Violence Prevention: a multiagency approach

Transcription

1 Forensic Psychiatry Faculty Annual Conference 2016 Violence Prevention: a multiagency approach Jonathan Shepherd Professor of Oral and Maxillofacial Surgery Director, Violence Research Group Cardiff University, UK

2 80-90% of injuries caused by violence affect the mouth and face JRSM1990;28:75-8

3 Position Statement PS01/2012 July 2012 Managing the impact of violence on mental health, including among witnesses and those affected by homicide Jonathan Shepherd Jonathan Bisson

4 TOP EIGHT CAUSES OF DEATH SOURCE: WHO Rank 5-14 years years years 1 Childhood cluster HIV / AIDS HIV / AIDS Road traffic injuries Road traffic injuries Tuberculosis Drowning Tuberculosis Road traffic injuries Respiratory infections Self-inflicted injuries Ischaemic heart disease Diarrhoeal diseases Interpersonal violence Self-inflicted injuries Malaria War injuries Interpersonal violence HIV / AIDS Drowning Cerebrovascular disease War injuries Respiratory infections Cirrhosis of the liver

5 RECORDING OF VIOLENCE BY THE POLICE AND EMERGENCY DEPARTMENTS (EDs) Only a quarter to a half of violent offences which result in ED treatment are recorded by the police Police recording varies by victim age and gender and violence location

6 VIOLENCE IN ODENSE MUNICIPALITY (DENMARK) 1403 (100%) victims 869 (62%) patients 327 (23%) 207 (15%) victims ODENSE UNIVERSITY HOSPITAL POLICE Faergemann, 2006

7 Police recording is only loosely linked to injury severity 13% of firearm violence recorded in Atlanta EDs not represented in police records Kellerman el al, Arch Emerg Med 2003

8 Reasons for Limited Police Knowledge of Violence Many incidents are not reported because of fear of reprisals, inability of injured people to identify assailant(s), unwillingness to have own conduct scrutinised and need for emergency treatment Reported incidents not recorded by police

9 IMPLICATIONS National / Regional measurement Emergency Department data Local surveillance/prevention

10 CORRELATIONS WITH VIOLENCE IN ENGLAND AND WALES Source: Matthews et al, Applied Economics 2006

11 PROTOTYPE SAFETY PARTNERSHIP: CARDIFF VIOLENCE PREVENTION GROUP Statutory in UK: 373 crime reduction partnerships Crime and Disorder Act 1998 Police Reform Act 2002

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14 ED DATA COLLECTION AND USE FOR VIOLENCE PREVENTION Step One: 24 hour electronic data collection (precise violence location, time and weapon) by ED receptionists when assault patients register Step Two: Data anonymised and shared with crime analyst by hospital IT staff Step Three: Police and ED data combined Step Four: Violence times, locations and weapons summarised Step Five: Prevention action plan continuously updated and violence trends monitored

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16 VIOLENCE HOTSPOTS IN 21 st CENTURY CARDIFF

17 Brisbane

18 Brisbane violence locations Accuracy of targeted policing could be significantly improved using information from emergency health services. De Andrade and Homel 2014

19 Cardiff Model violence data : London borough of Hackney Source: Hackney Community Safety Team

20 CHOLERA HOTSPOTS IN VICTORIAN LONDON

21 VIOLENCE PREVENTION Targeted policing Tavern/club/bar regulation Environmental interventions: Targeted street patrols, CCTV, redeployment of police from suburbs into city centres at night Plastic glassware, fast food outlet relocation Pedestrianisation of entertainment streets

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24 Woundings per 1000 population

25 VIOLENCE RELATED HOSPITAL ADMISSIONS AND WOUNDINGS RECORDED BY THE POLICE Hospital Admissions: down 24/year/100,000 population in Cardiff up 36/year/100,000 in comparison cities Florence et al BMJ 2011

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27 How does information sharing work?

28 SAME MECHANISM AS CCTV

29 The use of this information from EDs facilitates earlier and more frequent police intervention and keeps people out of hospital and out of prison

30 OTHER MECHANISMS OF EFFECTIVENESS Identification and support of people injured in domestic violence prevents repeat victimisation Identification of weapon trends informs weapon control Identifies violence hotspots, park locations and walkways for example, which can be targeted by local authorities

31 Published evaluations Cardiff Florence et al. Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence BMJ 2011;342:d3313 doi: /bmj.d3313 Cambridge Boyle et al. External validation of the Cardiff model of information sharing to reduce community violence. Emerg Med J doi: /emermed Merseyside Quigg et al. Data sharing for prevention: a case study. Inj Prev doi: /injuryprev

32 Systematic Reviews Targeted policing prevents violence, Eg Braga 2007 and has violence prevention diffusion effects. Eg Weisburd et al 2007 Information sharing works. Droste et al 2014

33 ANNUAL COSTS AND BENEFITS OF THIS PREVENTION MODEL Annual cost of prevention: 5,176 Cost of violence per case: 8,852 Cases prevented: 89 (CI ) Cost of cases prevented (benefits): 789k (CI 574-1,003) Cost/Benefit Ratio - total costs avoided: 1:152 (CI ) Analyses carried out by Curtis Florence at the US Centres for Disease prevention and Control. Source: Injury Prevention 2014;20:108-14

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35 UK IMPLEMENTATION Royal College Guideline Government Policy Wales: Welsh Government England: Mandatory under NHS contract Scotland: Violence Reduction Unit WORLD HEALTH ORGANISATION Implementation of the recommendations of the World Report on Violence and Health e.g. The Netherlands, United States, Australia South Africa

36 PREVENTION:GLASS INJURY

37 Non-toughened glass Toughened glass

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39 NATIONAL EFFECT British Crime Survey All violence Domestic Stranger Acquaintance (%) (%) (%) (%) Glass / 5 2 <1 < bottle weapon No weapon

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41 Violence can be prevented. Governments, communities and individuals can make a difference Nelson Mandela 2002