States use the nexus of mental health and security to scapegoat minorities

A woman seeks mental health support in the UK’s National Health Service (NHS). She suffered from terrible abuse, and the mental health team sees its impact on her. The woman converts to Islam and dons the headscarf during treatment. A new subject now enters the team’s clinical discussions alongside the woman’s existing abuse: the fear of possible radicalisation. 

The 21st Century has seen an enormous growth in what is known as the “pre-crime” industry—“interventions” to identify individuals deemed to pose a criminal threat before they commit said crimes. 

This industry reveals the expansion of policing as an institution, with predictive policing diffused into everyday life. Through public duties, governments normalise the surveillance, capture and management of extremists as a public health strategy. 

It is important to remember that countering violent extremism (CVE) originated foremost as a racist enterprise, ushering a wholesale transformation of Muslim communities into a matter of national security. Since then, CVE has grown in its breadth and sophistication, especially with regard to mental health.

This is not a new phenomenon. Psychology and psychiatry have historically played a significant role in making sense of and managing those deemed a risk to themselves, others and, significantly, the national order. 

Psychologists of the British empire, for instance, developed psychological profiles of counterinsurgents in colonial lands. Later, the same was attempted with the Irish during the Troubles.

Today, mental health has become key in counter-extremism. Wellbeing can be used to signify both “immunity” from as well as “vulnerability” towards alleged extremism and radicalisation.

Over the last 20 years, long-standing debates in Western countries about the “integration” of vulnerable communities—particularly Muslims— suddenly became a question of national security. As the so-called “War on Terror” has grown to global proportions, psychologists and psychiatrists everywhere have taken an interest in political violence. 

Marriage of security and mental health

The intersection of mental health and security can be found in programs across the EU and the US. Within Europe, practices in the UK are particularly revealing of how counter-extremism policies manifest themselves in mental health services.

Through the Prevent strategy, which has made it a duty for all public bodies like hospitals to identify and report individuals vulnerable to radicalisation, England has rolled out Extremism Risk Guidance 22+ (ERG)—which is supposed to identify risk factors leading to terrorist acts—and embedded it as a mandatory risk assessment in several NHS mental health institutions. 

Based on a process that has been deeply scrutinised for its “science,” the ERG offers risk factors associated with extremism, including common psychological attitudes, such as “us and them thinking” and, of course, “mental health.” 

This approach has grown significantly through the national rollout of Vulnerability Support Hubs (VSH), which establishes an unprecedented relationship between policing and mental health. Data and mental health rehabilitation of alleged pre-criminals are managed under the watchful gaze of the police. 

If we consider how racism operates within Prevent referrals—which include speaking up against the settler-occupation of Palestine, for example—then the ethical considerations of these VSH are tremendous.

It is important to appreciate the dual significance of screening for extremism for all mental health patients while conducting mental health assessments for all counter-extremism referrals.

In the former, an extremism risk assessment for all mental health patients reveals the growing policing role of mental health professionals. In the latter, forcing mental health assessments upon alleged and future “extremists” depoliticises legitimate grievances and individualises experiences of political repression. 

Such are the stark dual realities of what is to come: the framing of mental health in terms of security on one side and the infringement of psychology discourse into national security on the other. Both are parallel streams that speak to the present-day marriage of security and the “psy” professions.

Mental health colourblinds racism 

The shift towards mental health seems related to two social realities: CVE’s desire not to appear racist following long-standing accusations of Islamophobia and the growing concern with the “far-right” and ethno-nationalist politics across Europe. This mental health rhetoric achieves several noteworthy spins for CVE. 

First, it reconfigures political thinking as a question of one’s state of mind. Presumably, everyone is equally susceptible to radicalisation if they are psychologically vulnerable enough to catch an ideological virus. Using “psychology talk,” CVE is rendered “colourblind” and positioned as a protection against all alleged forms of “threat.”

Second, it allows the state to incorporate anti-racism and anti-fascism activism within its security apparatus. Presumably, Muslims should now find solace in that CVE strategies are looking to identify the psychologically vulnerable within the white majority who might later join the far-right. Yet racialised Muslims are 22 times more likely to be referred to VHS for alleged Islamism than white British individuals are for “far-right.” 

This should not come as a surprise. Indeed, leaked letters revealed UK police chiefs expressing their opposition against efforts to define Islamophobia as racism, for it would undermine counter-terrorism operations. Racism in counter-terrorism is not incidental⁠—it’s essential.

It is difficult to predict what the future holds if mental health becomes increasingly securitised, but we can certainly begin by acknowledging how mental health shrouds the counter-extremism strategy with benevolence. 

While promoting a mental health framework appears to be a “good” thing, there are problems with this logic.

The first lies within extremism itself. Extremism is neither a valid nor reliable construct; it is foremost a political one. Mental health then helps anchor extremism as a valid issue devoid of its racist implications. 

Given the budget cuts to mental health services through austerity—where 1.6 million people are on the waiting list for NHS mental health care—Prevent also incentivises mental health professionals to refer patients as vulnerable to extremism, as they can be made to skip the waiting line.

It is also important to bear in mind that the nexus of security and mental health is symptomatic of the wider expansion of policing in healthcare. The use of the Serenity Integrated Mentoring (SIM) model, which employs police officers to manage “difficult” patients, demonstrates the dark underbelly of this growing relationship between security and mental health. There are also data sharing practices whereby the Home Office can deport families based on information accessed through patient mental health records. 

These developments cannot be divorced from the wider discussions of either race or the increasing management of mental health services through state policies.

There is a need to be critical of the state’s narrative on mental health as it relates to national security, as well as the growing number of academics and mental health professionals carving their niche in this subject.