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introduction to literature review pdf

Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.



How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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Literature review chapter template.

If you’re preparing to write your literature review, our free literature review chapter template is the perfect starting point. In it, we cover each section of the literature review chapter step by step, along with plain-language explanations and examples .

Download: Literature Review Template

What’s Included In The Literature Review Template

This template is structure is based on the tried and trusted best-practice format for formal academic research projects such as dissertations and theses. The template includes the following sections:

Each section is explained in plain, straightforward language , followed by an overview of the key elements that you need to cover. We’ve also included practical examples to help you understand exactly what’s required in each section.

The cleanly-formatted Word document is fully editable , so you can use it as-is for your dissertation or thesis, copy over the contents to a fresh document, or convert it to LaTeX.

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Frequently Asked Questions

What format is the literature review template (DOC, PDF, PPT, etc.)?

The template is provided in a fully editable MS Word document (.DOCX). You’re welcome to convert it to whatever format works best for you, such as LaTeX or PDF.

What types of literature reviews can this template be used for?

The template follows the standard format for academic literature reviews, which means it will be suitable for the vast majority of academic research projects (especially those within the sciences), whether they are qualitative or quantitative in terms of design.

Keep in mind that the exact requirements for the literature review chapter will vary between universities and degree programs. These are typically minor, but it’s always a good idea to double-check your university’s requirements before you finalize your structure.

Is this template for an undergrad, Master or PhD-level thesis?

This template can be used for a literature review at any level of study. Doctoral-level projects typically require the literature review to be more extensive/comprehensive, but the structure will typically remain the same.

What structural style does this literature review template use?

The template assumes a thematic structure (as opposed to a chronological or methodological structure), as this is the most common approach. However, this is only one dimension of the template, so it will still be useful if you are adopting a different structure.

Does this template include the Excel literature catalog?

No, that is a separate template, which you can download for free here . This template is for the write-up of the actual literature review chapter, whereas the catalog is for use during the literature sourcing and sorting phase.

How long should the literature review chapter be?

This depends on your university’s specific requirements, so it’s best to check with them. As a general ballpark, literature reviews for Masters-level projects are usually 2,000 – 3,000 words in length, while Doctoral-level projects can reach multiples of this.

Can I share this literature review template with my friends/colleagues? 

Yes, you’re welcome to share this template in its original format (no editing allowed). If you want to post about it on your blog or social media, all we ask is that you reference this page as your source.

Can Grad Coach help me with my literature review?

Yes, you’re welcome to get in touch with us to discuss our private coaching services , where we can help you work through the literature review chapter (and any other chapters).

Need a helping hand?

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How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes .

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, frequently asked questions, introduction.

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

Literature review guide

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

You can also check out our templates with literature review examples and sample outlines at the links below.

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Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).


The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.


If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:


A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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introduction to literature review pdf

The response to the Independent Review of Prevent (accessible)

Published 8 February 2023

introduction to literature review pdf

© Crown copyright 2023

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/independent-review-of-prevents-report-and-government-response/the-response-to-the-independent-review-of-prevent-accessible

February 2023

Return to an address of the Honourable the House of Commons dated 8 February 2023 for the response to the Independent Review of Prevent.

Ordered by the House of Commons to be printed on 8 February 2023.

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 .

This publication is available at www.gov.uk/official-documents .

Any enquiries regarding this publication should be sent to us at [email protected] .

ISBN 978-1-5286-3711-4

E02805319 02/23

Foreword by the Home Secretary

The first duty of the government is to keep British citizens safe and our country secure. Reducing the threat to the UK from terrorism is a key part of that duty, and as Home Secretary, I am personally committed to doing all I can to achieve this.

Prevent is one of the 4 pillars of CONTEST, the government’s counter terrorism strategy. Prevent is critical in stopping people from becoming involved in terrorism or supporting terrorism in the first place. Dealing with the risk early prevents individuals from committing acts of terrorism, and reduces the chances of radicalisers spreading their insidious, extremist ideologies.

The Independent Review, led by William Shawcross, is a vital part of ensuring Prevent is fit for purpose and agile enough to meet the threat we face. I would like to thank William Shawcross and his team for their hard work and dedication in completing such a thorough piece of work. In his report, the reviewer is clear that while Prevent is a crucial element in our armoury against terrorism, it needs to refocus on its core mission of stopping people becoming terrorists or supporting terrorism. This includes Prevent placing greater emphasis on tackling ideology and its radicalising effects, rather than attempting to go beyond its remit to address broader societal issues such as mental health.

The reviewer also finds that in its efforts to tackle the causes of radicalisation, Prevent has become overly focused on addressing vulnerabilities rather than protecting the public from those who willingly support extremism. Someone who supports extremist ideology has not necessarily been manipulated.

Prevent must be careful not to deny personal responsibility or agency. It is therefore crucial that we do not underplay the agency of individuals when they align with extremist groups and draw a clear distinction between susceptibility to radicalisation and any background vulnerabilities that individuals may have.

Prevent funding must only go to those directly delivering Prevent’s objectives rather than wider community initiatives, and in no circumstances should funding go to groups linked to extremists.

The threat from terrorism is becoming more diverse, but Islamist terrorism remains our primary and deadliest threat. The Islamist attacks in recent years – including at Fishmongers’ Hall, Streatham, Forbury Gardens in Reading, and the horrific murder of Sir David Amess in 2021 – provide stark reminders of the enduring threat posed by those inspired to violence by Islamist ideologies. Yet Islamist terrorism is severely under- represented in Prevent. The Review finds that there has been an institutional hesitancy to deal with Islamist extremism and a reticence in challenging those who claim that our efforts to tackle it are Islamophobic.

This has also contributed to Prevent applying different thresholds for different ideologies. It has defined the extreme right-wing too broadly, so that it sometimes draws in right-wing and centre-right politicians and commentators. Meanwhile it has given too narrow a scope to Islamist extremism, which has enabled some extremist groups to operate unchecked. I will rid Prevent of any cultural timidity so that it meets every threat head on and does more to identify and challenge non-violent extremism. It is also clear from the review that Prevent needs to better understand the prevalence of antisemitism across ideologies and do more to combat it.

I fully agree with the findings and welcome the 34 recommendations that the reviewer has made to further strengthen Prevent. We will work at pace to deliver the following changes across Prevent:

Prevent’s first objective will be tackling the ideological causes of terrorism

we will work with other government partners to step up our approach to disrupt radicalisers and extremists who create a permissive environment for violence and who spread poisonous ideologies that undermine our values and our society

we will introduce a security threat check process that will ensure Prevent decision- making is consistent with the terrorist threat

we will overhaul Prevent training and operational guidance for Prevent staff and others to whom the Prevent Duty applies. This will improve their understanding of the ideological nature of terrorism and mean that the same threshold for saying something is extremist applies across all ideologies

we will radically reform our Prevent delivery model so that we have agile and more effective operational teams that can drive up the standard of Prevent delivery nationwide

we will move to a single national model of delivery for the Channel early intervention programme that ensures those susceptible to radicalisation receive multi-agency support, but without losing focus on addressing counter terrorism risk

we will undertake a full evaluation of Channel, so that it performs better and there is no disparity in the thresholds applied to Islamist or extreme right-wing ideologies

we will strengthen our oversight and decision-making of the civil society organisations we fund to ensure they challenge extremist and terrorist ideology effectively and that we do not, under any circumstances, work, engage with or fund extremists

we will do more to rebut those attempting to spread fear and disinformation about Prevent, while continuing to welcome challenge

we will ensure greater understanding of the prevalence of antisemitism in Channel cases so that we can better disrupt radicalisers who spread antisemitic views or are supportive of those that harass and violently target the Jewish community

Significant steps have already been taken to implement many of the review’s recommendations, but there remains a lot more work to do. As a reflection of how seriously the government takes its responsibility to keep the British public safe, we not only commit to implementing all the reviewer’s recommendations, but in many areas will go further. This includes delivering some of the recommendations through the refresh of the CONTEST strategy, so that the implications and lessons from the review can be applied beyond Prevent where applicable. I intend to implement the majority of recommendations within twelve months. I commit to reporting on our progress a year from now.

It is of the utmost importance that we are not deterred from our efforts to fight terrorism and extremism in all its forms. That fight is made possible by dedicated frontline public servants who strive to keep the public safe and defend our country’s values, and it is supported by work across government and society. For Prevent to be successful it cannot be delivered by the Home Office alone – it requires a close-knit partnership of government departments, sectors, local authorities, policing and community organisations.

That is why I commit here, on behalf of government, to fully implementing the recommendations from the review. Through strong and joined-up delivery with other government departments, we will ensure a united front in the fight against terrorism. I will look to the Commission for Countering Extremism to provide independent scrutiny, expertise, and thought leadership as we deliver the government’s response. This review, which has been critical in sharpening our focus, will be used as a blueprint for strengthening our response to the threat that terrorism, and the extremist ideologies that underpin it, poses to our safety and to the fabric of our society.

Rt Hon Suella Braverman KC MP

Home Secretary

Section 1: introduction to Prevent

Prevent plays a critical role in the UK’s counter terrorism strategy, known as CONTEST. Prevent aims to stop people becoming terrorists or supporting terrorism and extends to supporting the rehabilitation of those who are already involved in terrorist- related activity.

The threat from terrorism continues to endure. While CONTEST remains agile enough to adapt to all forms of terrorism, Islamist terrorism remains the greatest threat, accounting for three quarters of MI5 and Counter Terrorism Policing’s ( CTP ) casework. Since the start of 2017, MI5 and the police have together disrupted 37 late-stage attack plots. Eight of these potentially deadly plots were in the last year. All these disrupted plots were Islamist or extreme right-wing terrorism. Domestically, we have seen a further shift towards self- initiated terrorists operating independently from organised groups. As well as adapting to tackle this change in threat, Prevent must also recognise the prevalence of antisemitism across ideologies and do more to tackle it where it is relevant to its work.

Prevent has a vital role in tackling radicalisation and stopping people becoming terrorists or supporting terrorism. There is no single track to being radicalised. There are many factors which can, either alone or combined, lead someone to subscribe to extremist ideology, and in some cases, even terrorism. These factors often include exposure to radicalising influences, real and perceived grievances (often created or exacerbated through grievance narratives espoused by extremists), and an individual’s own susceptibility.

Prevent is a cross-government capability, with the Home Office, the Department for Education, and the Department of Health and Social Care, working in partnership to tackle radicalisation. Prisons and Probation, CTP and local authorities also play fundamental roles as statutory partners in the delivery of Prevent. The statutory Prevent Duty was introduced in the Counter Terrorism and Security Act 2015. This placed a statutory duty on specified authorities, including health, education, police and local authorities, to have “due regard to the need to prevent people from being drawn into terrorism”. This includes referring individuals at risk of radicalisation to Prevent for safeguarding support.

All Prevent referrals are confidential and do not result in a criminal record or any other form of sanction. When a referral is made, it is assessed by CTP to determine whether there are reasonable grounds to believe the individual is at risk of being drawn into terrorism. Only those that meet that threshold will be considered for support from Channel. Since 2012, over 3,800 people have been supported through Channel, Prevent’s multi- agency programme that works with individuals to reduce their radicalisation risk. Channel panels are chaired by local authorities and include health professionals, social workers, police and other professionals. Panels collectively assess the risk to a person and decide on a tailored package of support that can be offered to the person to help them move away from harmful activity.

The government also has a responsibility to protect the public from extremism because it threatens the freedoms and rights which make up the very fabric of our society. Extremism poses a risk to society through the vocal or active opposition to our fundamental values, including democracy, the rule of law, individual liberty and the mutual respect and tolerance of different faiths and beliefs. Prevent works with a range of government partners to challenge radicalisers who create a permissive environment for violence and spread poisonous ideologies that undermine our values and our society.

Our free, open, and inclusive society is something to cherish and protect from ideologies which seek to destroy it. [footnote 1] Where we see threats to integration and the fabric of our communities from extremism, the Department for Levelling Up, Housing and Communities ( DLUHC ) lead on work to tackle this. DLUHC will also use their experience and insight to inform training on wider extremist harms. The Commission for Countering Extremism ( CCE ) provides the government with impartial, expert advice and scrutiny on the tools, policies and approaches needed to tackle extremism. The CCE has become the government’s independent ‘centre of excellence’ on counter extremism, and its work will continue to inform policymaking. The CCE will also develop mandatory training on ideology as recommended by the review.

Much work has already been done to strengthen Prevent. This includes improving the referrals process, professionalising case management and learning from terrorist incidents where an attacker may have had a previous Prevent footprint. However, we recognise there is still much to do and we must strive to continuously improve Prevent. We welcome this review and its recommendations and intend to implement the majority within the next twelve months, to continue to improve this critical capability. To ensure transparency, the Home Office will report on implementation of the recommendations a year from now.

Section 2: commitments to the review’s guiding principles

The review’s guiding principles.

Prevent should go back to first principles and reassert its overall objective of stopping people from becoming terrorists or supporting terrorism. The strategy rightly sits as a crucial pillar of the UK’s counter terrorism architecture, and its focus should always centre upon protection of the public from those inclined to pose a security threat. A significant proportion of Prevent is safeguarding vulnerable individuals at risk of exploitation or abuse. However, Prevent must not overlook those perpetrating this harm, nor those who pose a terrorism threat of their own agency and ideological fervour. In line with this recalibration, the Prevent Duty ought to be redefined, the statutory guidance updated and Prevent’s vulnerability framework tightened.

Prevent needs to develop expertise and instil better levels of understanding of extremist ideology and radicalisation across the system. Improving staff training system-wide and providing clearer guidance and information to frontline practitioners is integral. This will ensure those delivering Prevent possess the confidence needed to identify extremism and understand the ideological nature of terrorism.

Prevent needs to enhance its approach to delivery. This should involve restructuring to a regional model, moving away from short term annual funding cycles when projects warrant it, and considering the expansion of the statutory Prevent Duty to an increased number of public agencies.

Prevent should create processes for responding to disinformation being spread about the scheme. Equally, Prevent should encourage public trust by improving transparency and establishing better oversight of how the strategy is implemented. Where members of the public or practitioners have grounds for believing Prevent may have fallen short of its own standards, they must have a place to formally take their complaints. Demonstrating that Prevent has nothing to hide by upholding complaints when they are justified, while also putting on public record when allegations are unfounded, can only enhance public trust in the scheme.


Recommendation 1.

Revise Prevent objective one of 3 in the duty guidance, and legislation where necessary, to clarify and emphasise the importance of tackling extremist ideology as a terrorism driver. Prevent’s first objective should be to ‘“tackle the ideological causes of terrorism”.

We accept this recommendation and agree that ideology is an essential factor in radicalisation to terrorism. Terrorism is a unique form of crime in that it is, by definition, inherently ideological (driven by a set of ideas and ideals). We will change the first objective of Prevent to clearly specify the need to tackle the ideological causes of terrorism. We will ensure that the revised first Prevent objective is clearly reflected in the updated Prevent Duty guidance and, where necessary, in legislation. We will also ensure, drawing from expertise from the CCE , DLUHC , and wider government counter extremism experts, that the training on ideology currently being developed by the CCE is mandatory for all Prevent staff and the frontline sectors to whom the Prevent Duty applies.

Recommendation 2

Move away from ‘vulnerability’ language and towards ‘susceptibility’, wherever accurate. The Vulnerability Assessment framework should become the Prevent Assessment framework. ‘Vulnerability’ should be reserved for welfare concerns and circumstances beyond an individual’s control.

We accept this recommendation and recognise that Prevent should be focused on tackling radicalising influences themselves, to which some are susceptible, rather than wider issues such as mental health. Prevent work must always be aware of the risk presented by the individual or group in question and recognise the agency of individuals in aligning with extremist groups. We commit to using the term ‘susceptibility to becoming terrorists or supporting terrorism’ where relevant and defining this language more clearly for all Prevent staff, the frontline professionals to whom the Prevent Duty applies, and for the public.

We will do this as part of updating our Prevent training offer, refreshing the Prevent Duty guidance, and by updating frontline operational guidance.

Work is underway to further strengthen Prevent case management and ensure robust decision-making on counter terrorism risk. The Vulnerability Assessment framework will be replaced by a new, more rigorous, tool that we will call the Prevent Assessment framework. This tool will align with the recommendation to narrow the use of the term ‘vulnerable’ to discussions relating to welfare concerns and circumstances beyond an individual’s control. The CCE will offer independent scrutiny and feedback to this process as it develops.

Recommendation 3

Reset thresholds to ensure proportionality across Prevent workstreams. Prevent must work to one bar across the ideological threats. This should apply to all teams and products, including national, regional and local delivery, referrals and the Channel process, RICU and Homeland Security Analysis and Insight products, training and Prevent-funded counter-narrative work via civil society organisations, and other funded projects. The bar should not be set so high as to only include concerns related to the most established terrorist organisations, nor so low as to capture mainstream politicians, commentators or publications. Prevent duty guidance should be amended to clarify this new standard.

We accept this recommendation and agree it is important to have one, consistent and proportionate threshold across all extremist ideologies and workstreams. We will review our threshold at each stage of Prevent delivery, including identification, assessment, prioritisation and decision-making, and apply this at the national, regional and local level. We will ensure designated Prevent leads across our statutory sectors have the training and support they need to provide effective advice on the threshold for referrals. Through our work to develop the new Prevent Assessment framework, we will better define the criteria used to determine whether a case should be considered for Channel intervention. This will ensure thresholds are proportionate and consistent across ideologies.

As part of refreshing the Prevent Duty guidance and updating training for all Prevent staff, we will clearly set out the requirement for consistency across the referral process, Channel case management, and national and local delivery.

We will also set out rigorous criteria to ensure that the proportion of funding allocated to civil society organisations to tackle specific ideologies is fully reflective of the threat we face. This will help ensure a consistent approach to ideological thresholds at each stage of Prevent delivery. We agree with the reviewer that the research and training products which inform Prevent and its staff must adhere to one threshold across ideological threats, and that not doing so risks confusing practitioners and creating a false equivalence about the nature and scale of different threats.

We acknowledge the review’s finding that this has not always been the case – that the bar for what the Research, Information and Communications Unit ( RICU ) has included on the Extreme Right-Wing is comparably lower than that for Islamism and that RICU products on right-wing terrorism and extremism have sometimes included centre-right commentators and debate. We will ensure that RICU products and the wider information we use to inform our approach are refocused and proportionate across all ideologies. They will be guided by the principles of the new security threat check (see commitment to recommendation 12 ) and must clearly show how the material they cover is relevant to meeting Prevent’s objectives.

Recommendation 4

Improve understanding of ‘blasphemy’ as part of the wider Islamist threat. The Homeland Security Group should conduct research into understanding and countering Islamist violence, incitement and intimidation linked to ‘blasphemy’. It should feed a strong pro-free speech narrative into counter-narrative and community project work.

We accept this recommendation and agree that with the worrying number of incidents such as the killing of Asad Shah, the attack on Sir Salman Rushdie, and the incident at a Batley school, there is more to be done to counter blasphemy-related violence. As the overall lead for religious hatred, DLUHC will lead on tackling blasphemy-related incidents and Prevent will focus on where this contributes to radicalisation or terrorism. We have requested that the CCE conduct research on violence associated with blasphemy. Once they complete this research, we will consider with DLUHC , the CCE and wider Prevent partners, how Prevent should adapt to address the challenge of blasphemy violence.

We also acknowledge the review’s finding that historically there have been examples of Prevent-funded projects delivered by civil society organisations that may have reduced support for free speech among Muslim participants. Where relevant, we will provide support to civil society organisations to empower them to make the argument for free speech.

Recommendation 5

Explore the prevalence of antisemitism in Channel cases and whether this is reflected in a breakdown of Channel referrals more widely. Feed these findings into work to disrupt radicalisers and counter extremist narratives. This includes confronting UK extremists supportive of terrorist movements which target Jewish communities (such as Hamas and Hizballah) and addressing the anti-Jewish component of Islamist and extreme right-wing ideology and groups.

We accept this recommendation and agree it is vital to understand the role of antisemitism in extremist ideology. Antisemitism, like other forms of hatred aimed at communities, is a destructive and pernicious trend which the government, led by DLUHC , is working to reduce. We will devote more analytical resource to improving our understanding of ideologies that spread antisemitic narratives and take direct action to address this, with the CCE providing independent scrutiny and advice. This will include taking steps to disrupt radicalisers that spread harmful views which explicitly target the Jewish community. Additionally, we will continue to support DLUHC ’s work to counter other forms of racial and religious hatred, such as anti-Muslim hatred.

We will also conduct a study on the prevalence of antisemitism in Prevent cases and use the findings to inform Prevent work. To ensure there is appropriate support for those referred to Channel with antisemitic tendencies, we will increase our pool of intervention providers that specialise in tackling antisemitism. The role of these intervention providers is to deconstruct and dismantle extremist narratives and ideologies.

Recommendation 6

Revise the Prevent Duty to ensure the scheme meets its revised objectives. Amend the Counter Terrorism and Security Act 2015 to stipulate that relevant agencies must “have due regard to the need to prevent people from becoming terrorists or supporting terrorism”. This alters the current duty to “have due regard to the need to prevent people from being drawn into terrorism”. Amend duty guidance and CONTEST accordingly.

We accept this recommendation and agree that, in line with our commitment to recommendation 1, the Prevent Duty must directly reflect Prevent’s objectives. We commit to revising the Prevent Duty legislation to specify the need to prevent people becoming terrorists or supporting terrorism. This change will also be reflected in CONTEST and in the Prevent Duty guidance.

Recommendation 7

Keep current terminology to describe Islamist and extreme right-wing ideology to ensure language is accurate and accessible for practitioners, public sector staff, and the wider public. Amend any products, guidance, and training materials to ensure that the use of terminology is consistent across Prevent.

We accept this recommendation and agree with the importance of ensuring that terminology is accurate and accessible to those using it. The government assesses that the existing terminology around Islamist and extreme right-wing ideology is accurate and fit for purpose and we will continue to use it. We will ensure this is communicated clearly to all Prevent staff, our partners and the wider public, in our training products, operational guidance and communication materials.

Recommendation 8

Explore extending the Prevent Duty to immigration and asylum (through UK Border Force, Immigration and Protection Directorate) and to job centres (via the Department for Work and Pensions).

We accept this recommendation and agree that all organisations who work with people at risk of radicalisation should have strong and robust processes in place to identify and refer these individuals to Prevent. We will work closely with partners, including those in Border Force, Immigration and Asylum, and in the Department for Work and Pensions, to explore how Prevent can be embedded operationally in these sectors. We will scope extending the Prevent Duty to Border Force, Immigration and the Department for Work and Pensions.

This will be explored fully, together with other recommendations for legislative changes, as part of the refresh of the CONTEST strategy. We will also launch a Prevent Partnership Forum for wider non-statutory partners that will strengthen their Prevent delivery, provide opportunities to share best practice, and build their understanding of the threat picture and radicalisation risks across their sectors.

Recommendation 9

Restrict Prevent funding to groups and projects which challenge extremist and terrorist ideology via counter-narratives and activities. Prevent budgets should not be allocated towards general youth work or community initiatives that do not meet these criteria.

We accept this recommendation and recognise that Prevent project funding has focused too broadly on wider community initiatives and insufficient checks have been conducted on those we fund. We also acknowledge the review’s finding that there was limited evidence that Prevent and RICU -funded projects countered extremist ideology. We will refocus on projects that explicitly counter radicalisation and challenge extremist and terrorist ideology. We will also strengthen our approach to moderating funding bids from local authorities for civil society projects. We will do this by inviting DLUHC , the CCE , and CTP to join moderation panels to share their expertise and help inform Home Office decisions on whether projects meet the Prevent threshold for funding. We will provide clear communications to local authorities on the need for projects to challenge extremist and terrorist ideology and ensure appropriate oversight is in place. In addition, in line with recommendation 13 , we will develop and implement an enhanced evaluation strategy for Prevent projects. We will also strengthen our due diligence procedures to ensure Prevent funding does not reach those linked to extremism (see recommendation 25 ).

Recommendation 10

Ensure Prevent disruptions takes action to limit the influence of ‘chronic’ radicalisers and networks which sit below the terrorism threshold. These actors promote narratives legitimising terrorism and terrorists without breaking the law. Low level but influential groups and activities must have appropriate weighting in prioritisation and risk models.

We accept this recommendation and commit to accelerating and strengthening our work to disrupt chronic radicalisers who seek to radicalise others into terrorism but operate, often intentionally, below legal thresholds. We will do this by introducing a new partnership approach with local, regional and national partners, law enforcement agencies, DLUHC (the lead for freedom of faith and belief), the CCE , other government departments, and wider counter extremism experts. This will improve information sharing, increase collaboration between partners, and help bring to bear the full breadth of government tools and levers to reduce the reach and influence of groups and individuals that radicalise others into terrorism and extremism.

We will provide specialist training to local authorities, sectors, Prevent practitioners and civil society organisations, on the activities and harmful narratives of such radicalisers. This will make sure they are well equipped to confront such activity locally.

Government has a responsibility to challenge extremist ideology that leads to violence, but also that which leads to wider problems in society, such as the erosion of freedom of speech. We will work with DLUHC and the CCE to establish a cross-government mechanism to co-ordinate work on tackling non-violent extremism.

Recommendation 11

Move national Prevent delivery to a regionalised model that has consistent lines with the centre of Prevent in the Home Office. Regional Prevent advisers should sit alongside the same geographic areas as regional counter terrorism units. Advisers should support, oversee, and guide Prevent delivery within their region and serve as a communication point between central and local government.

We accept this recommendation and agree that our Prevent delivery model of funding over 40 local authorities of highest threat no longer provides the flexibility and adaptability we need to address the terrorist threat. We also recognise the need to strengthen our support to all local authorities and ensure they are delivering the statutory Prevent Duty to the standards we would expect.

To address this, we will move to a regional Prevent delivery model directly overseen by the Home Office and significantly reduce the number of local authority areas of highest threat that we fund. This will increase join-up with CTP and other regional partners, ensure each local authority has access to expert Prevent support from Home Office regional Prevent advisers, and enable resource to be surged into areas to meet radicalisation risks. This will improve cross-area collaboration and help to improve the consistency of Prevent delivery nationwide. The formation of multi-disciplinary regional teams will also provide a single route for local Prevent practitioners to access guidance, advice and good practice.

To ensure our new regional network has the skills and experience they need, we will deliver regular briefings on the threat from extremists and radicalisers, both nationally and at a regional level. This will increase awareness of the specific risks Prevent leads in each region and sector are likely to encounter. We will draw on the insight and expertise of the Joint Terrorism Analysis Centre and RICU , as well as extremism experts across government and the CCE , to inform this training. By providing a consistent picture of the threat across all Prevent partners including health, education, policing and counter extremism, we will strengthen joint working to disrupt radicalisers and make informed referrals in line with the threat.

Recommendation 12

Ensure high level decision-making within Prevent is always informed by proper consideration of the terrorism threat picture. This should ensure that any action taken is proportionate. The Homeland Security Group and Counter Terrorism Policing should be guided at strategic leadership level by a new ‘security threat check’ – a series of principles to be included in Duty guidance.

We accept this recommendation and acknowledge that Islamist terrorism is currently the primary terrorist threat and that this is not currently reflected in Prevent caseloads. Prevent decision-making should always be informed by, and be proportionate to, the terrorism and extremism threat picture. We will build on the guidelines set out in the review to introduce a security threat check process that is informed by the latest assessments from the Joint Terrorism Analysis Centre, CTP , Home Office analysts, the CCE , DLUHC , and counter- terrorism local profiles. We will ensure the new security threat check process is outlined in the refreshed Prevent Duty guidance and that it underpins discussion and decision- making at strategic Prevent governance boards. This will give statutory partners and the wider public further reassurance about the rationale behind Prevent decision-making and ensure it is proportionate and consistent with the threat we face.

Recommendation 13

Lengthen the Prevent funding cycle to between two and five years in order to better sustain positive local work. The Homeland Security Group should develop an enhanced evaluation strategy for Prevent-funded projects with a focus on outcomes over activity or outputs.

We accept this recommendation and agree the importance of providing longer-term funding to the very highest risk local authorities and projects which have already demonstrated their effectiveness. We will explore options with HM Treasury for developing a multi-year plan for Prevent funding. This approach must be implemented in a way which provides value for money and complements our commitment to move to a regional delivery model, as outlined in recommendation 11 .

We also agree that any provision of multi-year funding would need to be accompanied by a comprehensive and robust evaluation plan. We commit to developing and implementing an enhanced evaluation strategy for Prevent projects.

Recommendation 14

The Scottish government should restructure Scottish Prevent in line with the regionalisation model for England and Wales. This would move Prevent from the communities and integration agenda towards other strands of CONTEST. The Scottish government should provide a dedicated Prevent lead, a HE/FE regional co-ordinator, and Prevent-funded projects for the region. Scottish police should also prioritise enhancing practitioners’ understanding of Scotland’s terrorism threat picture via the dissemination of regular local threat assessments (known as ‘emerging threat and risk local profiles’).

We agree in principle to the recommendation that Prevent, as part of CONTEST, should be delivered as it is in the rest of the United Kingdom, as a counter terrorism measure. We will work with the Scottish government to consider how this recommendation could be delivered. We already work closely with colleagues in Scotland to provide support, training and assurance for their Prevent case management capability. As we transition to a new regional Prevent delivery model, as per our commitment to recommendation 11, there will be opportunities to consider with the Scottish government the scope for further aligning our work. We will need to consider devolved structures and delivery mechanisms when determining the extent to which Scotland could or should align with England and Wales.

Recommendation 15

Develop a plan to improve the quality of referrals around revised core objectives. Referrals should have an identifiable ideological element that is consistent across ideologies. Case management data must record and detail the evidence in each case.

We accept this recommendation and agree on the importance of improving the quality of referrals to ensure Prevent is focused on its core objectives of stopping people from becoming terrorists or supporting terrorism. We will clearly communicate to frontline sectors, policing and Prevent practitioners, that Prevent referrals should only be made where they believe there are genuine concerns of radicalisation and that ideology is a critical consideration in that decision. We will do this through the Prevent Duty guidance, the Prevent information page on GOV.UK ( Get help for radicalisation concerns) , and in the new training products we will launch. This will include the training on ideology being developed by the CCE . This should translate to quality referrals entering the system, so that Channel is focused on offering support to those with a clear radicalisation concern and who are at risk of engaging with terrorism.

We are also working to strengthen referral pathways and improve information sharing across the system. We will do this through the rollout of a national Prevent referral form that will improve the consistency, quality and information available for all referrals. We are also improving the Prevent case management system to better record ideology and the nature of risk in a consistent way across ideologies. We will embed strengthened referral pathways and the new national referral form in Prevent practice by updating our training packages for Prevent staff and the frontline workers to whom the Prevent Duty applies.

Recommendation 16

Improve Prevent datasets by revising how referrals are categorised. The Homeland Security Group should consider all options, including delineating and/or removing the ‘mixed, unstable or unclear’ and ‘other’ strands, against Prevent objectives. The Homeland Security Group should record and publish sector-specific data about Prevent referrals, such as breakdowns within the education sector.

We accept this recommendation and agree that we need to improve our understanding of the categorisation of referrals. We acknowledge the review’s finding that the ‘mixed, unclear and unstable’ category may have been used inappropriately, risking unnecessary referrals for individuals who do not belong in a counter terrorism programme.

We have commissioned independent research to understand the types of referrals and cases that are currently categorised as ‘mixed, unclear and unstable’. We will use the findings of this research, alongside independent advice from the CCE , to improve the categorisation of cases against both Prevent objectives and the national threat picture. We will issue new operational guidance to CTP and Channel multi-agency panels, and further develop the training provided to Prevent staff.

We also commit to further improving the breakdown of data provided through the annual published statistics on Prevent. This will include delineating the ‘mixed, unclear and unstable’ category and ‘other’ category to provide greater clarity and transparency to the public.

Recommendation 17

The government should launch new initiatives to encourage referrals from friends, family and community cohorts. This should include developing an accessible GOV.UK resource signposting reporting mechanisms for radicalisation concerns. These resources ought to be easily reachable through simple online thematic searches.

We accept this recommendation and agree the importance of increasing awareness of Prevent. Friends and family can often be the first to identify radicalisation concerns in a loved one. Evidence demonstrates that positive family and social networks can help to reduce several radicalisation risk-factors.

We will continue to test and develop our new accessible GOV.UK resource that provides the public with information on Prevent, aids transparency, and enables those who are worried about someone they know to find out more. This activity complements CTP ’s Act Early campaign and online resources.

We will also increase our work with non-statutory partners, the third sector, and with communities to build awareness of the signs of radicalisation and how to get support. We will develop training products and communication materials for charities, communities, and those that work with communities, to increase their understanding of Prevent. We will also attend community engagement events to build public awareness and understanding of Prevent.

Recommendation 18

Counter Terrorism Police should investigate removing referral data for cases that did not make it to Channel, categorised as requiring ‘no further action’, after 3 years instead of the current 6. This ought to build confidence in making referrals. Scottish police should consider doing the same with such cases on their national intelligence note system.

We accept this recommendation and agree that the data retention periods for Prevent referrals should be thoroughly reviewed. CTP and Home Office will conduct a joint review of Prevent data retention options and consider the associated benefits and risks.

Recommendation 19

Streamline the Channel case management process by testing a hybrid model for referrals, risk assessment and information gathering. The police and local authorities would handle referrals simultaneously. Initial discussions with the referee would be carried out by either of these authorities, while the police would complete risk assessments and information gathering.

We accept this recommendation. Over the next 18 months, we will move to the national model of Channel delivery that the review recommends. All risk assessments and information gathering will be the responsibility of the police. We will update and strengthen the Channel Duty guidance so there is clear flexibility for the Channel panel to decide which professionals are best placed to undertake discussions with the referee. This single national model of delivery will ensure there is consistency between areas and that robust multi-agency support is available to Channel participants. It will also ensure that CTP are closely assessing and managing counter terrorism risk.

Recommendation 20

The Home Office should investigate whether there is an imbalance, or disparity, in thresholds applied to Islamist and extreme right-wing Channel cases, and if so why. Examine whether Islamist referrals tend to be individuals much further along the trajectory towards violence (‘active risk’, at a sub-pursue level), compared to referrals where individuals present a susceptibility to radicalising influences or extremist exploitation (‘passive risk’).

We accept this recommendation and recognise the need to ensure there is no disparity in thresholds for the adoption of Channel cases across different ideological threats. This could lead to a disproportionate focus on passive risk cases to the detriment of active risk cases. We have commissioned an independent outcome evaluation of Channel that will give us greater breadth and depth of understanding of the nature of the cohort, including across ideologies, how they progress through the Channel process, and of the impact that Channel has on counter terrorism risk. The Channel evaluation will review the process by which cases are adopted by Channel panels and this will include looking at whether and how this varies across ideologies. We will use the findings of the evaluation to drive operational improvements to Channel, including strengthening training and guidance relating to ideology and thresholds.

Recommendation 21

Commission for Countering Extremism to review all Prevent advisory boards and panels to ensure membership includes necessary, credible and impartial expertise on extremist ideology. The relevant government minister should sign off all membership and terms of reference. The Commission for Countering Extremism should oversee Prevent products informed by consultation with advisory boards, such as those used to identify and assess risk.

We accept this recommendation and agree the need to ensure those advising Prevent and RICU have the necessary levels of expertise on extremist ideology. We will review our arrangements and approach to external advisory support. We will seek the expertise of the CCE , DLUHC and wider government partners, to ensure the membership and terms of reference of current and future Prevent advisory groups are robust. We will also consult the CCE , DLUHC and wider government experts on products developed by advisory boards to ensure they are rigorous. We will continue to ensure the membership and terms of reference of all Prevent advisory boards is agreed by ministers.

Recommendation 22

Develop a new training and induction package for all government and public sector staff working in counter extremism and counter terrorism. Training should focus on improving understanding of the ideological nature of terrorism, including worldviews, objectives and methodologies of violent and non-violent extremist groups, grievance narratives and issues exploited by terrorist recruiters and extremists.

We accept this recommendation and agree there is a need for government and public sector staff to understand the ideological nature of terrorism and the extremist worldviews, grievances and narratives that drive radicalisation. Training is of the utmost importance to our programme. It is fundamental to ensuring our practitioners understand the Prevent landscape, the terrorist threat, extremist narratives, and emerging themes.

Training and briefing materials are continually reviewed to ensure that they meet the needs of our programme. We have recently launched updated and fully accessible training packages on GOV.UK on Prevent awareness, referrals, Channel, and a Prevent refresher course. We are also currently developing new courses that will allow users to improve their understanding of Prevent, terrorism, and extremism. In addition, a new Prevent face-to- face training course for public sector workers will be rolled out nationwide in 2023. This will be clear on the importance of ideology, the signs of radicalisation, and how to make good quality, proportionate referrals. The CCE , DLUHC and wider government counter- extremism experts will advise on the ideology content of new Prevent training products.

The CCE is developing ideology training, having completed a training needs analysis that identified gaps and made recommendations for government to consider. We will use the findings from this to inform future training content that we will ensure is mandatory for all Prevent staff. DLUHC are also developing and delivering wider counter extremism training for government and stakeholders on the ideologies and harms which affect our communities.

Recommendation 23

Ensure Prevent training upholds a consistent and proportionate threshold across ideological threats and avoids using double standards. For example, training materials should not focus on violent extremism for one ideology, while focusing on non-violent extremist narratives for another. Non-violent extremism should be included in training as it creates a permissive environment for radicalisation and recruitment into terrorism.

We accept this recommendation and acknowledge that an inconsistent approach has been applied across Islamist and extreme right-wing ideologies. We will ensure that our commitment to a consistent and proportionate threshold for Prevent intervention, assessment and prioritisation (as outlined in recommendation 3 ) is reflected in all Prevent training packages. Prevent training materials will clearly reflect the threat from both violent extremism and non-violent extremism.

Recommendation 24

Training for Prevent, Channel, and public sector staff subject to the Prevent Duty should include clear guidance on how and when to make appropriate referral decisions. Training must clearly specify new Prevent thresholds and the requirement to ensure referrals have an identifiable ideological element and terrorism risk. Thresholds and decision-making must be implemented consistently across all ideological threats. Prevent staff should be informed about how guidance materials disseminated by politicised third parties may have a detrimental influence on Prevent delivery.

We accept this recommendation and acknowledge the importance of ensuring Prevent training enables users to make appropriate referral decisions. We recognise that a more informed and muscular approach is needed to tackle the hesitancy and cultural timidity among some parts of the public sector when considering referrals into Prevent. Significant work is already underway to overhaul and improve the Prevent training offer which will support frontline sectors to understand the central role of ideology and make appropriate referrals to Prevent.

We will ensure that our commitment to a consistent threshold for Prevent referrals is communicated through the revised Prevent Duty guidance, the Prevent information page on GOV.UK, and within our wider set of training products to improve practitioners’ confidence in identifying and reporting concerns.

We will continue to monitor and improve our training to ensure it sets out the factors to consider when making a referral, which includes ideology, and to reflect the current threat picture. This will support sectors in making confident and proportionate decisions about whether a concern should be referred to Prevent. We will also roll out a new face-to-face training package to frontline public sector workers. This will provide clear insight into ideology, the signs of radicalisation, and will be tailored to the local threat and risk picture. This will be clear on the external challenges Prevent practitioners might face from those who seek to undermine Prevent delivery.

Recommendation 25

Ensure Prevent does not fund, work with, or consult with extremism-linked groups or individuals, and applies the same thresholds for non-engagement across ideologies. Training should include engagement process and principles, and a due diligence function to assess risk attached to engagement decisions. As a broader matter of principle, government as a whole must ensure it neither funds, works, or consults with extremism- linked groups or individuals.

We accept this recommendation and fully adhere to the premise that Prevent must not fund, work with, nor consult extremist linked groups or individuals. As a matter of principle, counter-radicalisation work cannot be entrusted to those who have shown themselves as sympathetic to extremists and their ideas.

We acknowledge the review’s finding that some Prevent funding has been awarded to individuals who have themselves promoted extremism or provided legitimacy to terrorists. This is not a proper use of public money, it undermines Prevent’s objectives, and falls well short of our commitment that funding should not go to extremists. We have already started to implement robust improvements in this area. Since April 2022, due diligence for all Prevent-funded initiatives has been conducted through our team of internal expert extremism analysts. We will work with the CCE and other government counter extremism experts to further strengthen our due diligence process. As part of updating training for all Prevent staff, we will clearly set out the requirement to not fund or work with extremist- linked groups or individuals.

We will take further steps to ensure that all organisations with whom we partner are fully aware of the behaviours and conduct we expect. We will further strengthen the procedures we have in place should any of our partners fall short of these expectations.

Recommendation 26

Professionalise and build in-house expertise in frontline and central Prevent. Prevent must become less reliant on consultancy and public relations firms and build capacity within RICU and the Homeland Security Group to fulfil some of the most sensitive functions that are outsourced to private companies.

We accept this recommendation and recognise the importance of professionalisation and reducing our reliance on external support. There is significant expertise in RICU and wider Homeland Security Group, including social researchers, intelligence analysts, extremism analysts, communication, policy and project professionals. But there is more that we can do to build the knowledge base of all officials in this area, including by drawing on expert- led independent scrutiny from the CCE and additional expertise from DLUHC . The review is right to challenge the outsourcing of Prevent’s due diligence work to outside companies. We recognise that due diligence work has national security sensitivities and should not be outsourced. We are taking urgent steps to reduce our reliance on external agencies and are developing and implementing new strategies that reflect this. We will:

significantly reduce outlay on external contractors

develop and implement a new in-house communications strategy

move the management of our network of Prevent-funded civil society organisations into the Home Office

Recommendation 27

Review Prevent-related staffing and training in prisons. Seek to increase expertise and skills with regard to understanding the ideological drivers and theological elements of radicalisation. HMPPS staff must adopt a ‘precautionary policy’ when assessing the risk of ideologically-driven offenders.

We accept this recommendation. Work to implement it is encompassed within a fundamental review of HM Prison and Probation Service’s counter terrorism training for both prisons and probation, to which we have already committed. The prisons element of this is in response to the report by Jonathan Hall KC on terrorism in prisons. His recommendation, which we have accepted, reads: “All staff, including governing governors and line managers, should have regular training on terrorist risk in the prison estate based on concrete examples.” This will include examples of ideological and theological elements of radicalisation. We will ensure that all relevant frontline staff benefit from this training.

We already take a precautionary stance to addressing extremist behaviour among offenders. Risk management of this cohort is underpinned through a multi-agency, end-to- end, case management process which considers a full range of factors, including index offence and ideology. In response to another, related, Jonathan Hall KC recommendation, we will develop new guidance asking staff to spot, report and challenge a wider range of behaviours that increase national security risk. These include activities that increase the influence and standing of ideologically-driven offenders. That recommendation reads: “Officials should establish Terrorist Risk Behaviour as a recognised and codified phenomenon in the prison context. Identifying Terrorist Risk Behaviour should not depend upon being able to establish the ideological motivation of particular prisoners.”

Ideological drivers play a complex role in terrorist offenders’ behaviour. While all new frontline staff are trained to understand extremist ideologies at a broad level, formal assessment of these is done using our existing Extremism Risk guidance tool. This considers 22 different factors to build a comprehensive picture of an offender’s risk profile. HM Prison and Probation Service is already reviewing the Extremism Risk guidance as part of our continual review process, including how it assesses ideology’s role in offending. We are also committed to ensuring that all Extremism Risk guidance reports in the community are either completed or reviewed by specialist counter terrorism psychologists who will receive any new training on ideology. This was called for in the Prevention of Future Deaths report from the Inquiry into the 2019 attack at Fishmongers’ Hall. It will ensure that staff with specialist expertise take decisions concerning ideological drivers.

More broadly, we continue to adopt a multi-partner approach to reducing the risk posed by offenders in communities during rehabilitation, drawing on contributions from the Probation Service, Police, health services, local government, local Prevent teams, civic groups and DLUHC .

Recommendation 28

Higher education staff responsible for authorising on-campus events with external speakers should be provided with training on how to manage and assess risk. Where necessary this should include conducting effective due diligence checks, and guidance on how to balance statutory obligations under the Prevent Duty with the legal requirement to protect freedom of speech.

We accept this recommendation and recognise the need to ensure those in higher education have sufficient training to manage and assess the risk of external speakers drawing people into terrorism. This will be done with careful consideration of the importance of freedom of speech in higher education. This is to ensure a culture where students, staff and visiting speakers feel able to discuss and debate issues freely, provided they are within the law.

The Department for Education will engage the sector to understand their training needs. They will work with the CCE , DLUHC and other government partners to ensure effective support is in place for those assessing the risk from external speakers, including on conducting effective due diligence. We will update the Prevent Duty guidance to reflect this recommendation and ensure clarity for the higher education sector on understanding its statutory requirements. In addition, to support higher education providers to develop and update risk assessments to best protect their students in higher education, we will commission research to explore the primary ways in which students interact with radicalising influences, including online.

The Office for Students will also carefully consider the review’s finding that more could be done to improve its Prevent monitoring framework, including whether greater weight should be placed on additional independent assessments of compliance in higher education. This will be included in the next Office for Students’ review of the Prevent monitoring framework alongside other relevant issues. These include the impact of the Higher Education (Freedom of Speech) Bill, to ensure any changes are co-ordinated and consistent with other duties on higher education providers.

Recommendation 29

The Home Office should implement a further due diligence procedure around the recruitment of intervention providers. This involves a comprehensive assessment of social media accounts and other public platforms to ensure the authenticity of views presented throughout the recruitment process.

We accept this recommendation and agree it is crucial that there are robust due diligence procedures for intervention providers. All intervention providers are subject to significant due diligence and security vetting, including being cleared to security check level, undergoing regular police and social media checks, and all intervention providers are approved by ministers prior to appointment. We commit to further strengthening these due diligence processes, and to bolstering the annual checks conducted on each intervention provider by our internal team of expert extremism analysts. This will include a more robust and extensive assessment of social media accounts and other public platforms. Our due diligence processes will be subject to independent scrutiny from the CCE .

We will also issue new guidance for intervention providers to ensure there are clear expectations of the behaviours and conduct we expect and of the disciplinary procedures in place should any of our intervention providers fall short of these expectations. This will be accompanied by additional training provided to all intervention providers on extremist ideologies and grievance narratives.

Recommendation 30

Establish a dedicated unit within the Homeland Security Group to rapidly rebut misinformation about Prevent and challenge inaccuracies via traditional and social media. The unit should co-ordinate with government departments to produce national resources for civil society organisations and Prevent delivery partners in local communities. These resources should tackle myths about Prevent and defend the practitioners who help protect communities.

We accept this recommendation and agree we need to take a more muscular approach to rebutting misinformation and disinformation about Prevent. We recognise that we have been too hesitant and timid in allowing misinformation to go unchecked. We are concerned by the review’s finding of a persistent Islamist-led campaign by a network of closely linked groups and individuals – notably CAGE and MEND – to encourage misperceptions of Prevent and undermine its work. We agree with the review’s assertion that such campaigns can be detrimental to the overall effectiveness of Prevent and have a negative impact on Britain’s Muslim communities, including by encouraging abuse towards Muslims who engage with Prevent.

We recognise the need to do more to build confidence in the Prevent system and better support those who work within it. We will tackle inaccurate claims through a dedicated Prevent communications team. We will also equip our partners and stakeholders, including civil society organisations, to challenge Prevent myths and related extremist narratives.

This team will produce new resources that can be used by frontline partners to demonstrate the work of Prevent and directly challenge myths and misconceptions of the strategy. We will take steps to rapidly rebut misinformation on Prevent and confront head- on inaccuracies carried by the media or social media.

In addition, as part of our implementation of recommendation 34 , we will create a standards and compliance unit which will fully consider accusations around the mishandling of Prevent referrals or cases, and failures to adhere to the Prevent Duty. While the results of these investigations must be communicated in a way which does not compromise the anonymity of those involved, it will provide the communications team with an important tool to direct people to if they have concerns about Prevent.

Recommendation 31

RICU should equip Prevent practitioners with better information about extremism-linked campaigns to undermine their work. This should include information about the networks involved and narratives used. Prevent-funded civil society organisations should be supported and encouraged to use this information to publicly challenge those who promote disinformation in an effort to undermine Prevent.

We accept this recommendation and agree we must provide Prevent practitioners with the information they need to effectively challenge misinformation about Prevent. Home Office analysts and RICU , together with DLUHC , the CCE , and law enforcement partners, currently monitor all forms of extremism in the UK. Their insight is provided to Prevent networks to build knowledge and understanding.

We will further strengthen this effort by identifying additional analysis that RICU and other Home Office analysts can provide to outline the activities of non-violent extremism-linked individuals, groups or organisations seeking to undermine the work of Prevent. This analysis will include information about the networks involved and the false narratives they use and will be shared with frontline Prevent practitioners.

Recommendation 32

Prevent-funded civil society organisations and counter-narrative projects should take on extremism-linked activists who seek to demonise the scheme. Civil society organisations should be ready and able to challenge and expose groups which promote disinformation about Prevent, particularly through media and social media campaigns

We accept this recommendation and agree we must support civil society organisations to better tackle misinformation and disinformation about Prevent. Many Prevent-funded organisations already work hard to advocate for and build awareness of Prevent within their local networks, and we are proud to support organisations who have such a positive impact within their communities. But we acknowledge that we have been too hesitant and timid thus far in countering misinformation, disinformation and extremist narratives that undermine Prevent.

Our new Prevent communications team will produce national resources to support civil society organisations in challenging dishonest narratives around Prevent. We will also provide improved support to civil society organisations taking on non-violent extremist narratives more widely in communities and online and enable them to actively promote Prevent. This includes providing training and creating communications capabilities which enable them to promote their work and that of Prevent via traditional and online channels.

Recommendation 33

Develop specific measures to counter the anti-Prevent campaign at universities. Higher and further education co-ordinators should work closely with institutional safeguarding leads to co-ordinate activities for students and staff which directly take-on and challenge disinformation about Prevent. The Department for Education should develop a network of speakers who are able to speak to students and staff about counter-radicalisation work and its benefits.

We accept this recommendation. The Department for Education’s network of Prevent co-ordinators work closely with safeguarding and Prevent leads, as well as with senior leaders within the higher education sector to support compliance with the Prevent Duty.

The National Union of Students has in the past provided a platform for others to spread misinformation on Prevent, including as part of its ‘Students not Suspects’ campaign.

Current National Union of Students policy, ‘Ending Securitisation, surveillance and Prevent’, inaccurately claims that referrals to the programme are based on “gut instinct” and “harmful stereotypes” which result in a disproportionate targeting of Muslims, police “interrogations” and a stifling of free speech. This fails to take into account how the Prevent Duty is risk-led, supported by training and guidance, and must be implemented in a proportionate way in accordance with other responsibilities, such as public sector equality, free speech and data protection responsibilities. Such misrepresentations of Prevent risks deterring effective engagement with the programme by those in the sector. We will look to develop a more constructive relationship on the implementation of Prevent in higher education, including with student bodies.

The Department for Education and Home Office will professionalise our shared pool of trusted and supportive partners with positive experiences of Prevent. This will challenge misinformation about Prevent and speak to students, staff and academics about counter- radicalisation work and its benefits. These credible voices (such as trusted academics) will use various communications, promotional and training materials to ensure this important message is delivered across campuses.

Recommendation 34

Create a new standards and compliance unit answerable to ministers on the Prevent oversight board. The purpose of the unit should be to process and investigate complaints from Prevent practitioners and the wider public. Ministers can task the unit to conduct specific investigations and a summary of findings following investigations should be made public. The Home Office should develop proper process and procedure for when agencies, or institutions, consistently fail to adequately uphold the Prevent Duty.

We accept this recommendation and commit to establishing an independent standards and compliance unit. This will provide a clear and accessible route for the public and practitioners to raise concerns about Prevent activity where it may have fallen short of the high standards we expect. Ministers will have the power to instruct investigations through the new unit, which will have clear procedures to be followed should investigations find failings. This includes in the event of failure of statutory partners to uphold the Prevent Duty. To build public trust in Prevent, we will publicise the unit on GOV.UK and guarantee a transparent process for publishing the unit’s findings in a way that protects the anonymity of those involved.

We also agree with the review’s assertion that there is a need for stronger oversight of Prevent, including greater co-ordination and communication between secondary oversight boards and committees. Therefore, as well as establishing a standards and compliance unit, we will consider options for reinvigorating the Ministerial Prevent Oversight Board so that there is a clear oversight mechanism for the standards and compliance unit, for implementation of the recommendations of the review, and other Prevent work.

Some groups publicly demonstrate behaviours that oppose the values and principles that underpin our society, the below examples exemplify this. Hizb ut-Tahrir promote the Caliphate as the ultimate system of governance and express views that Islam is fundamentally incompatible with the Western liberal democratic system. In a 2021 article on their website entitled ‘the global struggle and the inevitable return of the Khalifah’, they state “Muslims have been damaged by unislamic ideas that are preventing the return of our unique authority. These ideas are not just surface level and obvious ones we see around us but deep rooted, fundamental concepts of nationalism, secularism, liberalism, feminism, and democracy”. CAGE has campaigned on behalf of convicted terrorists, such as Afia Siddiqui and Munir Farooqi, and the group has published or invited al-Qaeda radicalisers to speak at its events, such as Abu Hamza in 2008, Anwar al-Awlaki in 2009, and Abu Qatada in 2015. Senior leaders in CAGE have advocated supporting violent jihad overseas in specific contexts, including in an interview published in 2020, where CAGE’s Outreach Director asserted the position that jihad refers to military conflict and that Muslims will be religiously obligated to “rise to the call” in response to oppression. In 2015, in reference to an al-Qaeda affiliate’s truck bombing in Syria, CAGE’s Director told a parliamentary select committee that suicide bombings can be “a price worth paying”. In 2021, CAGE’s Outreach Director described how “some positive changes have already been observed” since the Taliban had taken power in Afghanistan. Further, in 2015, CAGE’s Research Director stated that ISIS executioner Mohammed Emwazi was “extremely gentle, kind” and a “beautiful young man”. CAGE has pejoratively labelled Muslims who work to counter Islamist extremism as “native informants”. In 2015, CAGE’s Research Director refused to condemn violence such as female genital mutilation and stoning. Patriotic Alternative call for the voluntary ‘repatriation’ of those of ‘immigrant descent’ including those who currently hold a British passport. They claim that only white people with ancestral links to the UK are to be considered British. As part of their ‘plan’, they state on their website that “the British people are made of the English, Northern Irish, Scottish and Welsh. These are the indigenous peoples of the United Kingdom and only they have an ancestral claim to it”. They also state they will “overturn all policy that discriminates against the indigenous people” and “there will be a complete halt to all immigration unless under exceptional circumstances”. British Nationalist Socialist Movement promote nationalist socialism as the most appropriate form of governance in the UK whilst rejecting democratic values and venerating Nazism. In 2019, the group posted on their website that “nationalist socialism provides a source of higher thinking and a cause to campaign for and a future alternative to decadent liberal democracy”. The group has also used its Telegram account to celebrate the birth of Adolf Hitler. ↩

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Introduction The public health crisis of escalating mental health, behavioural and substance-related emergencies has revealed the need to approach these complex events from a health perspective, rather than the traditional criminal justice standpoint. Despite law enforcement officers often being the first responders to emergency calls concerning self or bystander harm, they are not optimally equipped to manage these crises holistically or to connect affected individuals to necessary medical treatment and social support. Paramedics and other emergency medical services (EMS) providers are well positioned to deliver comprehensive medicosocial care during and in the immediate aftermath of these emergencies, moving beyond their traditional role in emergency evaluation, stabilisation and transport to a higher level of care. The role of EMS in bridging this gap and helping shift emphasis to mental and physical health needs in crisis situations has not been examined in prior reviews.

Methods and analysis In this protocol, we delineate our approach to describing existing EMS programmes that focus specifically on supporting individuals and communities experiencing mental, behavioural and substance-related health crises. The databases to be searched are EBSCO CINAHL, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline, Ovid PsycINFO and Web of Science Core Collection, with search date limits being from database inception to 14 July 2022. A narrative synthesis will be completed to characterise populations and situations targeted by the programmes, describe programme staffing and composition, detail the interventions and identify collected outcomes.

Ethics and dissemination All data in the review will be publicly accessible and published previously, so approval by a research ethics board is not needed. Our findings will be published in a peer-reviewed journal and shared with the public.

Trial registration number https://doi.org/10.17605/OSF.IO/UYV4R

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .


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This protocol conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews 2018 guidelines.

Well-defined eligibility criteria focus on models of care involving mobile emergency medical services (EMS) and other groups that respond to incoming non-emergency calls for service in behavioural, mental health and substance use-related emergencies.

Anticipated results include detailed and actionable descriptions of EMS-led programmes supporting people with behavioural, mental health and substance use needs and thereby provide a framework for other agencies seeking to improve the care for these high-risk and high-needs populations.

Our focus will be limited to response models that use EMS and will not include other first responder models without EMS involvement.

The anticipated heterogeneity between programmes will likely prevent data synthesis.


Mental health, behavioural and substance-related calls comprise 5%–15% of 911 (emergency) call volumes in the USA. 1 These calls are received by regionally designated Public Safety Answering Point dispatchers, who are trained to route the call to local emergency medical, fire and/or law enforcement agencies depending on the nature of the call. Emergency medical services (EMS) are therefore responsible for responding to medical 911 calls as well as for the evaluation, stabilisation, temporising management and transport of patients to a higher level of medical care. 2 However, not all mental health, behavioural and substance-related calls immediately or solely triage to medical response. If high-acuity medical concerns are not present or immediately apparent to the dispatcher, or if there is concern for safety risk to the caller or others, law enforcement may be the sole first responder to the scene, with the patient stabilised and supported on scene, and ultimately potentially taken to a medical emergency department (ED) or jail afterwards. 3 4 This raises several concerns. First, because EDs and jails frequently serve as receiving centres for those experiencing behavioural emergencies, individuals may be diverted from the psychiatric care they need. Due to a scarcity of psychiatric inpatient beds, patients with mental health needs are increasingly being ‘boarded’ in EDs, where they can wait for days or weeks to receive psychiatric care. 5 These individuals often find themselves without treatment and in environments that may exacerbate their symptoms. 6 Although psychiatric EDs that concentrate solely on treating individuals in crisis exist, these programmes are limited in number and are not always present to receive patients from medical EDs and field transport by law enforcement. 7 Second, interactions with law enforcement can escalate individuals’ mental health crises and may precipitate volatile and potentially dangerous situations. 8–11

As a result, there is increasing interest in integrating mental and behavioural health expertise into emergency response to such calls. 12 13 This requires interdisciplinary collaboration, as professionals across multiple disciplines work together to evaluate the patient, stabilise the situation and deliver definitive and specialised care. 14 For example, law enforcement agents can evaluate the scene, ensure the safety of the individual(s) who are the focus of the call and of those around them and provide logistical and operational support to other first responders who can then be cleared to enter the scene. 15 In some agencies, mental health professionals have partnered with law enforcement to provide mental health and social services support during and after such calls. 16 In such coresponse models, mental health providers are typically employed by the law enforcement agency and corespond with law enforcement officers to specific calls. 17 18 However, neither law enforcement nor mental health professionals have the education, training or experience necessary to evaluate, triage and manage the medical aspects of mental health, behavioural or substance use-related calls. This gap calls for strategic integration of EMS providers into these calls beyond their role in emergency stabilisation and transport. Indeed, EMS involvement with mental health, behavioural and substance use-related response efforts has the potential to place greater emphasis on the mental health aspects of these emergencies and help ensure appropriate triage, management and follow-up of underlying medical and psychiatric conditions. 19

Emerging EMS response models to support individuals experiencing mental health crises have expanded options for receiving facilities beyond the ED or jail, and implemented collaborations among paramedics and mental health professionals to better address the crisis and direct the patient to definitive treatment as opposed to the ED. One of the earliest models is the Crisis Assistance Helping Out On The Streets programme in Eugene, Oregon, which paired a medic (either a nurse or an emergency medical technician (EMT)) and a crisis worker with experience in the mental health field to provide assessment, stabilisation, triage and referral, and transportation to a treatment destination. 20 Its pioneering success gave rise to other programmes across the USA. For example, in Wake County, North Carolina, the ‘Alternative Destination’ programme allowed EMS providers to transport patients undergoing mental health crises to a psychiatric facility rather than an ED as long as they met prespecified criteria related to vital signs, functional status and mental status. 21 22 This programme resulted in a 20% decrease in transports to an ED over a 2-year period. 21 Similarly, the Grady Health System in Georgia paired EMS staff with a crisis team consisting of a paramedic, a licensed counsellor and a clinical social worker. 21 23 In combination with an expanded dispatching service that allowed 911 calls to be transferred to the state-wide mental health services hotline, the Grady EMS response programme reduced the number of patients being arrested or restrained while improving treatment and conserving resources over its pilot period. 21 23 Expanded EMS programmes have been implemented internationally as well. The Mental Health Acute Assessment Team in Western Sydney, Australia, comprised a paramedic and mental health nurse, was able to refer patients to mental health facilities or general practitioners instead of EDs. 24 Ultimately, almost 70% of patients received treatment in non-ED settings, while two-thirds of patients were transported to mental health facilities. 24 Different EMS response models are currently in operation in Sweden, Canada and Australia. 19 21 25 26

Funding and staffing are major barriers to the implementation and sustainability of such programmes. 19 Sustainability may be increased through interagency collaboration and use of existing teams and infrastructures, rather than reliance on a dedicated and de novo assembled team. Better understanding of how interagency EMS collaborations have been implemented and funded to respond to mental health, behavioural and substance use-related calls is critical to improving the care for individuals experiencing these emergencies and their communities. We plan to focus specifically on interagency collaborations as these are most likely to be feasible and sustainable in diverse settings which may lack the resources to establish dedicated coresponse units.

To our knowledge, there has been no systematic assessment of how these programmes are organised, what agencies are involved in the collaboration, what conditions and populations are served, in what settings and communities they are located, how they are funded to ensure sustainability and what the outcomes of these programmes are. There is therefore urgent need to understand how EMS can be effectively and efficiently integrated into the acute and postacute care for people experiencing behavioural, mental health and substance-related emergencies. To address this knowledge gap, we propose a scoping literature review of EMS care models for behavioural, mental health and substance-related emergencies.

The described protocol aims to answer the following questions:

What professions and types of agencies, if any, collaborate with EMS services in interagency models of response to mental health, behavioural and substance use calls?

How are the programmes structured in terms of team roles and response models, modes of activation and required training?

What services are delivered as part of the intervention?

In what settings have these interagency models been implemented, focusing specifically on understanding their rurality, population size, income distribution, racial/ethnic distribution and geographic region?

What are the funding sources and budgets for these programmes?

What are the target populations for these programmes (ie, what are the eligibility criteria for receiving care in the programmes)?

What are the outcomes of these programmes, if described?

What were the implementation challenges of these programmes and what steps were undertaken to improve sustainability?

What are the implications of these programmes on issues of health equity, systemic racism and criminal justice reform?

Patient and public involvement

No patients or members of the public will be involved in this study, as it is a scoping literature review of EMS programmes supporting individuals experiencing behavioural emergencies.

Eligibility criteria

We will include studies meeting the following inclusion criteria:

Focus on non-emergency response and/or management of patients with mental health, behavioural health or substance (alcohol, drugs) use-related calls by EMS providers.

Models of care involve an EMS provider, including EMT, paramedic, community EMT or community paramedic. They may also involve other prehospital and first responder providers, such as law enforcement, social services, mental health professionals and others; engagement of these providers is not required for inclusion.

Models of care responding to incoming calls for service, whether those are 911 calls or an equivalent non-emergency hotline.

There will be no restriction on the affiliation of the EMS providers included in the study (ie, we will not restrict analyses to studies of EMS providers within ambulance services only and will include studies where EMS providers are part of fire departments, health systems, public agencies, etc).

All participant demographics (age, gender, ethnicity, etc).

All countries of publication.

Published in English.

All study designs.

The review described by this protocol is intended to describe the utilisation of EMS, particularly when involved with interagency collaborations, in responding to and managing non-emergent aspects of mental health, behavioural and substance use-related emergency calls. Therefore, any services that use non-mobile groups or do not include EMS providers will be excluded from review. Emergency stabilisation with transport to the ED (ie, 911 calls with transport to the ED) and interfacility transport calls will be excluded. Models of care based on appointments instead of calls by individuals, such as clinical patient referrals, will be excluded. We will further exclude studies that describe EMS providers’ attitudes towards mental health, behavioural health or substance use calls, as well as studies that solely focus on curriculum development or education.

Search methods

The literature was searched by a medical librarian for the concepts of EMS and behavioural health calls. Search strategies were created using a combination of keywords and standardised index terms. Searches were run on 14 July 2022 in EBSCO CINAHL with Full Text (1963+), Ovid Cochrane Central Register of Controlled Trials (1991+), Ovid Embase (1974+), Ovid Medline (1946+ including epub ahead of print, in-process and other non-indexed citations), Ovid PsycINFO (1806+) and Web of Science Core Collection (Science Citation Index Expanded 1975+ and Emerging Sources Citation Index 2015+). After limiting results to English language, a total of 3608 citations were retrieved. Deduplication was performed in Covidence, a web-based tool for reference importation and screening and data extraction, leaving 2660 citations.

We will also include grey literature of agency websites, relevant news articles about EMS programmes and service evaluations by additionally searching the names and locations of EMS programmes identified through screening of scientific literature.

We will use two reviewers to screen citations for inclusion. Screening will be conducted using Covidence software. Each reviewer will perform an initial round of screening based on titles and abstracts. Conflict will be resolved by a third reviewer. After the first screening phase, each reviewer will then perform a second round of screening using full texts to ensure citations fulfil inclusion criteria. Conflicts will be resolved by a third reviewer. The start date for the study was 19 July 2022, and the planned end date is 1 September 2023.

Data extraction

Data will be extracted from papers using an extraction tool developed for this review using the review questions as a guide. The data extracted will include details regarding the EMS team members, other agencies involved in the response, collaboration status (single team or interagency), call intake process, vehicles taken to the scene, typical response sequence taken, typical calls responded to, scope of coverage, funding sources, gaps in the response system, years since programme establishment, status of programme continuation, any barriers and facilitators to implementations discussed in the study, outcomes presented and discussions of health equity, systemic racism and criminal justice reform as related to the programmes.

Data analysis

The data extracted will describe EMS programmes. We expect that the heterogeneity between programmes and the descriptive nature of extracted programme features and outcomes will preclude ability to conduct data synthesis. A narrative synthesis will be conducted to characterise the programmes in terms of populations and situations targeted by the programmes, programme staffing and composition, interventions, implementation features, collected outcomes and implications for health equity, systemic racism and criminal justice reform in the emergencies responded to by the programmes.

The results will include descriptive summary data on the EMS team members, other agencies involved in the response, collaboration status (single team or interagency), call intake process, vehicles taken to the scene, typical response sequence taken, typical calls responded to, scope of coverage, funding sources, gaps in the response system, years since programme establishment, status of programme continuation, any barriers and facilitators to implementations discussed, outcomes presented and discussions of health equity, systemic racism and criminal justice reform as related to responses. No formal statistical modelling will be performed.

Behavioural, mental health and substance use-related emergencies are a rising problem with a need for community-based interdisciplinary solutions. Law enforcement has traditionally been one of the first points of contact in mental health crisis responses. However, new response models are necessary to increase access to medical and social support services for at-risk patients and communities. Though their usual role has been in acute stabilisation of patients and transportation of patients, EMS are in a unique position to provide increasingly efficient, directed care for individuals experiencing mental health crises. Interagency collaborations may be uniquely feasible and sustainable in diverse settings and populations. In this review, we will describe the ways in which EMS can augment existing models of response to mental health, behavioural and substance use-related calls to ensure safe, equitable and person-centred care.

We anticipate that the proposed study will be limited by the high level of heterogeneity between EMS programmes, which would preclude formal data synthesis and meta-analysis. However, the primary objective of our review is to characterise the types of programmes that have been implemented, and that includes appreciation for the wide variation that may exist.

Ethics statements

Patient consent for publication.

Not applicable.

Contributors MLD conceptualised, prepared and wrote the review protocol, and drafted the first version of the manuscript. DJG prepared the search strategy and edited the manuscript. RGM conceptualised and supervised the study and edited the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review Not commissioned; externally peer reviewed.

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