In the two decades since the UK government unveiled its ‘counter terrorism’ strategy ‘Prevent’, campaigners and human rights organizations have consistently documented its impact on racialized and otherwise marginalized communities, and the ways in which public services—including healthcare—have been weaponized in this process.
A part of the government’s broader counter-terrorism strategy called CONTEST, Prevent’s stated objective is to “prevent people from being drawn into terrorism.” First implemented in the aftermath of the 2005 London bombings, Prevent was amended in 2011 to deal with “all forms of terrorism and with non-violent extremism.” Extremism was vaguely defined as “vocal or active opposition to fundamental British values.”
While on paper Prevent’s ambit was expanded beyond ‘Islamist’ extremism, research shows that the program has continued to disproportionately target Muslims, with 73% of the Muslim population in England and Wales living in “Prevent Priority Areas.”
“From the outset, Prevent’s impetus has been to focus on Muslim communities in the UK. Documents that were leaked early on in the strategy’s life span also show that it was an inherent part of the project to focus on British Asian males between the ages of around 15 to their mid-30s,” Sarah Lasoye, poet, writer, and the Peace and Security Campaign lead at Medact, a health justice campaigning organization in the UK, told Peoples Dispatch.
In 2015, the UK passed the Counter-Terrorism and Security Act that created a statutory duty for public sector workers, including social workers, school staff, and health workers, to give “due regard to the need to prevent people from being drawn into terrorism” and to report potential “signs of radicalization.” This resulted in children as young as three and four years old being referred to “deradicalization” programs.
From “pre-crime” to criminalization
“Prevent operates in this ‘pre-crime’ space, so its intention, in the government’s own terms, is to identify ‘susceptibility’ or ‘vulnerability’ to radicalization—it is all in this space of potential,” Lasoye said. “Human rights organizations and even UN special rapporteurs have noted that nobody who has been referred to Prevent and diverted away from care or whatever service that initially acts as an in [or entry point] to a stream of government counter-terror security agencies has committed a crime.”
Meanwhile, the secretive Extremism Risk Guidance 22+ (ERG22+) tool, developed by the government to train public sector workers to detect ‘radicalization’, has been found to rely on unproven and insufficient evidence. Medact’s own research found racial bias in Prevent training materials, and noted that health workers are being instructed to use their “instinct” in the absence of “reliable predictive criteria.”
Based on data from nine National Health Service (NHS) Trusts, Medact found that Asians were reported to Prevent four times more than non-Asians. Muslim people were referred to Prevent eight times more than non-Muslims, in data from six trusts.
A key component of Prevent is Channel, a highly secretive “multi-agency program which identifies and supports at-risk individuals” and is led by the police. According to Medact, at least 90–95% of all Prevent referrals are deemed to not warrant further—or “Channel”—intervention by the police themselves. Medact calls these cases “false positives.”
“Ultimately, a policy that is operating based on a person’s ‘instinct’ is going to be susceptible to their own views and understanding of who is a threat and who is likely to commit an act of violent crime,” Lasoye said. This is compounded by widespread Islamophobia in the UK, and the differing and outright discriminatory thresholds of “suspicious” behavior outlined in Prevent training, which are “geared towards treating Muslim communities with more suspicion.”
Not only are “health workers being roped into treating their patients with suspicion, instead of prioritizing their care,” Lasoye added, Prevent ultimately also acts as a deterrent to seeking care for people “who are already dealing with problems accessing public services, people who have been treated poorly by health practitioners, and, broadly, communities who have faced racialized violence or negligence from health workers,” given that health workers now have a statutory duty.
Medact’s research has also shown that Prevent referrals can inflict both indirect and direct damage to the physical and mental health of not only the people who have been targeted by the strategy, but also their families and wider communities.
“A lot of health workers who unknowingly thought that maybe their patient would receive the care they need through Prevent have often never heard from those patients again. So we do not know if they received the care they needed or what impact the Prevent referral had on their life,” Lasoye said.
One of the risk factors or criteria associated with signs of radicalization in the ERG22+ is “mental health issues.” People with mental health conditions are disproportionately represented in Prevent referrals, as the government has continued to push an unproven link between mental health and terrorism, all of which is also rooted in ableism and stigma.
Not only is violent policing generally being deployed as a response to mental health crises, in the case of the UK, the police have also actively impinged upon mental health services to enforce counter-terror strategies.
Based on an analysis of the secretive “Vulnerability Support Hubs” run by the counter-terrorism police, Medact found that racialized Muslims were at least 23 times more likely to be referred to a mental health hub for ‘Islamism’ compared to a white British individual for ‘far-right extremism.’
Moreover, “counter-terrorism’s turn to mental health” has also led to a “securitization of care,” which has not only meant increasing influence of police over mental health services and treatment, but also a growing risk of the complicity of NHS workers in the criminalization and surveillance of people, not to mention blatant violations of the duty of confidentiality in healthcare.
What has made the government’s use of schools and health care workers to implement Prevent particularly insidious is the fact that for so many vulnerable people, these public services form a basic or primary point of contact with the state. Not only that, as Lasoye emphasized, these are “trusted” sites and, as such, have been very useful for the government as sites for the introduction of harmful policies like Prevent.
The Police, Crime, Sentencing, and Courts Act of 2022 had attempted to enforce a “Serious Violence Duty,” under which health workers would be required to share their patient’s confidential information with the police. While the law was ultimately passed, health workers in the NHS were ultimately exempt from the duty thanks to the mobilizing efforts of groups like Medact.
Rejecting securitization, centering care
In mid-February, the government’s widely-boycotted “independent” review of Prevent by William Shawcross was published. Condemned as a “whitewash,” the Shawcross report ultimately doubled-down on some of Prevent’s most harmful aspects, calling for harsher enforcement and a renewed emphasis on “Islamist extremism.”
Not only that, Shawcross called for the expansion of Prevent to asylum and immigration services as well as job centers.
“Who are the people who are accessing these services? It is racialized people, it is working class people, it is people who have always been on the underside of the state’s ‘hard’ security policies,” Lasoye said. “The expansion of Prevent into these services that are also incredibly vital to people will act as a deterrent to seeking these services for fear of being brought into yet another stream of government security and criminalizing policies.”
She further added, “From our perspective, criminalization is not at all a functional or effective response to what is often, if not always, a situation of unmet needs—be it social, political, or economic. As such, a truly public health approach to resolving these issues, to reduce acts of violent harm, would meet people’s needs.”
“We are in an incredibly difficult time, given people’s economic situation and cuts to public services that have been ongoing for decades. People are really struggling, and then we see an exacerbation of issues that are criminalized by the government, and a strengthening of the narrative that the only way to deal with this is to criminalize people and undertake punitive action.”
“Medact and the health workers that we work with are opposed to this kind of response. Instead, we are focusing on an approach with the intention to prioritize and center the health of everyone involved, and try to have some transformational change.”
Lasoye said, “The health perspective holds a lot of weight politically, and not necessarily in an elitist sense of ‘we should listen to doctors more than anyone else,’ but because it allows people to see the importance of everybody’s wellbeing, and what would it look like if we as a society decided to center everyone’s wellbeing. How would we care for each other not only on a big, economic level but also interpersonally?”