Recent research shows that mental ill health is rife in gangs, but a pilot project is reaching out to members to try to address these issues. Jackie Cosh reports.
For young people who are members of gangs, it seems that mental health issues are a part of everyday life. Recent research by Queen Mary, University of London found that, in a survey of 108 gang members, half had anxiety disorder, 25% screened positive for psychosis, 85% had a personality disorder and one third had at some point attempted suicide.
Professor Jeremy Coid, director of the forensic psychiatry research unit at Queen Mary and lead author of the paper, said the research – the first of its kind – identified a complex public health problem at the intersection of violence, substance misuse and mental health problems among young men.
He advocated that gang membership should be routinely assessed in young men presenting to healthcare services with psychiatric illness in urban areas with high levels of gang activity.
But gang members do not always access mainstream healthcare services. So some groups, such as MAC-UK, a community-based mental health charity in London, are going out directly to the gangs to work to address mental health issues.
MAC-UK was set up by clinical psychologist Dr Charlie Alcock in 2008, when she returned to Britain having worked with two of the most dangerous and notorious gangs in the USA.
The charity’s founding project, Music & Change, was a collaboration with a group of gang-involved young people that used music and other activities as a way of engaging youngsters between the ages of 16 and 25. From this grassroots beginning, Dr Alcock and her team developed their approach, which is now known as the Integrate model.
Instead of taking referrals they went out on to the streets, slowly building up relationships with groups of up to 50 young people and spending time helping them to set up their own project. This could be a boxing club, DJing or lyric writing sessions. They are then encouraged to take this project and develop it, passing what they have learned on to others. One group created an enterprise project called Mini MAC and went on to run DJ and lyric writing sessions in local schools and pupil referral units.
The first year of the original pilot resulted in 75% of the young people finding employment and 25% receiving appropriate care.
Within the first two years the multidisciplinary team had made contact with every name on the list of inaccessible people provided by the local authority and NHS. All contact was made informally, going to places where the gang members hang out, taking their time about getting to know the young people and building up trust. The Integrate model allows at least six months for initial contact to be made and the process is not rushed.
The long-term plan is for the model to be incorporated into mainstream services. To this end, two further pilots have been set up in other local authorities in partnership with statutory services and other agencies. These pilots will test if the model works outside the original area and whether different people working with the young people would result in different outcomes or not.
Both pilots are multi-agency partnerships, with MAC-UK working with local authorities and child and adolescent mental health and adult mental health teams to deliver the Integrate model.
“What is really exciting is that we are not only just delivering some models but we are testing whether it works in other parts of London and… whether it can be run by other service providers [and] not just MACUK,” explains Dr Alcock. “We were really keen but we didn’t want it just to work because MAC-UK did it, so we looked at how we could test whether it could be delivered by statutory services. If it is shown to be successful then could it be embedded into what they do routinely.”
In January 2012 the first Pilot Partnership Integrate project was set up in Camden, followed a year later by a second in Peckham, south London. Both pilots will run for three years and each has a research element to it.
A previous report from the Mental Health Foundation reported a positive downward trend in offending. The Centre for Mental Health has now taken over as research partner tracking types and number of offending as well as educational outcomes and take-up of support services through Jobcentre Plus.
The Camden project, which is being led by Camden and Islington NHS Trust, is showing positive findings in terms of who it is reaching and in having the capacity to bridge young people out of gangs and into employment or services.
“It is interesting because the outcomes are around offending and employment, even though the intervention is mental health-led,” says Dr Alcock. “Again we are moving towards client level outcomes. Often they may have mental health needs but say ‘I want to get a job’, so those are the outcomes we are measuring.”
Each project draws heavily from previous learning from the Integrate model and looks at how the service structure would need to change for that to become a model for statutory provision.
MAC-UK provides the project lead but in terms of governance the other partners take the helm. The view is that if the Integrate model is to be embedded into routine delivery, it needs to be led from the beginning by trusts and local authorities to avoid a situation where in three years each project is not able to stand on its own without MAC-UK’s input.
Other partners include the police, which assist in keeping staff and young people safe as well as sharing information and the housing department, which address any housing needs the young people may have. In Camden, the Department for Work and Pensions has allocated one person from Jobcentre Plus to work on the project for two and a half days a week, as well as a drug worker.
Meanwhile, the Peckham project is being led by the local authority and South London and Maudsley NHS Foundation Trust, where the local clinical commissioning group has been organising steering groups to look at how the model could work across the different agencies.
“It still remains to be seen whether our model will be adopted by the mainstream but the fact that these conversations are happening is pretty amazing,” says Dr Alcock. “This is a model which delivers on the frontline but also changes systems in the way partners work together.”
So far, the signs are that the model is transferrable and each local authority can find its take on it and make it their own.
“The principles the staff use are the same in terms of their work with young people. Where it has adapted is in how the partnerships work with the other agencies. In Peckham, they have a well-established gangs unit [and] that project works very closely with [the] Southwark Anti-Violence Unit. That structure doesn’t exist in Camden,” says Dr Alcock. “What is different is the way partnership and governance is done but essentially the principles on the ground on frontline delivery remain the same.
“What we are trying to avoid is a model where we [MAC-UK] parachute in and have a cookie cut out of how it’s done. It’s much more about how do we need to adapt locally to make this work and most of the adaptations are around the partnership.”
About the author
Jackie Cosh is a freelance journalist
This article first appeared in the September/October 2013 issue of Mental Health Today. For more information on the magazine, as well as details of how to subscribe, click here.