police forces.
Dr Alexandru Popescu highlighted the
serious dangers of political abuse of psychiatry with reference to personal
experiences of Communist attempts at Re-education and other sordid
international examples. It was right, proper and necessary that these concerns
were raised. However, when it came to the panel debate with Senior Coordinator for Counter Terrorism Policing DAC Helen Ball, Former Independent Reviewer of Terrorism Legislation Lord Carlile of Berriew and Fixated Threat Assessment Clinic Consultant Forensic Psychiatrist Dr Simon Wilson, it became apparent
that these legitimate concerns were in little danger of being replicated in the
UK. Whilst it is the case that the Mental Health Act 1983 can enable the
detention of patients in hospitals for years, it was widely accepted that this
is not a new challenge for the medical profession and its independently
regulated duties to do no harm and respect autonomy. In fact once again the real issue here is the inadequate number of hospital beds which result in scandalous reports of patients being admitted to hospitals hundreds of miles away from their home in the midst of severe episodes of psychosis.
In contrast to the under developed ethical
guidance of the American Psychology Association which led to allegations of
complicity in CIA torture, the long established process of diagnosing mental
conditions was highlighted as a simple safeguard to medical mission creep into
detention of UK political activists. No one present disagreed with the well
established wisdom that people who are seriously disturbed with the severe
symptoms of psychosis may require compulsory treatment in hospital, even if
they did not plan to carry out extremist violence. The issue of the
imperfections of diagnostic categories and the controversies of detaining
people with personality disorder were raised. However, no one expressed plans
to swoop up the one per cent of the UK population who meet diagnostic criteria
for antisocial personality disorder under the guise of counter terrorism.
The PREVENT strategy and any consequent
interventions from health services may or may not demonstrate empirical success
in reducing terrorism in the long term. However, concerns that it will convert
UK psychiatric hospitals into Gulags and GP’s into spies are thankfully
fantasies. I suspect that this common sense assertion may incense those who
Maajid Nawaz has dubbed the regressive left who shoe-horn Anti-Israeli, Anti-US
and Anti-Capitalist grievances into any accessible narrative. Capitalism may increase
gross global inequalities, the US & the UK may engage in harmful foreign
policies and Israel may deserve condemnation for the deaths of Palestinian
children. However, none of this makes it wrong for a doctor to fulfill their
PREVENT duty when a contemporary Daniel McNaughton comes to their attention and
admits that he is a hair’s breadth away from acting on his viable plan to
assassinate a senior politician on the grounds of his psychotic symptoms. In
fact I would go a step further and suggest that professionals who let their
political ideologies override their professional duties place future Daniel McNaughtons and their victims at unjustifiable peril. PREVENT provides an
opportunity to work with other agencies to try to manage precarious and complex
situations. Is it really so scandalous to suggest that public services should
try to escape the confines of working in silos when the stakes are high?
