Supporting the mental health needs of inner-city gang members
A London mental health nurse’s work with young people and families affected by gangs has been shortlisted for a prestigious national award.
Dorcas Gwata. Picture credit: Nathan Clarke
Clinical nurse specialist Dorcas Gwata is a finalist in the Mental Health category of the Nursing Standard Nurse Awards in recognition of her innovative ways of engaging with this difficult to reach group. The award was sponsored South London and Maudsley NHS Foundation Trust and London South Bank University.
She will find out whether she has won the award at a ceremony in the Savoy Hotel, London, on May 1. On the night, the Nurse of the Year 2015, selected from all the category winners, will be announced.
Dorcas works in the Westminster Integrated Gangs Unit (IGU) and with Central and North West London (CNWL) NHS Foundation Trust’s Westminster Child and Adolescent Mental Health Service team to help improve the health of socially stigmatised, deprived young people associated with gangs. The team works with social services, the police and community protection.
She was brought in following a Home Office Report in 2011, which showed significant unmet mental health needs in young people involved in gangs.
Some have developmental problems such as learning disabilities, as well as health needs and substance misuse. Furthermore, they often have longstanding behavioral problems. Some are known to traditional Child and Adolescent Mental Health Services (CAMHS) services. Some have a history of attention deficit hyperactivity disorder (ADHD).
Dorcas says: ‘Anxiety is a major problem. These young people need to carry knives from one part of the borough to another. And their high levels of substance misuse can escalate into untreated psychosis.’
Young girls carry particular risk factors - 20 per cent in Westminster are involved in gangs. They are at very high risk of sexual exploitation and, subsequently, self-harming. Substance misuse may also be a factor. Both male and female young people are at risk of kidnapping through gang activity.
Dorcas also helps families affected by gang culture. ‘There is a lot of parental stress from raising these children,’ she says.
She receives referrals from five key workers and has built links with youth offending teams and probation services. She does in-reach work in prisons to engage young people and build relationships before release back in to the community.
It can be a challenge to get young people with chaotic lifestyles to engage. Dorcas often uses their physical health needs as a way in to a mental health assessment. A key strategy has been to strengthen pathways with A&E units and other hospital and community services. Dorcas liaises with workers from Red Thread – a youth violence intervention project that covers A&E and trauma units.
She has to be highly flexible. She meets young people on the streets, in cafes, at home and in youth clubs. Patience is key. ‘I don’t have a Did not Attend list and I regularly get stood up at McDonalds, but I look at context and what it means. What is going on with that young person, their behavior and lifestyle?’ explains Dorcas.
‘There are many challenges and it takes a lot of perseverance. When a young person is not engaging with the team we have to look at diverse alternatives. We might intervene when they are at school, or if they are in custody I go there and see if we can have a chat.
‘Timing can be important. Some spiral further into crime, so there can be a dip before a breakthrough. There is a high level of violence around the transition from adolescence to adulthood, aged about 15 to 17, which carries on until they are 18 or 19.’
When the young person will not tolerate Dorcas, she will try to go through their parents. This has been successful, but not being judgemental is crucial. ‘I have had 80% acceptance from parents. It is very important that I’m not there to 'take their kids away'.
To help deal with the specific vulnerability of her young female clients, Dorcas has developed links with a sexual health clinic at St Mary’s Hospital in Paddington. ‘There are significantly high levels of chlamydia among girls involved in gangs,’ she says. ‘And we look at the mental health impact of sexual exploitation, which can escalate very quickly into self harm.’ There are safety planning measures for girls at risk of sexual exploitation and kidnapping, and a mental health plan to help reduce self-blame and self-harm.
A vast majority - 80% – of the young people are from a minority background, often first generation children.
‘If we don’t pay attention to culture and the impact that this has on the families we would be missing a huge chunk of potential positive interventions,’ says Dorcas.
There is a major conflict between young people’s values and their parent’s values, which tend to be conservative.
‘Parents find it difficult to discuss and understand the concept of their children having sex before marriage, and there is real stigma around that,’ says Dorcas. ‘Much of my work is about repairing relationships in these families.’
She adds that language is also important. ‘I never use the word gang in my work – it is about peer relationships.’
Dorcas knows that they are not reaching all the young people who need help. ‘We can only help those who become known to the police or social services,’ she explains. ‘Others may be at risk of exploitation and engaged in high-risk behavior, but are not yet proved to be committing crimes.’
However, her colleagues and partners say she has made real improvements to her clients’ health – and lives.
Acting Inspector Al Cowen of the Westminster Gangs Unit says the nurse input into their work has been ‘highly beneficial’. He adds: ‘She has worked with numerous gang members, many of whom have been subjected to highly traumatic experiences in their past. She is an integral part of our team.’
And her clinical supervisor, CNWL consultant child and adolescent psychiatrist Tami Kramer, says Dorcas’ outstanding mental health nursing knowledge, skills and experience, coupled with her empathy and commitment, have secured her success in a difficult field.
‘Dorcas is able to engage young people not primarily looking for help and are often initially dismissive of their need for professional intervention,’ says Dr Kramer.
‘Her warm, enthusiastic and persuasive style enables these difficult, often inarticulate, youngsters to share and reflect on their general health and mental health needs, and the links with their behaviour. She never gives up on giving young people the chance to find positive solutions to their life dilemmas.’