Case Blog - (2016) Volume 13, Issue 1
| Mary Dawood RN, BSc (Hons) MSc* Consultant Nurse, Emergency Directorate, Imperial College NHS Trust, London, UK Anne-Marie Burr Youth Worker, Redthread, London, UK |
| Corresponding Author: Mary Dawood, Nurse Consultant, Imperial College NHS Trust, London, UK, E-mail: mary.dawood@imperial.nhs.uk |
| Related article at Pubmed, Scholar Google |
An 18 year old man was brought by ambulance to the hospital with multiple stab wounds to his limbs. His life was clearly in danger but his response to the medical team and paramedics who were trying to help him was one of extreme agitation, verbal aggression and generally being uncooperative. This young British man of Afro/Caribbean ethnicity had been in care since a young age. His brother was in prison and it soon became clear that he lived in a state of hyper-vigilance, fearing for his safety and was unable to articulate his high levels of anxiety and insecurity. This was clearly manifested in his aggressive and constant questioning of the medical teams around him. It was evident that settings such as the hospital, which was located in an area of London where he didn’t feel safe, made him very anxious; in this state of anxiety he was unable to manage his anger. Fortunately for this young man and indeed for the medical and nursing team who needed to focus on stabilizing his condition, there was a youth worker from an organization called Redthread (http://www.redthread.org.uk) present who was able to stay with him offering the support and reassurance which allowed the medical and nursing staff to
| An 18 year old man was brought by ambulance to the hospital with multiple stab wounds to his limbs. His life was clearly in danger but his response to the medical team and paramedics who were trying to help him was one of extreme agitation, verbal aggression and generally being uncooperative. |
| This young British man of Afro/Caribbean ethnicity had been in care since a young age. His brother was in prison and it soon became clear that he lived in a state of hyper-vigilance, fearing for his safety and was unable to articulate his high levels of anxiety and insecurity. This was clearly manifested in his aggressive and constant questioning of the medical teams around him. It was evident that settings such as the hospital, which was located in an area of London where he didn’t feel safe, made him very anxious; in this state of anxiety he was unable to manage his anger. |
| Fortunately for this young man and indeed for the medical and nursing team who needed to focus on stabilizing his condition, there was a youth worker from an organization called Redthread (https://www.redthread.org.uk) present who was able to stay with him offering the support and reassurance which allowed the medical and nursing staff to concentrate on the priority that was his medical predicament. |
| In trying to alleviate his anxiety, the youth worker talked to him about his concerns and worries but also broached wider topics that may have been contributing factors to his anger and inability to control his temper. During this initial conversation this young man disclosed that he had a new baby son. This little baby was clearly his pride and joy and a bright light in the otherwise bleak and marginalized world in which he lived. Talking about his baby to the youth worker calmed him and made him smile and in stark contrast to his angry and sullen countenance he had a genuinely warm smile. Once calm he was more able to focus on his medical predicament and appreciate the gravity of his injuries; he began to ask sensible questions about the impact of his injuries. |
| This young man was discharged from hospital three days later to his girlfriend’s address. He promised to call the youth worker at Redthread once settled. After five days he had still not called, but, one morning at 8 am, he phoned the youth worker telling her that his wounds were not healing, and he did not know who to phone or what to do. The Redthread worker met him and accompanied him to the hospital where he was seen by the medical team and his wounds were re-dressed. At the hospital he again became verbally aggressive towards the medical staff, threatening to steal a wheel chair and insisting he was unable to walk. |
| The youth worker stayed with him during this attendance and challenged him again to consider his behaviour and the negative impact this was having on his need for medical care and the disposition of the medical staff towards him. The youth worker accompanied him to the hospital on the second occasion and he began to engage positively with her enabling her to link him with a social worker and housing worker. The housing team re-opened his housing placement on the condition that he engaged with them. Redthread arranged a joint meeting between the different workers in order to come to an agreement about these conditions. |
| Since then he has remained engaged with his placement. He is registered with a GP and has begun to attend counselling sessions. He is also registered with the Job Centre to find employment. As a result of his positive behaviour and successful engagement he has been offered a long-term housing placement with his girlfriend and baby. |
| Most probably none of this would have happened without the intervention of the youth worker from Redthread. Engaging positively with such dispossessed young people calls for sustained and consistent one-to-one interaction that is well beyond the remit or priority of the emergency team. |
| Redthread is a registered charity supported by the donation of individuals. It provides vital support for young people in their physical, social and psychological development. In particular the charity offers support to teenage assault victims, helping them avoid being drawn into gang activity and the ensuing violence and exploitation that has become synonymous with gangs particularly in big cities. |
| Vulnerable young people often have little trust in those they see as authority figures such as medical professionals and the police and can often be defensive and reluctant to engage. However, in a desperate situation such as this encounter they will often confide in an independent person who is not perceived to be part of the establishment. Intervening early to direct young people away from a violent and destructive lifestyle is imperative and can change the trajectory of their lives. It is also in the interests of society as a whole. |
| Redthread’s approach of placing youth workers in all the major trauma centres in London so they can optimise the “teachable moment” is an innovative and a more constructive response to tackling some of the real causes of knife crime. Whilst this might seem like just a drop in the ocean, it is a positive response to what is a significant public health issue that is blighting the lives of too many young people in our society. |
| Sadly youth violence and knife crime is increasing and the high profile and often over sensationalist media attention which creates fear has led to a number of responses and policy initiatives from the Home Office over the past decade. The most recent are Knife, Gun and Gang Crime (Home Office 2014) and Ending Gang and Youth Violence Programme (Home Office 2015). These responses are necessary and important but there is a danger that the focus and powerful gang rhetoric creates stereotypes and stigma which then can serve to obscure and even dismiss some of the underlying causes of social and spiritual deprivation that so need addressing. There is no clear definition of what constitutes a gang and, despite evidence to the contrary, (Alexander 2004, & Hallsworth and Young 2004), the history of the term has linked gangs with black, minority, ethnic and immigrant young men who are locked inescapably into cycles of deprivation and alienation based on cultural disadvantage (Alexander 2008). Youth violence affects all communities and while many of the perpetrators of knife crime are black and ethnic minority young men, they too are disproportionately the victims of such crime like the young man in this case. This focus can serve to overlook youth violence in other communities, which, in itself, is counter-productive. |
| It is all too convenient to attribute youth violence to gangs but we need to look beyond this perception to address the real issues of poverty and alienation. The underpinning ethos of Redthread is to work in a supportive non- judgemental way with the individual to break this cycle. Ultimately the aim is to offer hope and another way to young people, like the young man in this case, who have been failed by society. Supporting this approach is in all our interests to create a fairer and safer society. |
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