Understanding Violence

in Suffolk - summary

Anna Crispe, Head of Knowledge & Intelligence

November 2019

What is a ‘public health approach’ to tackling violence?

WHO suggests it is a focus on the primary prevention of violence through:

• Reducing risk factors

• Boosting protective factors

• Looking across the life course, recognising that violence is cyclical in nature

• Mitigating the effects of violence through provision of support to victims

Why take a PH approach?

The risk behaviours, protective factors and environmental agents we encounter throughout our entire lives have cumulative, additive, and sometimes multiplicative impacts.

Our experiences and exposures today influence our health and wellbeing tomorrow - if you are a victim of violence today you are more likely to be a perpetrator of violence in the future

Source: ‘The Public Health Approach’, WHO, 2017

Different factors are important in different contexts – we need to think about all of them… we are perhaps more familiar with some of them than others…

Source: ‘The Public Health Approach’, WHO, 2017

A Public Health Approach to

Violence Reduction

Apply this approach to:

• Supporting ‘acute interventions’ -urgent and emergency responses when required

AND

• Developing ‘primary interventions’ –reducing risk factors and boosting protective factors over the life course cycle

Source: ‘The Public Health Approach’, WHO, 2017

What does the data tell us about violence

in Suffolk?

Caveat: the trend data is influenced heavily by changes

in recording and reporting practices – and some data

sources don’t match!

Rates of admission to hospital for violence-related injuries in Suffolk have historically been statistically significantly lower than the England average

0 5 10 15 20 25 30 35 40 45 50

Suffolk

England

Rate of admissions to hospital for violence-related injuries per 100,000 population, 2014/15 - 2016/17

Source: PHE Fingertips, accessed 19/19/2018

Suffolk is generally a safe place to live, with relatively low reported crime rates

In 2018, Suffolk had lower reported crime rates than England in 9 out of 10 categories; only sexual offences were reported at a higher rate than the England average

Source: ONS: Recorded crime at Police Force Area Level 2018, accessed 03/09/2018

However, the total number of recorded offences in Suffolk has risen in recent years

Source: ONS: Recorded crime at Police Force Area Level 2018, accessed 03/09/2018

Similar areas to Suffolk show a similar pattern

All crime, rate for Suffolk and MSG PFAs, 2003-2018

The offence rates for violence against the person also show a similar trend, with rates increasing in Suffolk by 75% between 2008 and 2018

Violence against the person, rate for Suffolk and MSG PFAs, 2003-2018

Violence without injury

Violence with injury

Sexual offences

Possession of weapons

Homicide

Offences involving violence in Suffolk have risen in recent years, but numbers are still relatively low

Suffolk has seen reducing numbers of young people involved in youth justice services over recent years, and the rate of involvement has also declined

Oct 15 - Sep 16 Jan 16 - Dec 16 Apr 16 - Mar 17 Jul 16 - Jun 17 Oct 16 - Sep 17 Jan 17 - Dec 17

Suffolk 294 291 280 286 248 234

England 334 327 321 313 304 292

South East 269 256 246 237 226 224

YOT Family 351 334 326 316 315 288

Actual FTE no. 194 192 185 189 164 155

200

220

240

260

280

300

320

340

360

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0,0

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Source: Suffolk County Council

Risk factors for violence

The Serious Violence in Lambeth Needs Assessment (2015) identified the following risks, many of which are also relevant in Suffolk…

• Early adverse Life experiences• Severe behavioural problems in childhood• Peer relationships and gangs• Deprivation and income inequality• Alcohol and drugs• Cultural and social norms supportive of violence• Disability• Mental Health disorders• Brain Injury

However, wider risk factors are also relevant for other types of violence – and are there additional risks we should consider in Suffolk, based on further needs assessment work? Source: Serious Violence in Lambeth

Needs Assessment, 2015

There are also many aspects of vulnerability to violence which cut across wider public health issues – mental health and substance misuse are key…

The 2013 Tri-borough Public Health Report produced on behalf of the

Westminster Joint Health and Wellbeing Board reports that in a

sample of 100 young gang members, it could be expected that:

86 will have conduct problems (<18 years) or antisocial

personality disorder (18+ years)

67 will have alcohol dependence

59 will have anxiety disorders (including post traumatic stress

disorder)

57 will have drug dependence (mainly cannabis)

34 will have attempted suicide

25 will have psychosis

20 will have depression

Source: Madden V., Understanding the Mental Health Needs of Young People involved in Gangs, 2013

Lifestage:

Lambeth have developed a model to look at the costs of violence – they estimate nearly half a billion pounds of cost per year arises from violence

Estimated prevalence multipliers

and costs of violence in Lambeth

Source: Serious Violence in Lambeth Needs Assessment, 2015

Crimes relating to the

individual Total unit cost

Number of recorded

crimes in Suffolk in the

12 months Ending

March 2016

Recorded crime cost

calculation for Suffolk

Multiplier

applied

Total estimated cost to

Suffolk 2015/16

Homicide £3,217,740 2 £6,435,480 1.0 £6,435,480

Violence with Injury £14,050 4,762 £66,906,100 2.6 £173,955,860

Violence without Injury £5,930 6,927 £41,077,110 1.5 £61,615,665

Rape £39,360 502 £19,758,720 3.4 £67,179,648

Other sexual offences £6,520 1,105* £7,204,600 16.5 £118,875,900

Robbery £11,320 230 £2,603,600 4.3 £11,195,480

Domestic burglary £5,930 1,384 £8,207,120 3.6 £29,545,632

Theft of Vehicle £10,290 519 £5,340,510 0.8 £4,272,408

Theft from Vehicle £870 2,169 £1,887,030 2.6 £4,906,278

Theft from Person £1,380 412 £568,560 5.9 £3,354,504

£159,988,830 Total: £481,336,855

Applying these cost estimates and multipliers to the Suffolk data suggests a similar overall cost to Lambeth, which should perhaps be treated with caution – but it is important to note that Suffolk’s population is twice as large as Lambeth’s.

Source: Public Health Suffolk analysis

What works? Evidence led rather than evidence-based…

Evidence of effectiveness exists in the following areas (amongst others):

• Taking an epidemiological approach – Chicago ‘Cure Violence’, Glasgow, Lambeth

• Preventing Offending - diversion, restorative justice approaches, skills acquisition, work towards a long term goal, community relationships, CBT

• Preventing Youth Violence - creating positive change in people’s lives, school-based or family-focused interventions, family therapy

• Supporting children and families - parenting programmes, social and life skill development, home visiting, recognition and management of conduct disorders

• Working with gang involved and high risk young people - mental wellbeing, hospital based-programmes, school-based programmes, focussed deterrence, environmental design, injury screening

Chicago – ‘Cure Violence’

• Gary Slutkin – American epidemiologist working in Somalia to prevent spread of TB and cholera within refugee camps where 1,000,000 people were living

• On return home to Chicago – started mapping and graphing gun crime – and found the same patterns of spread, clustering and contagion you would see with infectious disease

• Focus at the time was on enforcement – ‘these people are bad and we know the right answer is to punish them’

• But human behaviour works by modelling and copying – so from a health point of view, you don’t blame, you try to understand and then develop solutions

• Language matters – don’t use ‘gang’, ‘thug’, ‘criminal’ – talk about ‘contagion, transmission, health’

AIMS - Interrupt transmission- Prevent future spread- Change group norms

• 67% drop in shootings in the first year• At least 40% drop in other areas• Evaluated by Northwestern and JH• Even though effective, funding cutSource: ‘Violent crime is like infectious

disease’, MOSAIC, 2018

Glasgow – Violence Reduction Unit• Glasgow ‘Murder Capital of Europe’ - established Violence Reduction Unit in 2005 – focus on

implementing evidence based interventions, using the WHO model and Gary Slutkin’s Chicago approach PLUS criminology approach based on David Kennedy’s work in Boston, in partnership with Medics Against Violence

• Gathers together gang members and gives them an option: renounce violence and get into education or work, or face tough penalties. This meant ramping up traditional penal measures –alongside preventive measures in line with the public health approach – political element.

• Use ‘navigators’ – to interrupt transmission, based in A&E – ‘very important that they or their associates do not leave A&E plotting revenge’

• Schools education programme about knife crime – delivered by doctors

• Also more holistic work - Braveheart Industries - a food truck that sits in the Partick area of Glasgow, dishing up peri-peri chicken burgers and fish tacos. It hires former violent offenders for a year, mentoring, psychotherapy, literacy, housing, parenting ++. Participants must have a criminal history, must abstain from drugs and alcohol, and they must be ready to change.

“… the more I was away from the chaos, the more my life just got better and better.”

Source: ‘Violent crime is like infectious disease’, MOSAIC, 2018

The Lambeth Approach – potential parallels with approaches to substance misuse?

Violence involving young men and

boys

Resilience of Public Environments

Violence against Women and Girls

Family Support and Interventions in Early Childhood

Primary Interventions

Acute Interventions

Social marketing –build community

resilience / challenge community norms

Hidden Violence –look in high risk / under-

represented groups

Head Injury –screening and referral at

key points

Evaluation–particularly of early

intervention services

…primary and acute interventions

identified for each theme…

Four themes….

… supported by system change

Data-led and data sharing approaches in Suffolk

• Involvement with and vulnerability to USG – combined a set of education, social care, early help, troubled families data – gave us new insights into comparative levels of involvement and risk

• Domestic abuse – about to start linking data from Suffolk County Council, District and Borough Councils, Constabulary and hospitals to see which individuals we can match across the different data sets. This will:

• Give us a better sense of the scale and location of this issue

• In time, potentially enable us to proactively flag victims across different services – but this will require further information governance work

Conclusions

• Nearly all the risk factors identified are complex and multi-factorial – there is no simplistic answer … but not tackling these issues lead to huge personal and societal costs

• A genuine multi-agency approach is the only approach

• We need better data to really understand these problems – we are developing lawful and appropriate, but leading edge, approaches to data sharing in Suffolk, including data on domestic violence and gang violence – there is much more to do here