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.