I am a Paediatric Emergency Medicine Consultant and Clinical Lead for the In-Hospital Violence Reduction programme at the Evelina Children’s Hospital, London.
In September 2022, I joined the NHS Violence Reduction Programme as the Clinical Lead for Outreach. This is a fantastic, dynamic and innovative team, passionate about reducing health inequalities and improving well-being through supporting communities to access NHS violence reduction programmes across London.
There is a strong ethos to the Outreach team which encompasses listening to the voice of communities through collaboration and co-production of violence reduction initiatives. Using an evidence based approach our work will evolve to understand the needs of specific at risk communities.
There is a clear message across London that there is a need to build partnerships with communities and organisations whilst removing logistical, behavioural and psychological barriers to accessing violence reduction initiatives (The Violence Reduction Unit Report (2020); Violence in London, what we know and how to respond). At the heart of our NHS Violence Reduction Outreach Programme is listening to the communities and working with our partners on the ground to jointly create a pan-London strategic approach that brings together young people, community partners and the NHS.
The 16 Days of Activism against Gender Based Violence is an annual international campaign starting 25 November, the international day for the elimination of violence against women, and runs until 10th December, Human Rights Day. As we approach this date, we reflect on the global theme “UNITE! Activism to end violence against women and girls” and focus our attention on the needs of girls and young women at risk of violence across our local communities.
We know that around half of mental health problems have their onset in childhood, before the age of fourteen. Social and economic disadvantage have an impact, with children and young people from more disadvantaged areas being more likely to experience mental health difficulties than children and young people from more affluent areas. Other groups, including looked after children, people with disabilities, those who identify as LGBT and people from Black and Asian backgrounds, particularly Black and Asian men, are also disproportionately affected.
Why is this so important to the London NHS Violence Reduction Programme?
Firstly, society often silences the female voice in violence. There is limited public awareness of how females are impacted by youth violence, county lines and gangs. Thus, their associated risks often go unrecognised. Females have multiple, interchangeable roles, predominately linked to their relationship with male gang members.
Young women and girls are far too often stereotyped as “mad or bad” when seeking support and recovering from trauma experienced through their exposure to violence. They can be seen as perpetrators (instead of seen as victims), immoral and sexually promiscuous when entrapped in sexual exploitation.
Statistics provided by the Advance Charity suggest a link between early negative intimate relationships (often with exposure to violence and abuse), subsequent poor mental health and offending leading to contact with the criminal justice system. 53% of women in prison in England report having experienced emotional, physical or sexual abuse; 40% of young women in custody have suffered violence at home; 30% of young women in custody have suffered sexual abuse at home.
A sense of blame
Female survivors of violence talk about feeling a sense of blame, with society and agencies perceiving them as involved in exploitation and violence as more of a choice. This shifts the perception of females away from being victims but as perpetrators or willing participants in exploitation. This often clouds the young female into not perceiving her role as exploitative and can act as a barrier in seeking help from supportive agencies. This can result in the risk of violence for girls and young women being underreported in our data.
Secondly, knowledge about gang associated girls and young women is far less developed than that for gang-associated boys and young men. The Children’s Commissioner’s report (2019) identified three defined groups of gang associated children and young people. The “Younger Group” comprises children within the 10 15-year-old age range and has the highest proportion of females compared to the other defined groups such as “Drug Offending” and “Extensive Offending.”
When we break down the specific risks to individuals within this “Younger Group,” we can see that there are higher rates for being a missing person, risk of sexual exploitation and victims of violence. Through understanding the “Younger Group” and the female associated risk factors for violence, we can begin building the foundations of a gender informed targeted approach for community driven violence reduction work and focus our attention to the need to deliver interventions to girls from as young as 10 years old.
Thirdly, criminality and the criminal justice system are poignant in considering a gendered approach to female violence reduction initiatives. Criminality can be used as a way to identify individuals at risk of violence but for females it is a poor predicative indicator for exposure to violence. However, once in the criminal justice system there is huge disparity and inequality of females who are marginalised as perpetrators and not perceived as victims when involved in violent crime.
We understand racial disparities exist and the Youth Endowment Foundation (YEF) 2022 Report highlights how Ethnic minority children and Black children are increasingly overrepresented in the criminal justice system. Black children make up 4% of 10–17-year-olds, 15% of arrests, 18% of children stopped and searched and 29% of children in custody – up from 17% in 2011/12. Our understanding of the varied impacts across ethnicity and race in young women and girls is of key importance to our programme.
It’s time to reflect
Never has there been a more important time to reflect and emphasise that young women and girls’ perspectives must be specifically considered in youth violence reduction work to ensure a gendered approach when shaping policy and developing violence reduction programmes.
As the Outreach team we can support NHS services to understand the pivotal role it has in supporting violence reduction. Using public health approaches, we can increase the awareness and understanding of risk factors for violence and exploitation in females to ensure timely access to community based violence prevention programmes.
We, all of us, who work within the NHS, need to act to remove the taboo of discussion around exposure and desensitisation of sexual violence, exploitation and coercion and promote collaborative educational intervention programmes.
Collectively we can link with key organisations that support girls and young women within our London network like Blondy’s People Sistah Space and Girls and Gangs.
Collaboration between health, social care, education and the criminal justice sectors will help us understand and tackle violence targeted towards girls and young women and influence real change.
Dr Kate O’Loughlin
Clinical Lead – Outreach Violence Reduction
