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.