My Diagnosis: Medical unwillingness to fulfill the PREVENT duty is regressive and fanciful.

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 25^th 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?