There’s a letter by me and Dr Lisa Conlan published yesterday in The Psychiatrist’s eLetters:

National DNA database and psychiatric patients

The advent of DNA analysis as a powerful tool for crime detection has led to the creation of England and Wales’s National DNA Database (NDNAD). This is one of the world’s largest databases of DNA information, storing profiles of nearly five million individuals (1). We write to raise a concern about the potential impact of this database on people with mental disorders.

The NDNAD has long been the subject of scrutiny and criticism with regards to how DNA profiles are collected and retained and from whom. This is because the current regulations on DNA profile collection mean that the NDNAD includes DNA profiles of a large number of people who have never been convicted of any crime. These DNA profiles are currently retained indefinitely. This practice, was challenged in the European Court of Human Rights who found England and Wales to be in breach of the European Convention of Human Rights. In light of this, both the current and previous UK governments have signalled their intention to enact reform but as yet there has been no change in legislation.

Some groups, including young black men, are known to be overrepresented on the database (2) and we are concerned that those with mental health problems, a vulnerable group of people, are similarly affected. This issue has been largely unexamined and there are no estimates for the number of people with mental disorders on the NDNAD. However in 2008, nine percent of mental health inpatients were admitted via the Criminal Justice system (3). Furthermore, studies of individuals in prison and on remand have concluded that mental disorder is extremely common in these populations with respective rates of 90% and 63% (4,5). It would be surprising if the population of the NDNAD were not to broadly reflect this state of affairs.

It is arguable that a person with mental health problems who has a profile on the NDNAD, despite being without criminal conviction, is not only disadvantaged but also criminalised. This is a potentially unhelpful outcome for the process of engagement and recovery. We have concerns about how some patients come to be on this database. Patients arrested as a direct result of their mental state may find themselves on the database despite being diverted into mental health services without charge. Given that police powers allow that reasonable force may be used to take a DNA sample without consent, a disturbed and oppositional patient may be injured in the process. There is also lack of any formal pathway for removal from the NDNAD, which is at present difficult to navigate.

The new UK Coalition Government has undertaken to adopt the current Scottish model whereby DNA profiles of those arrested but not convicted are retained for six years only. DNA profiles of those convicted will be kept indefinitely as before. This reform would go some way to addressing our concerns.

We would welcome a debate amongst clinicians on the issues surrounding mental health patients and the National DNA Database.

References

1.National Police Improvement Agency. National DNA Database Report 2007-2009 [document on the internet] National Police improvement agency; 2009 [cited 2 September 2010] Available here

2.Rt Hon Baroness Scotland of Asthal QC, Minister for Criminal Justice and Offender Management. Minutes of evidence 13 March 2007 (Q653) [document on internet] House of Commons [prepared 15 June 2007; cited 2 September 2010] Available here

3.Commission for Healthcare Audit and Inspection. Count Me In 2008 [document on the internet]. Commission for Healthcare Audit and Inspection; 2008. [cited 2 September 2010] Available here

4.Singleton, N., Meltzer, H. & Gatward, R. (1998) Psychiatric Morbidity among Prisoners in England and Wales (Office for National Statistics). London: Stationery Office.

5.Maden, A., Taylor, C. J. A., Brooke, D., et al (1995) Mental Disorder in Remand Prisoners. London: Home Office

Picture credit Wikipedia

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This made is into the No2id newsletter 157

There is much rejoicing here at Frontier Psychiatrist HQ as both parties in the new coalition government are committed to abandoning ID cards and the National Identity Register.  And that’s not all – the Contact Point Database is also toast.  Page six of the coalition agreement has actually brought a lump to my throat.

However the fight against intrusive and unnecessary state run databases is far from won.

Since I posted last about the Summary Care Record it’s become one of the most popular posts on this site.  Here is an update on what’s been going on.

As you may remember, the Summary Care Record is part of the NHS National Programme for IT.  It is a national database which makes health records available for healthcare staff to access wherever a patient needs treatment, regardless of where they live (so long they haven’t strayed into Scotland).

Given the vast number of people who will potentially be able to access healthcare records, there are issues surrounding the privacy of personal data held in this way.  Any benefits will be to a small number of people but for the vast majority the SCR it will make no improvement to their care.  Recruitment to the database is via a controversial ‘opt-out’ system and opting out appears to have deliberately been made difficult.

This year the government began to roll out the SCR across the country.  The BMA kicked up a stink, saying that patients were not sufficiently aware of what was going on.  The brakes were put on mid-April and the roll out was suspended.  Despite this, some primary care trusts were reported to be asking permission to continue uploading patient records.

On May 5 the BMA and the DoH signalled that they had come to an accommodation and released a statement.

Connecting for Health (CfH) and BMA have agreed that the upload of information to the Summary Care Record (SCR) should only take place in any practice once the practice and the primary care trust (PCT) agree that patients have been adequately informed about the process and properly enabled to opt out should they wish.

It remains to be seen what this actually means.  I maintain that the only reasonable way to populate a database of healthcare records is by informed consent.

As for the future: if the current trajectory is followed then there are plans for A&E discharge summaries and out-patient letters to be included.  A&E departments could also create for you your own SCR entry should you not have one, meaning those of us who do not wish to be ‘opted in’ will need to be constantly on guard.

But the SCR’s future under the new government is uncertain.   The coalition document does not mention the SCR, but it is thought that the Conservatives are hostile to the NPfIT and will cancel the portions of it not yet completed.

Links

Here’s a reasonable summary of the SCR in the Mail

And another article in the Mail.  I don’t care for its tone, but it’s on the right track

Wikipedia has the basics

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The article I wrote on the Summary Care Record has been featured in the no2id newsletter number 145.

NO2ID is the UK-wide, non-partisan campaign opposing the government’s National Identity Scheme (‘ID cards’) and the database state and is an organisation I support.  If you wish you can donate to them here

Here is a letter I wrote to forth.ie

Sir,

On 7 December I wrote an opinion for this site about the launch of identity cards in Manchester. I received one comment, from Joan Burton, who wrote: “It’s a cliche but a true one – if you’ve done nothing wrong you have nothing to fear.”

One of the problems about the current UK government’s overarching surveillance project has been a lack of debate, both publically and in parliament, so I welcome any engagement with these issues.  I have heard the above sentiment voiced before and I address it here to provide clarification and, I hope on Ms Burton’s part, reevaluation.

Public protection from criminal activities is a key responsibility of the state but this should not allow the state whatever means it wishes in the pursuit of this goal.  Governments need to keep in mind that their populations predominantly comprise law abiding citizens whose rights and wishes should be balanced against any reasonable requirements the state may have to pursue its duties.  The ‘done nothing wrong/nothing to fear’ paradigm ignores any need for balancing public and private needs to the extent there is nothing that cannot be justified by its invocation.  It would, for instance, endorse the enforcement of the fitting of positioning devices to everyone living in or entering the UK, something that might drastically reduce crime but at the expense of massive state intrusion.

Thinking this way ignores the need to evaluate state surveillance projects and dismisses those who object as oversensitive to individuals’ rights, or failing to see the threat that we face.  The point I wished to make about ID cards is that not only are they intrusive, but they fail to meet any of their objectives, even though these objectives have changed over the years.  Now, more than ever, the UK Government must be careful with its taxpayers money and, civil liberties issues aside, that project of the expense of that of the ID cards is now being promoted as first and foremost a convenient way to prove identity at the post office is of concern in itself.

Finally within ‘done nothing wrong/nothing to fear’ thinking there is a tacit assumption that governments are inherently benign and have the interests of their populations at heart.  Whilst this may be broadly so for the UK it is foolish to think that this is a universal attribute of governments or that adverse change is not possible.  It is a sad fact that the majority of acts of violence committed in the modern world have been visited by those in governmental power against those who are out of power.  Indeed the word ‘terrorism’ actually dates from the French revolution and refers to the use of terror by governments against their own populations (1).  One estimate holds that during the 20th century governments killed 7.3% of their populations.  ID cards have  been documented as having been assets in mass killings both recent and historical and continue to be used to target vulnerable populations.

Yours etc.,
Dr. Stephen Ginn MD,
London.

References:

In February of this year I posted this open letter of protest on this website.  This is a campaign by 725 physicians (including myself) from 43 countries to compel the World Medical Association (WMA) to examine the medical ethical track record of the Israeli Medical Association, one of its member associations, in relation to its adherence to the Declaration of Tokyo, a key WMA code. This declaration mandates doctors not only to refuse any involvement in the practice of torture, but to speak out and confront it whenever encountered.

Unfortunately there is reputable evidence of the collusion of doctors with torture in Israel.  Our letter to the WMA Council in May set out some of this evidence and also queried the probity of IMA President Yoram Blachar’s position as WMA President as a result of his inaction in addressing this matter.

We continue to press the WMA Council for a response.  Dr Blachar however has responded on his own account by instructing solicitor Mark Stephens of Finer, Stephens & Innocent to issue the campaign convener, Dr Derek Summerfield, with a threat of a libel action – directed to him personally.  This would appear to be an attempt to muzzle this issue of high public interest and principle, as regrettably English defamation laws are weighted heavily in favour of the plaintiff and libel actions here are costly to fight.

What is particularly puzzling is that despite writing to Dr Summerfield, solicitor Mark Stephens would appear to be constitutionally placed to be sympathetic towards our campaign’s wish to be heard.  Perusal of the website of Index on Censorship, who campaign for freedom of expression, indicates that he is a trustee of their organisation.

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Doctors demand Yoram Blachar resign as ethics chief over Israeli torture Guardian 21 June 2009

I’m learning guitar.  Recently I went to visit Alex, my tutor, and briefly overlapped with the student who was before me; he’s a pleasant young man of perhaps 10 years old.  Also in the room was his father.  He looked a bit glum.  I assumed that this man was simply there, somewhat begrudgingly, to collect his son but Alex said that he routinely sits in for the duration of his son’s lessons.  Apparently this is common practice amongst parents these days.

The parents of Alex’s students aren’t prepared to give him the benefit of the doubt and assume that he’s not a paedophile.   I was surprised by this initially, but then when I thought about it some more I was surprised that I had been surprised, because the risk of an abuser taking advantage of one’s child is now one that is  impossible to take too seriously – for individual parents and government alike – and trumps all other considerations.

Modern psychiatric and psychoanalytical thinking has played a part in this.  As ‘talking therapy’ has become increasingly popular so has the notion that the events and relationships of childhood are causative of subsequent problems.  Such a vulnerable period will require careful marshalling and the exercising of a high index of suspicion.  But as the vast majority of people are decent, the consequence is that young people will be wary of those in whom they should place trust and potential role models will be discouraged from entering professions where their probity will be doubted; primary school teachers are for instance now staffed predominantly by women.  More prosaically, many more children will die from car crashes on the school run than would ever have been abducted.

This is not to say that there haven’t been some children who have suffered horribly and we have learnt about the failures of services charged with protecting vulnerable children through inquiries into what went wrong.  The most recent of these were those of Victoria Climbié and Baby P.  In both cases the authorities involved failed to act at crucial times and poor communication was exposed.  Lord Laming’s report into the circumstances surrounding Victoria Climbié’s death stated that ‘the extent of the failure to protect Victoria was lamentable’. There had been ‘no fewer than 12 key occasions when the relevant services had the opportunity to successfully intervene in the life of Victoria’.

Something else Laming said is very instructive:

‘Tragically, it [a successful intervention in into Victoria’s life] required nothing more than basic good practice being put into operation. This never happened.’

Encouraging good basic practice is not something at which politicians excel, as they favour grander gestures.  Under the policy heading of ‘Every Child Matters’ the Government has embarked on a mission to change the approach to child protection in the UK.  It’s strikingly similar to the way they’ve sought to tackle the threat posed by terrorists: expensive, technically complex, intrusive, restrictive, superficially impressive, and ultimately of dubious value.

Just like Alex, everyone is under suspicion and even those with the most fleeting access to children.  From November 2010 every adult who works with children will have to be registered with the Independent Safeguarding Authority (ISA).  This includes teachers and paediatricians, but also casual volunteers, including any authors who may wish to visit a school to read their work.  Last month Philip Pullman, author of the His Dark Materials Trilogy, said he would refuse to undergo these checks as he found them insulting.

“…we are teaching children, that the world is a dark and nasty place were everybody wants to murder and rape them.  It assumes that the default position of one human being to another is predatory rather than kindness.  It says to the very few people who are inclined to rape and murder children that they are no worse than anybody else, because they would do it too if they could.”

Worse, the ContactPoint Database will be a record of the details of the all the children in the UK under age of 18.  It stands accused of being vulnerable to inappropriate access, and violating the principle of privacy in a free society.  Its operation suggests that when it comes to access to personal information, the UK is two-tier as information about the children of ‘celebrities’ and MPs can be ‘shielded’.  The price tag is £224million, which although put into shade by the billions already spent on the national identity scheme, is still a staggering amount of money.

Such databases and reorganisations do nothing to help parents decide on the appropriate level of supervision for their children or encourage a more sensible risk assessment.  The events that these databases have been installed to prevent are so rare that their utility can never be established.  Child abuse is commonest in failing families whose problems are caused, at least in part, by social inequality, an altogether tougher nut to crack and one to which the UK government has generally paid no more than lip service.  London social work teams suffer from high staff turn over and are often demoralised.  Social workers often carry massive case loads and their contact with the children with whose care they are charged can be sporadic.  Why not start by taking Contactpoint’s £224 million making social work a better career?

Baby P: dont’ turn this tragedy into a policy Spiked.com

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Addendum 11 September 2009

About a quarter of adults are expected to have to sign up to the ISA, as anyone who regualarly transports children for sports or social clubs will face a £5000 fine could face prosecution if they do not.

BBC today programme segment 11 September

BBC Today segment 12  September 2009

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Addendum 16 September 2009

Another invasion of liberty and only the Tories are alert – Jenni Russell CiF 16 September 2009

In Kafka’s The Trial (buy Amazon), published in 1925 Joseph K, a bank clerk, is unexpectedly arrested by two unidentified people for an unspecified crime.  Although the novel was never finished (and Kafka actually wished it destroyed) in what exists K spends his time trying to navigate a legal system which is at once ubiquitous, immensely powerful and totally lacking in transparency.

This novel comes to mind whenever I think about control orders, which were introduced by the British Government in the Prevention of Terrorism act in 2005 in response to the House of Lord’s ruling against indefinite detention without charge or trial for foreign nationals contained in the Anti-terrorism Crime and Security Act 2001.

Control orders enable the Home Secretary to impose an unlimited range of restrictions on any person he or she suspects of involvement in terrorism. Among the restrictions that can be imposed are curfews of up to 16 hours enforced by an electronic tag, restrictions on the use of mobile phones and the internet, vetting of all visitors and meetings and restrictions on an individual’s movements. The Home Secretary also has the power to add new restrictions or obligations as he sees fit.  Based on suspicion and secret intelligence, those subject to an order do not know the accusation or case against them and are powerless to dispute it or show their innocence.

Legislation which severely curtails personal liberty in this way, which can be enacted on the basis of vague criteria, and which has inadequate oversight is more than just concerning.  The legality of control orders is currently being tested in the High Court following a critical House of Lord’s judgment in which Lord Hope said:

…a denunciation on grounds that are not disclosed is the stuff of nightmares. The rule of law in a democratic society does not tolerate such behaviour. The fundamental principle is that everyone is entitled to the disclosure of sufficient material to enable him to answer effectively the case that is made against him.

The Liberty 75 conference was attended recently myself and, more notably, Mahmoud Abu Rideh who has been subject to a control order for the past four years.  Prior to this he was interned for three and and a half years without trial.  Mr Abu Rideh must comply with a regime of telephone reporting three times every 24 hours; daily reporting in person to a police station; a 12-hour daily curfew and meetings outside the house and visits to anyone in the house prohibited except for persons cleared by the Home Office.

Mr Abu Rideh’s mental health appears to be severely compromised by his situation and he has made several suicide attempts and at one point was on hunger strike.  And control order do not only affect the person to whom they are subject as their families suffer alongside their subject, as this article explains.

The civil liberty pressure group Liberty are campaigning against control orders and their director, Shami Chakrabarti has said:

As stupid as they are cruel, control orders are the worst hangover from Britain’s War on Terror. No real terrorist is ever going to comply with house arrest and a large number of suspects have disappeared. But an innocent person can be subject to indefinite and severe punishment without ever having been charged or brought to trial.

I agree; the UK Government should show its hand and prosecute any persons who it is currently subjecting to a control order as anything else is cruel and degrading.  I am not aware of any representation having been made on behalf of doctors on this issue but there is a policy adopted in 2003 by the World Medical Association that suggests we should be heard.  It states that there is an:

..ethical obligation on physicians to report or denounce acts of torture or cruel, inhuman or degrading treatment of which they are aware.

Liberty: control orders - details what you can do.

Addendum 9 September 2009 Most control orders likely to be revoked after terror suspect freed

The Metropolitan Police have launched a new poster campaign clearly pitched to engender paranoia and anxiety in London’s population.  A picture shows a wheelie-bin brimming with carelessly discarded toxic chemical containers accompanied by the smug caption:

‘These chemicals won’t be used in a bomb because a neighbour reported the dumped containers’

At the edge of the shot – to remind us what is at stake – a mother and child approach, totally unaware that such danger lurks in their community.

The scenario is clearly simplistic, as well as being inconsistent with previous government statements.  Are these terrorists, so overcome by fanatical zeal they find themselves unable to dispose of incriminating evidence with necessary care, the same terrorists whose plots are so devilishly complicated that investigators supposedly needed 42 days to unravel their schemes?

For several years now, the Government and security services have been feeding us information about the ever-present threat to us from international terrorism in the shape of Al-Qaeda.  Al-Qaeda is apparently well financed, well organised and poised to strike at the heart of our freedoms.  The danger is so serious that it necessarily requires a government and security force with increasingly wide ranging powers to defeat it.  But their threat has also not materialised, and in 2005 the only significant attack on UK soil has not been successfully linked to them.  So, with international terrorist attacks increasingly appearing largely a fantasy, and in the face of civil liberties protests against draconian and frequently misused police powers, the Met’s posters are more about maintaining the police’s might and authority by reiterating the precariousness of our security, and the necessary evil of strong policing, than about catching terrorists (such as they do exist) per se.

Appealing to our wish for security is a technique at which politicians are already well practised.  The Government’s assessment of the current terrorist threat, made available in the name of keeping us informed, is ‘severe’.  This ‘threat level’ has been published since August 2006 and has since been either ‘severe’ (terrorist attack highly likely) or ‘critical’ (terrorist attack imminent) ever since.  With such an apparently unwavering crisis, one is reminded of the plot of 1984 wherein a state of perpetual war was used to justify the control of Oceania by Stalinist methods.  Constant news of inevitable attacks feeds the assertion that threats are all around us and can only be tackled by strong government, whose actions are all ultimately in the common good.  Furthermore, having over-exaggerated the security risk, continued absence of any attacks serves to strengthen their point, and ‘prove’ the success of their policies.

The social divisiveness of all this, and especially the current campaign, need hardly be pointed out.  Given that it’s almost impossible to differentiate between a man wearing a rucksack full of books and a similar man with a rucksack full of explosive there will inevitably be a large number of people falsely detained following the actions of well meaning, but ultimately misguided amateur anti-terrorist sleuths.  It pays to do a little maths;  imagine that there are 8 million people in London and that amongst their number there are 150 ‘terrorists’.  We know from this poster campaign that every member of the public is under suspicion.  Let us suppose that the intuition displayed by members of the public in spying on our neighbours with the aim of catching terrorists is correct an incredible  99.99% of the time.  Since our ‘test’ is very sensitive, our 150 terrorists are successfully caught, but it still gives a false positive rate of 0.01% which means that 80 000 people will be wrongly identified and possibly victimized.  Such simple calculations and the collateral damage they imply appear to have been entirely overlooked.

The Police and Government have a duty not to engender panic as a way of achieving their own ends.  Many people find modern life distressing enough without having to feel that they must be constantly on the look out for terrorist cells; the psychological health of society at large should be considered before the use of alarmist campaigns.  Successful society relies on mutual trust and widespread suspicion encouraged by this campaign is more akin to that seen in communist East Germany than to 21st century Britain.

Update – this piece appeared in the Daily Mail 15 April 2009 With recent police activity, anti-terror adverts and CCTV everywhere no wonder we’re all scared stiff.  Whilst I agree with much of what it says, it does read like the transcript of a right wing shock jock show.  Here’s the Mental Health Foundation report he talks about.