London Division 22nd November 2016

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2 London Division 22nd November 2016 Counter terrorism and Psychiatry Adrian James Registrar

3 Mohamed Lahouaiej-Bouhlel Nice 14 July 16

4 His father said Lahouaiej-Bouhlel underwent psychiatric treatment before he moved to France.

5 Omar Mateen,12 June 2016 Orlando

6 In 2009, Mateen married his first wife. Following the nightclub attack, she said Mateen was "mentally unstable and mentally ill" and "obviously disturbed, deeply, and traumatized"

7 NHS referred 420 staff and patients over radicalisation Five Live 20 Nov 2016

8 Section 26(1) of the Counter-Terrorism and Security Act 2015 Specified authorities, including health bodies, must, in the exercise of [their] functions, have due regard to the need to prevent people from being drawn into terrorism

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11 CAGE The authors have not provided sufficient evidence to support the ERG22+ s science. The study s conclusions have been implemented far beyond the original intention. A process that should have only ever been used by experts in a limited circumstance has been opened up to the entire public sector.

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13 Open Society Justice Initiative Prevent s structural flaws include the targeting of pre-criminality, nonviolent extremism, and opposition to British values intensifies the government s reach into everyday lawful discourse targeting of non-violent extremism raises serious concerns about possible violations of the right to freedom of expression

14 Open Society Justice Initiative Risk of discrimination, particularly against Muslims Prevent duty risks breaching health bodies duty of confidentiality towards their patients and undermining the relationship between health professionals and their patients

15 Open Society Justice Initiative Serious indications that Prevent is counterproductive

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17 Royal College Psychiatrists Psychiatrists place the care, treatment and safety of their patients at the centre of all they do GMC RCPsych

18 Psychiatrists have a duty to safeguard both their patients and the public Serious mental health problem.. significant risk to themselves or to others they will act

19 Terrorism causes enormous human suffering, and in itself can lead to psychiatric consequences

20 Concerns about the implementation of Prevent Variable quality of the evidence underpinning the strategy Potential conflicts with the duties of a doctor Reduce the willingness of people to access mental health treatment

21 All agencies leading on Prevent need to share data and information Feedback for their individual patients to know what happens to them in the Prevent and Channel processes

22 Culture within Prevent Sharing of information is the norm, and secrecy, including the perception of secrecy, actively avoided

23 Fleeing war-torn parts of the world Overly identifies them with the terrorism from which they have fled, as this could add to their trauma

24 Terrorism, radicalisation and mental illness Terrorism is a complex phenomenon Radicalisation is not a mental illness erroneous inference that psychiatrists who have special expertise in treating conditions characterised by abnormal beliefs may also have a role, as well as the technical tools, to participate in de-radicalisation programmes

25 Mental illness and terrorism Evidence suggests that mental illness is probably not a useful explanatory factor in group-based political violence Terrorists who act alone (perpetrating what are often known as lone-actor events) are statistically more likely to have a background that includes mental illness

26 Risk prediction tools No reliable adult or child and adolescent evidence-based tools that can predict involvement by individuals in terrorism Current tools and methodologies should be viewed with considerable caution Predicting very rare events is extremely difficult

27 DONALD J. TRUMP S VISION Fix our broken mental health system

28 Trump All of the tragic mass murders that occurred in the past several years have something in common there were red flags that were ignored. We can t allow that to continue

29 Trump We must expand treatment programs, and reform the laws to make it easier to take preventive action to save innocent lives

30 Trump Most people with mental health problems are not violent, but just need help, and these reforms will help everyone

31 Recommendations 1. Regional hubs: data collection, improve expertise 2. Share data including evaluation of eg ERG More research: open data/ peer reviewed 4. Public Health interventions and research 5. Ethical guidance

32 Recommendations 5. Ethical guidance 6. Psychiatrists primary duty is to their patient, and their clinical judgement and expertise should be valued and respected.. no compulsion for psychiatrists to act in ways that go against their evidenced best judgement

33 Recommendations 7. Caution re assessment tools/ beware false positives 8. Commitments made to improve mental health services for troubled adolescents and young people are honoured

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