Public Health approaches to Radicalisation: The Evidence Base

Public Health approaches to Radicalisation: The Evidence Base

Charlotte Heath-Kelly

Increasing emphasis is being placed on public health approaches to countering extremism and radicalisation. Public health is defined as the science and art of preventing disease, prolonging life and promoting health. But – is radicalisation comparable to a disease? What is the evidence base for using the public sector to identify and divert potential terrorists in advance, to secure their wellbeing and ours? And do efforts to counter radicalisation create more problems than they solve?

The academic and professional literatures on public health approaches to terrorism, radicalisation and extremism are growing exponentially. Unfortunately, this growth is not the result of new breakthroughs in scientific studies, but driven by the political and academic will to know what causes a person to engage in terrorism. This will to knowledge results in many studies replicating common-sense assumptions about terrorism, sometimes without an appropriate evidence base. To render transitions to terrorism ‘knowable’, models of radicalisation all tend to follow the same approach – dividing a person’s journey towards terrorism into hypothesised stages, each demonstrating different indicators of disassociation from social and behavioural norms.

This builds a picture in the academic and professional literature of an identifiable, and disruptable, process of radicalisation. But is this borne out by evidence? Unfortunately not. Systematic reviews of the evidence are highly critical of the professional tools used to judge radicalisation and terrorism risk, and the security services can be equally scathing of counter-radicalisation effectiveness – with the Home Office determining 98% of their own Prevent funded activities as ineffective. Similarly, in 2008 MI5 completed a study of several hundred individuals involved in, or closely associated with, terrorism. Their findings (obtained by the Guardian) showed that there is no identifiable pathway into terrorism; rather individuals were ‘demographically unremarkable’ and presented a large and heterogeneous array of pathways into political violence. So what hope is there for public health approaches to terrorism?

Forensic psychologists have tried to shed more light on this confusing picture of radicalisation. No less than 30 risk assessment tools currently exist to evaluate the attitudinal and behavioural signs associated with high risk of terrorism – including the Extremism Risk Guidance 22+ toolkit, upon which the UK’s Prevent Strategy relies. However, systematic reviews of the quality of these studies pose significant concerns about their replicability and methodological transparency – the cornerstones of medical research.  The authors provide a damning indictment of the risk assessment tools used to detect potential terrorists:

just over half of the criteria necessary for a transparent description of the instruments were reported across the different studies, and even less were reported in the articles that developed the professional instruments. Second, the same was found for the assessment of the psychometric properties, which was of poor quality overall. It is important to note that the instruments used by experts, and approved by their respective governments, are based on either minimal information or on un-critiqued information, which remains inaccessible to researchers to develop further.

In the face of stringent critiques about the quality of scientific evidence underpinning counter-radicalisation programs, policymakers defend Prevent on the basis that it must be better to do something to counter terrorism than nothing. But is it better to do something, in the hope that it works, rather than doing nothing? A recent study of the effect of counter-radicalisation training in the NHS has highlighted significant negative consequences to Prevent, which I elaborate below.

Breaches of Safeguarding Protocol and Information Governance
Prevent is performed as a ‘safeguarding’ measure throughout the UK’s health, education, prisons and social services. Safeguarding positions counter-radicalisation within the care responsibilities of public sector workers for vulnerable people – ostensibly to protect them from radicalisation grooming. But safeguarding protocols were established to protect victims of domestic violence, sexual exploitation and elder abuse. Stretching them to include the ideological manipulation of persons comes with a significant array of tensions and concerns for safeguarding law and information governance.

Firstly, safeguarding is governed by an established set of protocols and laws. The Care Act 2014 collects and formalises standards for safeguarding. It defines adult safeguarding interventions as occurring when:

an adult has needs for care and support (whether or not the local authority is currently meeting those needs); is experiencing – or is at risk of – abuse or neglect; and as a result of those needs, cannot protect themselves from that abuse or neglect.

In the context of adult safeguarding, care and support needs are formal criteria including severe mental health needs, dementia, significant disability, homelessness and drug/alcohol addiction. The British Medical Association emphasises that these needs alone do not mean an adult should face a safeguarding intervention, as they still maintain agency. Rather, an adult with such needs who simultaneously faces financial, physical, psychological or sexual abuse can be given protective assistance by safeguarding teams.

But Prevent bypasses the ‘care and support needs threshold’ for safeguarding – advocating that an unspecified process of ideological grooming constitutes abuse, and that this grooming is potentially dangerous for every member of society. By removing the ‘care and support needs threshold’, every member of society becomes a potential subject of safeguarding intervention regardless of their agency and capacity. Prevent is divergent from safeguarding protocols and laws, because it is not limited to the protection of vulnerable members of society. If everyone is supposedly vulnerable to radicalisation, then Prevent more closely resembles a surveillance measure than act of care for those classed as formally vulnerable.

Secondly, the information governance standards usually associated with safeguarding are bypassed in Prevent referrals. Normal safeguarding referrals strictly require informed consent for personal information to be shared with other agencies. Exceptions can be made when the person lacks mental capacity to give informed consent, or a serious crime has been committed, or people are at risk of harm. However, the Prevent Leads and safeguarding professionals interviewed in academic studies of Prevent in the NHS all confirmed that they have never obtained consent before making a Prevent referral.

Furthermore, NHS England has released information governance guidance for Prevent referrals which emphasises that consent is not required to share patient information. The justification for not informing patients of a Prevent referral is the ‘prevention of crime’ exception to the Data Protection Act, which enables public sector information sharing in the public interest without prior consent. This exception is commonly used in Prevent referrals, where referred persons often don’t find out they have been reported until a Police Officer knocks on their door to make sure the report is accurate.

There is a major contradiction with safeguarding protocol here. If Prevent is safeguarding, why are public sector workers using the criminal exception to the Data Protection Act to make referrals? The Prevent pathway is not designed to take reports of imminent crime or terrorist conspiracy – such reports should be phoned through to the emergency services or police. So what kind of crime is thought to be imminent from those disenfranchised people referred to Prevent? None. The ‘crime prevention’ exception is pragmatic and expedient, facilitating the greatest number of early-stage referrals for police evaluation. The ‘criminal exception’ to the Data Protection Act is being overused, raising serious concerns for appropriate information governance and medical confidentiality.

Finally, to accept the Prevent Strategy as a safeguarding procedure one must ignore or refuse the evidence that referrals can damage wellbeing. While Home Office statistics outline the support provided to Prevent referred persons through Channel or public sector organisations, nearly 500 people have applied to the charity Preventwatch for support after discriminatory and/or traumatising experiences of Prevent referral.

The Alternative
As I have outlined above, there are serious costs to safeguarding compliance and information governance when implementing counter-radicalisation programs – especially when the evidence base which underwrites counter-radicalisation is so poor. So what should be done? How can societies tackle radicalisation without returning to the hard criminal justice models of old?

There is an alternative. Policymakers could take seriously the reports of professionals and academics that adverse childhood experiences, social disenfranchisement and mental illness frequently figure in the backgrounds of terrorists. Rather than embedding counter-terrorism in the work of the public sector, why not simply fund the public sector to do what it does best – to respond to needs?  If public and social services were appropriately funded, rather than starved by austerity policies, then these needs would be picked up at an earlier stage.  The populations at-risk of radicalisation due to their social and health needs would never require the interventions of the Prevent Strategy. Then the police would be free to respond to the minority of terrorism cases where ideological drive, rather than social need, prompts engagement with violent groups. This would constitute a genuine public health approach to terrorism.


Charlotte Heath-Kelly is Reader in Politics and International Studies at the University of Warwick.

Image: Victus