The un-intended consequences of the bizarre incentives catalysing the referral of mental health patients as radicalisation threats

One has to stretch the imagination to conceive that a new policy might result in health professionals in Britain considering whether to refer patients with mental health needs as radicalisation threats in order to gain quicker access to necessary support and services. In this post, Dr Chris Allen examines the un-intended consequences of the bizarre incentives catalysing the referral of mental health patients as radicalisation threats.

As Charlotte Heath-Kelly and Erzsebet Strausz explain in their piece on this blog, this follows an announcement by the British government’s Home Office in November last year. As they go on to explain, anyone that is referred to Prevent – Britain’s counter-terrorism strategy – that has mental health or psychological issues will now receive urgent psychiatric care. For them, such a scenario offers something of a ‘perverse incentive’ in that referring as a radicalisation threat not only guarantees quicker access to psychiatric care but so too the types of education, healthcare and welfare support that have been drastically cut as a result of austerity measures.

Such concerns will do little to counter the white noise that surround debates and discussions about the Prevent strategy and Britain’s approach to countering extremism and radicalisation. As I have previously set out, Prevent has historically been criticised for being a state-endorsed policy designed to ‘spy’ on Muslims and their communities, for justifying Islamophobia through the validation of negative stereotypes about both Muslims and Islam, and for seeking to impose a government-backed ‘British Islam’ compatible with secular and liberal values among numerous others. Because of this, not only is it extremely difficult to have a balanced and objective conversation about Prevent in the public and political spaces but so too is the need to better understand the positive impacts of Prevent routinely obfuscated.

There is some rationale for improving the links between approaches to counter-terrorism and mental health. As a 2016 British police study found, around half of all those feared to be at risk of terrorist sympathies were thought to have mental health or psychological issues. In this respect, the joining up of services that seek to address all the various risk factors at play – recognising mental health alongside other factors including British and Western foreign policy, social and cultural alienation, poverty and socio-economic deprivation and religious ideology – make an awful lot of sense. The ‘perverse incentives’ however, do not.

Aside from the ‘perverse incentives’, there is potential for quite damaging ‘unintended consequences’ also. For one, the latter has the potential to be the direct consequence of the former; whereby a referral is likely to result in access to urgent services and support. Given the Race Equality Foundation – as indeed others – have evidenced the significant racial and ethnic inequalities that exist as regards the provision of mental health services for Black, Asian and Minority Ethnic (BAME) people, to what extent might the ‘perverse incentives’ find themselves being unduly determined on the basis of ‘race’, ethnicity or heritage? As the overwhelming majority of British Muslims have BAME heritages, so an unintended consequence could be that a greater number of Muslims find themselves being subsequently referred to Prevent. While the ‘perverse incentive’ would be the main driver, any increase in the numbers of Muslims being referred to Prevent has the very real potential to compound wider criticisms about Prevent as also wider perceptions about extremism and radicalisation being a ‘problem’ of Britain’s Muslim communities only.

Another relates to concerns raised previously about the Prevent Duty. Following changes to Prevent made under the Counter-Terrorism and Security Act 2015, the rationale for the Duty was that those working in the public sector were uniquely placed to see the ‘changes’ in the behaviours and attitudes of those being radicalised or vulnerable to becoming so. The problem here is that because the premise is that such ‘changes’ are easily identifiable and thereby understood in simplistic and somewhat naïve ways. In this way, noticeable ‘changes’ can be reduced to those that suggest someone is becoming ‘more Muslim’: growing a beard, wearing a hijab or adopting the niqab for instance. If similar approaches evident in British educational settings were replicated elsewhere, for instance in health settings, then it could be that Muslims experiencing mental health or psychiatric issues without links to extremism or radicalisation could find themselves duly being referred. The old adage ‘better safe than sorry’ comes to mind. Given Heath-Kelly and Strausz note how the number of people referred has rocketed since the introduction of the Prevent Duty, one might reasonably argue that many of these were made on the basis of simplistic and reductive understandings of ‘changes’ in behaviours and attitudes. That such a combination is likely to result in greater numbers of Muslims again being referred to Prevent is therefore another potential unintended.

As with the ‘bizarre incentives’, the unintended consequences are potential as opposed actual. Nonetheless, this should not mean that either or indeed both are routinely dismissed out of hand. For a Prevent strategy that continues to struggle to shed its historical legacy, such concerns will no doubt be pounced upon by those who seek to criticise and condemn it at every given juncture, many of whom do so for their own ideological or political gain. For those seeking ‘evidence’ that extremism and radicalisation is solely a ‘problem’ of Muslims and Islam, so the unintended consequences have the potential to feed their fires also. For them, any increase in numbers of Muslims being referred to Prevent would be a god-send that they – like those previously – would seek to equally exploit albeit for entirely ideological and political causes: those that seek to demarcate and divide along the lines of who can and cannot be a part of who ‘we’ are perceived to be.

In spite of the criticisms briefly referred to previously, Britain’s Prevent strategy was recently described as the ‘best practice model’ for tackling counter-terror by the head of Europol (the European Union’s law enforcement agency). In this respect, it can only be positive that the strategy is placing a greater emphasis on the potential links between mental and psychiatric health and an individual’s vulnerability to extremism and radicalisation. While so, it is always necessary to reflect on the less obvious impacts of any new policy directives or innovations to ensure that the unintended consequences and perverse incentives are, at all times, minimised.