The government’s terror strategy 'compromises the Mental Health Act and must be challenged'

Post 9/11 Islamophobia and the pathologisation of black people should be tackled as part of the Mental Health Act review, argue former psychiatrist Suman Fernando and researcher Tarek Younis.

Stephen Lawrence’s murder in 1993 led to the Macpherson inquiry that attributed police failure to prosecute the murderers to institutional racism. The government of the time took various actions to counteract institutional racism, sometimes with apparent success. A general view developed (instigated also by the advent of Barrack Obama in the White house) in the early 2000s that racism in the UK was at least under some control, if not on the way out. People even talked of Britain becoming ‘post-race’. As complacency developed, anti-racism movements lost support. The apparent gains were ultimately illusory.

"In 2015 the Home Office made the Prevent policy a statutory duty for public bodies to have ‘due regard’ in identifying and reporting patients deemed vulnerable to radicalisation."

In the last 18 months, two major events exposed the unfortunate persistence of institutional racism. First, there was the Grenfell Tower fire on 14 June 2017. Doreen Lawrence, the mother of the boy who was murdered by racist thugs, rightly noted a “striking parallel” between the inquiry into her son’s murder over two decades earlier and the public inquiry into the Grenfell fire. “We like to think that we have moved on since Stephen was killed, and that race is no longer an issue, but of course it is,” she said. “It is the elephant in the room inside the (Grenfell) inquiry.’

Then there was the Windrush scandal in the spring of 2018, which exposed the atrocious treatment of people who had migrated to the UK from the Caribbean fifty years earlier because of the hostile environment policy — promoted by Theresa May when she was Home Secretary. Member of Parliament Alison Thewliss said ‘the hostile environment policy is being applied across all areas of immigration’.

Racial inequality in mental healthcare

Unfortunately, what happened to the residents of Grenfell and the Windrush scandal are not the only indications of institutional racism in the UK. Racial inequality in the diagnosis of schizophrenia and compulsory treatment (with deprivation of liberty) has been noted in the UK since the early 1980s — facts that medical-psychiatric research has been unable to explain, but my (Fernando) study into areas including the pathologisation of black people and post 9/11 Islamaphobia can and does. 

• See also: Psychiatrists acknowledge 'unconscious racial bias'
• See also: Breaking down racism in mental health care
• See also: Using evidence from the Race Disparity Audit to reform the Mental Health Act

Add to this how, in 2015, the Home Office made the Prevent policy [Prevent is a controversial programme that aims to divert people from terrorism before they offend, and is currently voluntary] a statutory duty for public bodies to have ‘due regard’ in identifying and reporting patients deemed vulnerable to radicalisation. Doing so, the UK government has designated healthcare settings a ‘pre-criminal space’. Elusive terms such as extremism and radicalisation have racial connotations in public consciousness, associated primarily with the Muslim ‘other’. Add to this the securitisation of integration discussions with the Prevent policy’s insistence on ambiguous ‘British Values’, it is unsurprising then that British Muslims are 40 times more likely to receive a Prevent referral than someone who is not a Muslim– despite the increased emphasis on the far-right. Now, an individual vulnerable to ill-defined radicalisation who is sectioned under the Mental Health Act will continue to have their information shared with the local authority outside the hospital setting if this is deemed necessary.

It is evident today that British racism never really retreated, as some of us thought around the turn of the century — it had merely changed its form from being predominantly overt (in-your-face) to being mainly ‘institutional’ (subtle, cultural). What appears to have happened is that racism lay hidden, apparently dormant, for a few years and now with the Brexit campaign and Trump in the USA, racism is once again out in the open, often re-defined from skin colour talk to culture talk. Just as the UK took action in the 1960s and 1970s — more so than most other European countries — to deal with overt racism, it is necessary now to deal with institutional racism.

In December 2017, Theresa May ordered a review of the Mental Health Act led by Simon Wessely, former president of the Royal College of Psychiatrists, ‘tasked with looking at the rise in the use of the MHA [Mental Health Act] over the last 10 years, but also the significant over-representation within that cohort of BAME [Black and Minority Ethnic] communities and, within that, a significant over-representation of people of African-Caribbean and African descent’.

In January 2018, the NGO ‘Race on the Agenda’ (ROTA) set up a study group to examine ways of counteracting institutional racism in mental health services and co-organized a conference on the topic. The result is that specific recommendations are now on the table for Simon Wessely’s consideration. There is now a glimmer of hope for change — depending on final recommendations in the report due at the end of the year and, more importantly (because the Government can always dismiss those parts of his report that deal with institutional racism) the political will of the government to take action.  

Nonetheless, there persists a fear that, unless Simon Wessely argues strongly for counteracting institutional racism and the government takes action on this, changes in mental health legislation may be used to expand the extent of sectioning even further, thereby worsening the conditions for black people in an increasingly race-blind society.

We are also concerned with the expanding focus of the Prevent policy within mental health, which may usher a new era in which ‘individuals vulnerable to radicalisation’ may be pathologized and sectioned against their will for ‘rehabilitation’— a phenomenon that would surely affect BME individuals, debasing British ethnic minority communities. These are not empty fears; talks of ‘compulsory deradicalisation’ are already underway. It is our hope Simon Wessely attends to these concerns of institutional racism in his review.

Tarek Younis is a psychologist analysing the impact of Prevent, with the research conducted under the supervision of the UCL Division of Psychiatry. Suman Fernando is a former psychiatrist and the author of Institutional Racism in Psychiatry and Clinical Psychology.