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Chuka Umunna's calls for knife crime to be treated as a mental health issue

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I co-wrote this article with my Clinical Supervisor Dr Tami Kramer in response to MP Chuka Umunna’s  recent ground breaking link between gangs and mental health. The evidence is clear, there is a growing epidemic of knife crime in our inner cities that requires innovation and triangulated approaches to tackle gang crime and improve outcomes in young people. Far too many young people are living with trauma, high exposure to violence and sexual exploitation which increases risk of poor mental health in their adulthood.
MP Chuka Umunna  demands that the knife crime epidemic in London should be treated at a ‘mental health’ issue among young people (Evening Standard, 7 June 2017)
Chukka Umunna MP for Streatham is to be applauded for raising the profile of knife crime in London and the link with young people’s mental health. Police reports indicate the frequency of knife crimes have been rising. Scotland Yard reported in the Evening Standard on 19 June 2017 that over 2700 people were charged with possessing knives in the capital in the previous year. Data on serious youth violence, which is also rising, indicates use of a knife in almost half of cases. Presentations to hospital Accident and Emergency Centres following knife crime have increased, resulting in both life changing traumatic injuries and death.  Most of the victims and perpetrators are young, frequently from neighbouring if not the same localities. Every fatal stabbing is a tragedy leaving behind devastated, grieving families and communities.
What lies behind this increase of knife carrying? For some, carrying and use of weapons is part of a broader pattern of serious antisocial behavior, and might be associated with other serious violence, gangs or the drug trade. However according to a Police and Crime Committee report (Serious Youth Violence, July 2016) gang activity accounted for less than 5% of knife crimes  and that following an incident of serious violence, some young people will carry a knife if they feel unsafe. Many ordinary young people believe that they need to be prepared to defend themselves, displaying perception of a feeling of threat combined with a need to respond on their own, possibly indicating that they don’t perceive other means or sources of support to manage the threat.
The links between knife crime and young people’s mental health are manifold. At the one end of the spectrum, young people who develop seriously antisocial behavior suffer high rates of neurodevelopmental and emotional difficulties (such as Attention Deficit Hyperactivity Disorder, specific learning difficulties, anxiety, depression, substance misuse, Post Traumatic Stress Disorder, self harm and suicidality). Vulnerable girls are groomed and exploited by young men in gangs to become agents for drugs, weapons and sex. These difficulties occur most frequently in families facing multiple adversities such as poverty, isolation, domestic violence and parental mental health difficulties. At the other end of the spectrum young people within ordinarily supportive families are experiencing fear and anxiety about their personal safety, and are traumatised by actual or virtual exposure (via social media) to threats, stabbings and even murder. Support needs to be available to these young people and their families.
The police have been visible in launching a number of initiatives to specifically tackle knife crime in the capital, such as Operation Sceptre since 2015, which includes a range of components, from law enforcement to school education programmes. But as implied by Chukka Umunna addressing  the underlying risks and full impact of knife crime  requires broader, bold, innovative measures. This systemic problem requires multiple complex interventions across agencies and services with high levels of cross sector collaboration.
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One such evidenced based intervention, Multisystemic Therapy has offered community and home-based intervention for young people and families in parts of England. It targets factors underlying young people’s involvement in knife crime, or other forms of antisocial behavior including individual, family and community vulnerabilities. Counselling Psychologist, Jai Shree Adhyaru notes that MST endeavors to bring systems together to work collaboratively to reduce risk, for example by supporting families to work with local schools and police, addressing parental and child anxiety using educative as well as psychological intervention.
Our Trust, CNWL NHS Foundation Trust is at the forefront of providing mental health interventions for young people affected by gang culture within Westminster Integrated Gangs Unit (IGU), a unique multi-agency team which has contributed to reduction of serious youth violence. The IGU team incorporates police, probation, youth workers, employment specialists and  Clinical  Nurse Specialist, Dorcas Gwata with Consultant Child Psychiatrist supervision. Dorcas works outside traditional settings using innovative methods to access young people affected by gang culture. Her work challenges the notion of ‘hard to reach’ groups by seeing young people wherever they are, in youth clubs, schools and prisons. Dorcas added ‘We have taken what works in the clinic onto the streets. We are working to divert vulnerable young people from the dangers of knife crime and supporting parents who are otherwise struggling to parent their children whilst validating their efforts and appraising their values within their culture and religion. We are looking to expand our outreach and run community based mental health support in areas of high exposure to knife crime’. The role of the Child Psychiatrist is to offer support with understanding the needs of very complex young people and families; identification of specific mental health needs;  and advising on the most appropriate intervention approaches. Those who offend will face enforcement but gang involved young people are also helped to address their difficulties and  supported to find healthier lifestyles.
While Child and Adolescent Mental Health Services need to offer intervention for more serious psychiatric disorders, involvement from Public Health is required to develop interventions which reduce the background risks for involvement with knife crime, i.e. targeting the strengthening of family resilience and the cohesion and safety of local communities. Schools, youth services, youth justice and Local Authorities are essential partners alongside voluntary sector organisations such as Redthread ( who work specifically with youngsters in gangs). Innovative approaches which are sensitive to the cultural diversity of our population are urgently needed.
Chukka Umunna’s call to action should be heard by all who believe that London remains a relatively safe city, that should be enjoyed by all, free from fear, most especially by our children and young people.
Dr Tami Kramer, Consultant Child and Adolescent Psychiatrist
Dorcas Gwata. Clinical Mental Health Leader, Intergrated Gangs Unit
Westminster CAMHS
June 2017. All rights reserved.
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