Interrupting care: How Prevent undermines Muslims’ access to UK’s public health sector

COVID-19 brought to light the widespread racial inequity in the UK’s public health sector, compounded by the poverty crisis, social housing issues, and the air pollution crisis.

The past two years stressed the importance of access, trust, and care in public health services for racially minoritised communities in Britain that were disproportionately impacted by the pandemic.

However, as long as Prevent exists in the NHS, these crucial cornerstones of healthcare will remain out of reach for the Muslim community.

"Recent government data shows that the NHS was the third most common sector for Prevent referrals between 2020 and March 2021 (11% of 4,915 referrals)"

The chilling effect of Prevent is widely recognised across the education sector in Britain, in particular how the policy causes a breakdown of trust between teachers and students. Yet, the impact of Prevent on healthcare has largely gone silent in the policy and academic discourse.

Although the referrals come from the education sector and police, recent government data shows that the NHS was the third most common sector for Prevent referrals between 2020 and March 2021 (11% of 4,915 referrals).

These startling stats comes on top of findings by Medact’s False Positives report in 2020, which discovered that Muslims were eight times more likely than non-Muslims to be referred to Prevent through healthcare.

The leaked contents of the Shawcross review will only lead to a harsher crackdown on Muslims already under state surveillance. While racism is becoming acknowledged as a public health crisis across the world, are we also recognising how Prevent can lead to racial outcomes in health for the Muslim community?

A breakdown in confidentiality and trust

Prevent is a mandatory duty for healthcare staff in the NHS, and by default, it undermines trust in public health services.

In a conversation with Reem Abu-Hayyeh, the Campaigns and Policy Lead for Peace and Security at Medact, she discussed Prevent in relation to undermining the importance of informed consent. “[Prevent] duty itself reminds people of their confidentiality and consent-seeking practices, but it also prioritises national security concerns over other professional and ethical obligations for medical practitioners,” Abu-Hayyeh states.

The False Positives research report found that Prevent training itself actively discouraged healthcare professionals from seeking consent. In turn, this means a patient may be unaware that a Prevent referral has happened on their behalf by a healthcare provider. Thereby, disrupting the element of trust – which lays the foundation between a patient and a healthcare practitioner.

The report also raised the concern from doctors that Prevent referrals could lead to patients withdrawing or disengaging from care.  “[Prevent] does have a negative impact when it comes to trust in the health service, at a time when we should be seeking to increase people’s trust in healthcare, and improve health-seeking behaviours,” Abu-Hayyeh adds, drawing reference to the impact of COVID-19 and the high mortality rates among racially minoritised communities in the UK.

“The first issue to recognise is the fact that a securitised space is obviously not an inviting space,” Dr Tarek Younis, Senior Lecturer in Psychology at Middlesex University comments on how Prevent may impact Muslims accessing mental health services. “I've had people come to me – especially those who know about my work – for therapy, explicitly because they don't feel safe going to the NHS.”

The concern around safety aligns with the findings from The People's Review of Prevent – notably, how Prevent masquerades itself as a safeguarding policy but in fact, does the opposite of protecting people from political violence.

"As a result of the War on Terror, state security has cast Muslims as an existential threat to Western society by securitizing every public space that Muslims access – from schools, universities, mosques, to hospitals"

The policy itself jeopardises the safety of Muslims by casting a net of state surveillance. As a Muslim, the moment you enter an A&E ward, visit your local GP, or attend a counselling appointment, your health suddenly becomes an object of political analysis.

“Access is immediately impacted. But another issue that has not yet been captured is that most people generally don't know about Prevent in the NHS. When they think about Prevent, they think about education. And a lot of people self-censor when they [access mental health services in the NHS], but they won't talk about everything that matters to them. Which goes against the purpose of therapy.” Dr Younis expands further.

Another possible realm in which Prevent widens health inequalities is by disrupting the patient-physician dialogue, which is a key factor in understanding any individual’s health needs.

Performative colour-blindness

As a result of the War on Terror, state security has cast Muslims as an existential threat to Western society by securitizing every public space that Muslims access – from schools, universities, mosques, to hospitals.

By extension of this racist state surveillance, Prevent also inherently equates Muslims with the threat of terrorism, and this association is reflected in its safeguarding training.

However, the ostensibly "colour-blind" aspect of the Prevent duty is an attempt to somehow cleanse itself of racism.

Although Prevent was revised to include far-right extremism, the training follows an ambiguous yet broad framework (ERG22+) to detect risk factors that inevitably point the finger back to the Muslim community – including feelings of exclusion (resulting from societal struggles such as poverty), or feeling “distant” from their religion or culture as potential signs of radicalisation.

Dr Younis’ academic research provides a striking example of performative colour-blindness with respect to Prevent training in the NHS: a question is posed around the risk factors of a child vulnerable to radicalisation in one of the online training materials, with ‘attending the local mosque’ as a potential answer to the question.

Although this was not the correct answer, the Prevent training still made that association of Islam with radicalisation, thereby reinforcing Islamophobic preconceptions.

“I think it's important to emphasise that there is nothing colour-blind about Prevent,” Dr Younis explains further. “By rendering [Prevent] colour-blind, it exacerbates a racist policy.”

Strengthening care on all fronts

As the False Positives report points out, doctors are concerned about Prevent eroding and interrupting access to care in public health services. However, the statutory aspect of the Prevent duty silences healthcare workers from speaking up.

For instance, challenging Prevent on an individual level may result in disciplinary action or professional consequences, particularly for any staff facing precarity in the NHS. But there is also strength in numbers.

The Securitisation of Health group at Medact, led by Reem Abu-Hayyeh, brings together health workers, academics and students to challenge how security is perceived within the medical and health sector, through evidence-based research and campaigning. “Prevent's chilling effect also means that challenging the policy collectively – rather than as individuals – is both more effective and safer; I would urge health workers and those impacted by Prevent in the health service to get involved in Medact's work to end Prevent," Abu-Hayyeh says.

For any health workers concerned with Prevent in the NHS, joining Medact and getting involved in the Securitisation of Health group is a good place to start. Ultimately, everyone is entitled to care and trust in their healthcare providers, and this should not be overlooked at this critical moment in public health.

Aida Hassan is a PhD student at Queen Mary University of London and a writer focused on the intersection of politics, race and global public health.