UK doctors urged to boycott 'unethical' anti-extremism programme

#Prevent

Senior psychiatrist says legal duty to attend Prevent training is 'a corrosion of the ethics of the doctor-patient relationship'

NHS staff now have a legal duty to help 'prevent people from being drawn into terrorism' (AFP)
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Friday 23 December 2016 10:02 UTC
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The extension of the British government’s controversial Prevent counter-extremism programme into the National Health Service is “medically unethical” and will corrode doctor-patient relationships, a senior psychiatrist has warned.

Derek Summerfield, a consultant at the South London and Maudsley hospital and an honorary senior lecturer at London's Institute of Psychiatry, also accused professional medical bodies of a “failure of ethical leadership” and called on doctors to refuse to attend mandatory counter-terrorism workshops.

In an article for the forthcoming edition of BJPsych Bulletin, the journal of the Royal College of Psychiatrists, Summerfield said that many doctors had expressed unease about Prevent and were “responsive to the idea that they should say no to these workshops”.

Summerfield cited the case of a young Muslim man with a “mild depressive picture” who had been referred by a doctor for a psychiatric assessment to explore his views because he had stated that he got angry watching events in Syria on television.

“A GP would never refer up a patient with moderate depression to a specialist service, so the referral was merely because of the remark he had made about how he felt when he was watching events in Syria,” Summerfield told MEE.

“This is a corrosion of the ethics of the doctor-patient relationship, and is to prime us for an activity which is a duplicitous deviation from the medical assessment, advice and treatment that has brought the patient to us.

"It is basically a form of spying and of scapegoating, and essentially about Muslim patients."

Summerfield's article is due to be published in the April print edition of BJPsych Bulletin, but was pre-published online on 11 February.

Since the introduction of a new counter-terrorism and security act last year, public sector workers in the UK including doctors, hospital staff, social workers and teachers have had a legal duty to have “due regard to the need to prevent people from being drawn into terrorism”.

Training to hundreds of thousands of public sector workers has been delivered through so-called WRAP sessions (Workshops to raise awareness of Prevent) over the past few years.

But Summerfield said that professional medical bodies including the General Medical Council and the British Medical Association had been silent on the ethical implications of what doctors were being asked to do.

'Dereliction of duty'

Referring to the GMC, which describes itself as “an independent organisation that helps to protect patients and improve medical education and practice,” he said. “For a statutory body whose raison d'etre is medical ethics, this is a dereliction of its core duty.

“In my view, the Prevent workshops raise a significant medical ethical issue for doctors and should be a matter for the GMC to address.”

Summerfield told MEE he was also pressing the Royal College of Psychiatry, the professional body for psychiatrists, to set up a working group to look at the consequences of Prevent for mental health specialists.

“There is a particular challenge for psychiatry because psychiatrists may be seen as the kind of doctors who can best get at the deep, intimate, private thoughts and feelings of someone and the state has become interested in that. They will expect more from us than from orthopaedic surgeons,” he said.

A National Health Service Prevent training document published last year states that the healthcare sector is “one of the best placed sectors to identify individuals who may be groomed in to terrorist activity”.

“Staff must be able to recognise signs of radicalisation and be confident in referring individuals who can then receive support in the pre-criminal space,” the training document says.

Adnan Siddiqui, a practising doctor and the director of the civil liberties group Cage which has campaigned against Prevent, told MEE that Summerfield's remarks “pretty much echoed what we have been saying, which is that Prevent is discriminatory and unethical”.

Siddiqui said that doctors would face difficult decisions whether to “medicalise or securitise” patients who displayed symptoms of mental disorders, or confided anger or unhappiness issues.

“Safeguarding is the bread and butter of our job but there is so much to Prevent that plays to stereotyping and prejudice. NHS workers and public sector workers should be looking after the interests of their patients and their clients and not serving the government's agenda.”

'Security prism'

Prevent was originally introduced by the Labour government following the 2005 London bombings and has long been a source of concern and complaint among Muslims. Critics argue it is implemented in a discriminatory fashion and amounts to surveillance.

Prevent's remit has been extended under the current Conservative government which has focused increasingly on tackling so-called "non-violent extremism," with rising numbers referred to Channel, a counter-radicalisation programme within Prevent targeted at young people.

“Prevent and the WRAP training forces medical professionals to view their patients through a security prism rather than from the perspective of health and wellbeing,” Abed Choudhury, head of advocacy at the Islamic Human Rights Commission, told MEE.

“This then leads to the perverse situation where vulnerable patients are being treated as criminals rather than as people needing medical support.”

A spokesperson for the General Medical Council said it would not comment on Summerfield's remarks but referred MEE to a letter sent by Niall Dickson, the GMC's chief executive to parliament's health select committee last year.

In that letter, Dickson said it was “not within our remit or expertise to advise doctors on how the new Prevent duty... should operate in practice, or what would constitute a 'concern that someone is bring drawn into terrorism'.”

He also said that doctors had been advised to follow existing guidelines on patient confidentiality.

“People may avoid seeking medical help, or may under-report symptoms, if they are concerned that their information will be disclosed by doctors without their consent,” said Dickson.

“As such, it is in everyone's interest that doctors should not disclose information without a careful weighing of all of the interests involved.”

Earlier this month, David Anderson, the UK's independent reviewer of terrorism legislation, called for an independent inquiry into Prevent, citing concerns that aspects of the programme were ineffective and being applied in an “insensitive or discriminatory manner”.

The UK parliament’s Joint Committee on Human Rights also announced an inquiry into the government’s counter-extremism strategy and its compliance with European human rights law.