Changing perceptions of the mental health and vulnerability of young gang members
Suzella Palmer discusses the need for a better understanding of the mental health issues of gang-involved young people.
Often buried within current discourse around gangs is the issue of gang members and the problems they experience with their mental health. Researchers, policy makers, and practitioners have recently begun to conceive of gang members as “vulnerable” and “victims”.
This is particularly apparent within the context of 'county lines' where criminal drug dealers are said to be grooming and exploiting vulnerable children to sell and transport drugs (Home Office 2018). However, applying the term “vulnerable” to those who may occupy more central roles within the gang is, for obvious reasons, more of a challenge. This is true even if they are known (and indeed, many are) to have been exposed to adverse childhood experiences and have multiple and complex needs as a result.
Back in 2013, the findings of a large-scale cross sectional study showed that gang members in the UK have significantly high rates of anti-social personality disorder, psychosis, suicide and anxiety disorder (Coid et al, 2013), which has contributed to this very gradual shift towards viewing young people who engage in violence as vulnerable.
Although the progress made on building on this research has been slow, practitioners within the public sector, particularly those working in education and health, have now begun to consider and consequently address the issue of gangs and mental health (Madden 2013; Public Health England 2015; Children's Commissioner 2019).
Existing research demonstrates that young people may be coerced into gangs, or freely choose the lifestyle, for a variety of reasons and that gang members’ roles are varied (Pitts 2008). Once in a gang, individuals may be involved in different levels of violence as victims, as perpetrators or as both victim and perpetrator (Palmer and Pitts 2006; Palmer 2009; Beresford and Wood 2016).
The more reluctant recruits can be viewed as vulnerable at the point of joining, in that they may be taken advantage of, easily coerced, and susceptible to exploitation and intimidation. However, once they are members, reluctant or otherwise, they become exposed to the violence and intimidation that occurs within the gang and the impacts on their mental health can become more apparent.
As Macfarlane (2018) has demonstrated, there is a strong body of research to show that witnessing violence within a gang context or engaging in violence as a perpetrator or a victim, can put gang members at risk of PTSD. Anti-social personality disorder, anxiety disorder, and suicide all appear to be symptoms of being immersed in gang lifestyles.
Additionally, around a quarter of females involved in gangs have diagnosable mental health problems. Female gang members are also at risk from higher levels of self-harm and suicide and may engage in sexually risky behaviour which itself can result in mental health problems (Public Health England 2015). Clearly, the impact of mental health issues on young people who associate with gangs is significant.
In terms of the overall response to the mental health needs of young people involved in gangs in the UK, this sits within the current public health approach to tackling violence. This involves a pragmatic approach that enables an assessment of the nature and scale of the problem, followed by the implementation of evidence-based interventions.
However, research on the effectiveness of these forms of interventions is scarce and those proposed tend to be based on the results of studies involving non-violent offenders and not specifically on gang members (Macfarlane 2018). Nevertheless, the available research points to both cognitive behaviour and systemic intervention therapies as effective ways of reducing violence amongst gang-involved young people and treating the symptoms.
Whereas cognitive behaviour therapies (which target anger management, decision making, moral reasoning, and social skills training) focus on changing the mind-set or behaviour of a gang involved individual, systemic interventions are geared towards changing dysfunctional social environments (with a particular focus on the family). When these are taken together, they can, in theory, provide solutions for reducing serious youth violence and the mental health issues associated with being in a violent gang.
The successful delivery of these interventions is dependent on the ability to access and engage young people who are often distrustful of 'authority', which includes public sector agencies (Madden 2013; Farran 2014; Public Health England 2015).
To overcome the problem of access, successful interventions tend to be those that are delivered by services that are prepared to meet and engage young people in the neighbourhoods where they live, spaces that they occupy, and/or with individuals who they can trust (Public Health England 2015). As well as being sufficiently trained in terms of their knowledge on mental health, practitioners should also be able to demonstrate a high level of cultural competence.
Whilst being able to engage working class and generally disaffected young people comes with a range of challenges, engaging young black people, particularly within the mental health services, appears to be much more of a challenge, partly due to the historic perception of racism and discrimination in the diagnosis and treatment of black people (Royal College of Psychiatrists 2018).
With the number of young black people that are believed to be engaged with gangs relatively high, this needs to be a priority. Developing an empathetic understanding of the lives of gang-involved young people and the challenges that they will face is key to building trust and interventions.
Arguably, former gang members are well placed to have that empathetic understanding because they are seen by current gang members as 'having been where they are' and are therefore more likely to be receptive to forming key relationships which can then lead to them accessing services.
Furthermore, involving gang members and former gang members in the interventions, can help to ensure that strategies are more appropriate and effective (Public Health England 2015). There is also an important role for third sector organisations, who have been delivering support and interventions from this bottom-up approach on the ground, despite their often-limited funding.
The research that provides an in-depth understanding of the links between gangs and mental health that does exist, represents an initial impetus for action. Viewing young people engaged in gangs as vulnerable is essential.
While common understanding typically views these young people as offenders rather than as vulnerable, they also need to be viewed as victims. It is this wide-spread shift in focus that acts as a starting point for building effective interventions. Additionally, accessibility to services and culturally competent practice should be at the heart of interventions and these can all serve as the starting point.
Suzella Palmer is Senior Lecturer in Applied Social Sciences at the University of Bedfordshire.