By Mary Sadid, NSUN Policy Officer
Medact’s latest report, ‘Racism, mental health and pre-crime policing: the ethics of Vulnerability Support Hubs’, brings to light worrying practices affecting racialised communities and their access to mental health services. Revealed through a series of Freedom of Information requests, this report shows us that some mental health services are involved in questionable, coercive and potentially harmful practices in the name of ‘care and security’, and in potential contravention of their codes of ethics. NSUN joins the report’s call to close Vulnerability Support Hubs (VSH) and to resist the securitisation of care.
Vulnerability Support Hubs, also known as the Vulnerability Support Service, are shrouded in secrecy. They appear to be assessment centres where individuals deemed vulnerable to ‘extremism’ and ‘radicalisation’, as well as mental health conditions, are referred. The Hubs have been in existence for five years, with the 3 Hubs, located in England, assessing a total of 3842 individuals in a 4 year period. They are operated by counter-terrorism police with mental health professionals acting in a ‘consultancy’ role. What they do on paper appears to range from contacting mental health teams to giving advice and holding meetings. Hub documents state they will not act outside of the healthcare remit or principles, or manage any terrorism related risk. Medact’s report pieces together Hub activities, but they remain outwardly vague.
Vulnerability Support Hubs are a part of Prevent strategy, a branch of the government’s CONTEST counter-terrorism programme. Prevent duty under the Counter-Terrorism and Security Act 2015 mandates institutions like NHS trusts and schools to ‘have due regard to the need to prevent people from being drawn into terrorism’. Bodies under this duty include early-years providers, schools, hospitals, and local authorities. In recent years, counter-terrorism has experienced a ‘turn to mental health’, demonstrated by the emergence of Vulnerability Support Hubs.
The Hub model is based on an unevidenced link between ‘extremism’ and mental health. As well as being ‘pre-criminal’, in that individuals are referred because of suspicion and not on the basis of having committed a crime, many of those referred to Hubs are also ‘sub-clinical’ i.e. they don’t have a diagnosable mental health condition. The National Police Chiefs Council writes of VSH: ‘Not all of these cases offered support will have a [counter-terrorism] vulnerability but all will have unmet health needs. Clinicians are embedded within police Prevent teams and together they are reducing the risk to individuals and the public’. In the Central Hub, as many as 100 out of a total of ~350 had their mental health condition listed as ‘None’. In this ‘sub-clinical’ space, mental health professionals risk working beyond their competence.
Whilst some may not have a diagnosable condition, a number of those referred were already in contact with mental health services. In the North and Central Hub, 43% of patients referred were known to mental health services. Individuals in Hubs may have been passed on from clinician-led care to a police-led ‘pre-criminal’ setting based on perceived risk of ‘extremist’ ideology.
Critically, many of those referred to Prevent who may end up in such Hubs are referred for banal reasons. As Tarek Younis, one of the report’s authors, highlighted in a recent podcast, examples include a Muslim chaplain being asked by a clinician if they should be concerned about a patient who had started wearing a kufi (skull cap). Here we see that visible signs of Muslim faith become part of a risk profile, triggering ‘gut feelings’ that may lead to referral. In understanding how we perceive risk, acknowledging the role of racialisation and racism is key. In the Hub context, Muslims are 23 times more likely to be referred for ‘islamist’ ideology than a white British person for ‘far-right extremism’.
Going beyond professional competence is a key concern in the Hubs. Mental health professionals are not able to assess someone’s future risk of offending. Despite this, it appears they may be asked to do so – in collaboration with police – in the context of these Hubs. Mental health assessments are carried out with a police presence. There is ‘intensified monitoring of patient medication regime compliance’.There are also indications of detentions under both the Mental Health Act and Deprivation of Liberty Safeguards (DoLS) where health professionals appear to be under pressure from police in their decision making. These are all deeply worrying findings which point to a challenge in maintaining professional conduct and an urgent need to close these Hubs.
The real mental health risk lies in the significant surveillance and stigmatisation that can result from being visibly Muslim.
Like many emerging interventions, Hubs are pitched as an efficiency savings project. They ‘save police time and resources’. The reality is that situating mental health ‘care’ within police settings could be placing some at risk of harm, in particular individuals from racialised communities. This harm might come in many forms, including a fear of surveillance and referral which may deter those with mental health needs from seeking help.
At NSUN, many of our members are engaged in their communities on the ground. Many are from marginalised and racialised groups and meet their communities’ needs in a way that services (especially ‘colourblind’ ones) often cannot. Where there is real mental health need these Hubs may claim to meet, this should be through better funded mental health services whilst also recognising the need for a right to refuse mental health care. Better funding means within statutory services, but also to community groups – who need the freedom to lead themselves.
Transparency, scrutiny and evidence are critical to good practice. We urge mental health leaders to welcome transparency and dialogue in this area and review their engagement in these processes in line with their codes of practice.
We must resist the securitisation of mental health care and the weaponisation of mental health concerns to draw racialised people into a pre-criminal setting.
Read the report, bring it to the attention of your MP and NHS trust, and join us in calling for Vulnerability Support Hubs to be closed.
You can download the report here.