I recently joined the NHS London Violence Reduction Programme as the Clinical Lead for mental health. It’s a great role and I am excited about the work and the challenges in front of me. I am a psychologist in a forensic mental health service and improving mental health to support a reduction in violent behaviour is something I have felt strongly about for a long time.
From my daily work with people in forensic mental health services, I know that too often mental health difficulties are not picked up soon enough and support is offered too late, after a violent incident has already happened. All too often I have spoken to families who had concerns for a loved one and tried to access services but were turned away or faced multiple barriers to getting the help they needed and deserved, only for something terrible to happen later.
The link between mental health and violence is not straight forward. Let’s be clear, not everyone who struggles with their mental health engages in violence and likewise not everyone who engages in violence has mental health difficulties. There is no single theory to explain why people act violently, and each incident has a distinct set of factors which led up to it. However, mental health can sometimes be one of those factors.
In 1998 a survey, which was commissioned by the Office of National Statistics, estimated that around 90% of the prison population in England and Wales may have a diagnosable mental health problem. More recently, research into the impact of adverse childhood experiences (ACEs) has shown that the more ACEs someone has, the more likely they are to develop mental health difficulties. ACE also increases the likelihood that someone will end up in the criminal justice system. For example, people who have experienced multiple traumas are more likely to feel unsafe and may then feel they need to carry a weapon to protect themselves.
October 10th was world mental health day and this year, the theme was “Make mental health and wellbeing for all a global priority”. This highlights the current inequalities that exist both in terms of the social determinants of poor mental health and access to mental health support both in the UK and across the world.
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.
We know from feedback, that mental health services often don’t meet the needs of people from these backgrounds. A young person from a more disadvantaged background may not have the support and resources they need to enable them to attend a regular clinical appointment. Young people who have experienced adversity may struggle to trust some mental health professionals, because they have had negative experiences of services and with people in positions of authority.
There is a wealth of feedback that tells us that our mental health services are not culturally sensitive enough and that staff are not representative of the communities they serve. Therefore, services, at best, can feel less relevant and helpful for some people from those communities and at worst they can feel discriminatory and excluding. So, reflecting on 2022 World Mental Health Day, there is still a lot of work to do.
But I feel more optimistic because of the work of organisations like the London Violence Reduction Programme and their partners, who understand that we need to develop services based on listening to people whose needs are not being met, about what they believe they need.
Already there are some really positive developments in the pipeline, such as the Vanguard model across three of London’s Integrated Care Systems (ICSs), offering services to children and young people at risk from violence, up to the age of 25, so lessening the challenging transition to adult services at the age of eighteen. And, identifying case managers, who can provide continuity of care for young people who may have lots of different agencies involved.
So, lots to do but also lots to celebrate, thanks to the work of many, who are pushing hard for improvement and change.
Clinical Lead for mental health, London Violence Programme.