Race and religion are major factors behind referrals from the NHS to Prevent, the government’s controversial anti-extremism programme, according to a medical charity. Muslims are eight times more likely than non-Muslims to be referred to the programme, and Asians four times more likely than non-Asians, a report by Medact found.
Data gathered by a Freedom of Information request shows that, from 2017 to 2018, 43 percent of those referred to Prevent from a sample of NHS trusts were Muslim, with 32 percent of unknown religion. From 2018 to 2019, as the number of referees whose religion is recorded as unknown rose to 52.9 percent, Muslims were still by far the largest group whose religion was known, at 26.4 percent.
The author’s disproportionality calculations treat "unknown" data as non-Asian or non-Muslim. Since many of these could in fact be Asian or Muslim, the author states that the calculations “very likely under-estimate true levels of disproportionality”.
The report, “False Positives – the Prevent counter-extremism policy in healthcare”, by Dr Hilary Aked, argues that the unconscious biases health workers may have are “elicited and empowered”, as Prevent training materials tell health workers to “trust your instincts”.
Training materials cited in the report show how Prevent uses vague, subjective criteria to identify those vulnerable to radicalisation, which often have a racialised element. According to one webpage, “A need for identity, meaning and belonging” are signs of vulnerability to radicalisation. Since these criteria could apply to anyone, the website helpfully adds: “individuals may be distanced from their cultural/religious heritage and feel uncomfortable with their place in the society around them”.
Another page states: “often the most vulnerable [to radicalisation] are those who perceive discrimination, experience racial or religious harassment”.
“That’s quite clearly pointing the finger at racial minorities,” Hilary Aked told VICE News. “The vast majority of people who experience racism are not going to become terrorists. There’s no evidence to say that it actually increases [the risk of radicalisation], first and foremost, so what you’re doing is stigmatising black and brown people.”
As one example of an unconscious bias about extremism, the report mentions a health care professional who declined an interview request from Medact, explaining, "I'm working in Portsmouth these days. I’m not sure if I’d be much use to you, given the local population." The understanding is that they perceive Portsmouth as a largely white city, which therefore has no problem with extremism, making it implicitly an issue for BAME populations.
The report also finds that people with mental health problems are more likely to be referred to Prevent. As the majority of Prevent referrals are of people ages 20 or younger, the author argues that, “For individuals who exist at the intersection of these ethnic, religious, age and mental health identity markers, the discrimination that this amounts to may be compounded.” The author argues that Prevent therefore risks worsening existing health inequalities.
In one example cited by the report, the nine-year-old son of a Muslim man who was on the Prevent Strategic Group came into contact with the programme. His son attended Catholic school and joked to friends that he would “blow the windows” out of a limousine going to the upcoming school dance, in order to “eat the chocolate” inside. Another child of the same age reported these remarks to a teacher, who referred him to Prevent. The child was upset, and both his parents were deeply affected: the father was admitted to hospital overnight with angina after experiencing chest pains from the stress; the mother was diagnosed with depression and started taking medication. The father stepped down from the Prevent Strategic Group because of his experience.
Another case study describes how a Muslim man in his twenties, who was severely ill and totally dependent on his mother and carers, was referred to Prevent. The referral came from a psychotherapist who noticed him watching a YouTube video of Islamic scholars discussing religion. The man’s GP was contacted by police, who told them, “I can’t believe that this has been referred to Prevent. The young man cannot walk or feed himself, and yet you’re asking me if he’s a threat or risk.”
The GP said that the health worker did not refer “out of malice”, but “because of the training that they’ve had, they think they are doing the right thing”. The incident led to a complete breakdown of trust between the man’s family and the health team, interrupting his treatment.
This isn’t the first time Prevent has been accused of racial bias; the programme has long been criticised for its disproportionate focus on Muslims. When the programme started, funding was allocated to different areas based on an algorithm that used the size of the local Muslim population to estimate risk. The government’s new anti-terror bill rolls back its commitment to conduct an independent review into Prevent – something that was called for in 2018 by the UN special rapporteur on contemporary forms of racism.
The report highlights transparency issues around Prevent in the NHS. Only 4 percent of the trusts in the sample that Medact approached made full disclosures of data, including ethnicity data.
“Any information perceived to be related to national security – such as Prevent – seems to engender an especially acute lack of transparency,” the report says. It adds, “It also appears that government agencies have specifically sought to encourage health bodies to maintain secrecy and undermine public access to information around Prevent and Channel.” NHS England and the Department for Health and Social Care provide guidance for health trusts on how to argue against disclosing information, and the Home Office advises trusts on which exceptions can be used to get out of providing information. This lack of transparency “should be regarded as a grave problem in a democratic society”, says the report.
Responding to the report, a government spokesperson told VICE News: “Healthcare practitioners recognise Prevent as part of their safeguarding duties, and with over 300,000 patient contacts every day, the NHS has an important role to play in preventing vulnerable people being drawn into terrorism. A key part of Prevent is to enable frontline staff to recognise and safeguard individuals at risk from all types of radicalisation, referring them to pathways for appropriate support.
“Mental health conditions may contribute to a person’s wider vulnerabilities, though the relationship between mental health and radicalisation is complex.”
This response appeared to be related to referrals to Prevent of people with mental health problems – something other media led their reporting with. When we pointed this out and asked for a comment specifically about Prevent’s alleged racial and religious discrimination, the government did not respond.