health, crime and community safety presentation

Health, Crime and Community Safety: Links and Opportunities

Hertfordshire Community Safety Board20th March 2013Jim McManus, Director of Public Health

Longer version – for reference use

This slide deck

• Is the longer version of the presentation for the discussion session at the Herts Community Safety Board

• Provides some information on links between health and crime

• Accompanies the report on health and crime links which can be obtained from [email protected]

Summary

• What’s the issue?

• Links

• What can we do

• Some suggestions

• The report for the workshop is here (double click on the icon)

Word 2007 Document

Some useful reading

• The revolving doors briefing on inequalities in health and offenders http://www.revolving-doors.org.uk/partnerships--development/programmes/spark/improving-health-cutting-crime-and-saving-public-money-workshops/

• Jim McManus – resources on community safety and health

• http://www.jimmcmanus.info/Community-Safety-Resources.html

Crime and Safety Indicators (EN Herts CCG)

East & North CCG Comparators

Crime and Safety Indicators

Broxbourne

East Herts

North Herts

Stevenage

Welwyn Hatfield

Hertfordshire

Herts Worst

Herts Best

England

Youth Offending5.0 3.1 6.1 10.5 7.3 5.4 - - 5.9

(per 1000 10-17 pop)

Domestic Burglary7.9 4.6 5.3 4.9 6.4 6.4 17.2 1.1 -

(per 1000 households)

Violent Crime9.8 6.9 8.0 16.5 9.1 8.7 80.4 1.2 -

(per 1000 population)

Domestic Violence12.2 7.4 9.6 17.2 14.2 11.1 41.5 2.3 14.1

(per 1000 population)

Crime and Safety Indicators(Herts Valleys CCG)

Herts Valleys CCG Comparators

Crime and Safety Indicators

Dacorum

Hertsmere

St. Albans

Three Rivers

Watford

Hertfordshire

Herts Worst

Herts Best

England

Youth Offending5.3 5.6 4.5 2.7 6.3 5.4 - - 5.9

(per 1000 10-17 pop)

Domestic Burglary7.1 8.4 6.7 6.1 6.9 6.4 17.2 1.1 -

(per 1000 households)

Violent Crime7.4 6.9 6.1 4.8 15.1 8.7 80.4 1.2 -

(per 1000 population)

Domestic Violence10.0 13.2 7.4 9.2 14.7 11.1 41.5 2.3 14.1

(per 1000 population)

A & E admissions due to assault

Hertfordshire had significantly less hospital admissions due to assault between April 2012 and March 2013. However there were still 235 people in Hertfordshire who had to attend A & E due to assault.

Trends in Violent Crime in Hertfordshire 2010-2013

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Steven-age

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NorthHerts

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East & North CCG Herts Valleys CCG

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Violent Crime Trend

In both England and Hertfordshire the reported rates of domestic violence have not varied significantly between 2010-13. Although East Herts has the lowest rates of domestic violence it was the only district to show a significant increase over that period.

Youth Offending

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Youth Offending Trend

The rates of youth offending have been reducing faster in Hertfordshire than in England in recent years

Alcohol related assaults presented at A&E

• The ‘Cardiff Model’ of data sharing between Watford A&E and Community Safety Partnerships has been in place for several years

• The Lister hospital has just started to collect this data

• The aim is to enable CSPs to target resources more effectively at identified ‘hotspots’

• Evidence is also used to support license reviews

Data from Watford A&E

Data from 2012 showing top 15 locations

Location Non Assaults Assaults Total

Oceana Watford 25 30 55

Watford High Street 17 18 35

Area Watford 10 12 22

Batchwood St Albans 7 6 13

The Pararde Watford 4 8 12

St Albans Town Centre 3 4 7

Rehab Watford 3 4 7

Watford Junction 4 2 6

Outside Oceana Watford 4 1 5

Function Rooms Hemel 4 1 5

St Albans Road Watford 3 2 5

Clarendon Road Watford 4 1 5

Bed Watford 2 2 4

Hemel Town Centre 1 3 4

London Road St Albans 3 1 4

Total 94 95 189

Adults in Drug and Alcohol Treatment

Alcohol 1441 Up 18%

Opiates 1611 Up 5%

Non-opiates 803 Up 22%

Drugs total 2414 (was 2195 in 12/13)

Up 10% (compared to -1.5%

nationally)

Latest 12 month data compared to 2012/13

April 2013: 1,713 opiate and/or crack users in treatment, approx 45.6% of opiate/crack users estimated to be in Hertfordshire

Alcohol Treatment

Indicator Local Comparison

Clients waiting over 3 weeks to start treatment

1.2%(3.9% in Q2)

National: 7.1%

Successful completions as a proportion of all in treatment

36.1%(was 33.1% in Q2)

National: 36.6%

Re-presentations within 6 months

6.9%(was 7.5% in Q2)

National: 11.2%

Adult DOMES report: alcohol; Q3:

Drugs Treatment

Indicator Local Comparison

No of opiate users leaving drug retreatment successfully and don’t represent (% of total in treatment)

6.6%(was 3.9% in Q2)

Similar to England

No of non-opiate users leaving drug retreatment successfully and don’t represent (% of total in treatment)

28.2%(was 33.1% in Q2)

Lower than England

Adult DOMES report: drugs; Q3:

Drugs TreatmentIndicator Local Comparison

Opiate abstinence 48.8%

(same as Q2)

Expected range 42%-54%

Opiate clients in treatment over 6 years

28.8%

(was 27.6% in Q2)

Cluster: 25.0%

Key messages – D & A Treatment

• Aging population, reflected in treatment population

• Changing landscape requires service flexibility

• Access to treatment is positive

• Need to focus on – re-presentations particularly non-opiates– those who are longest in treatment –18-24 year olds

Health in the Criminal Justice System• Health inequalities higher and more complex than the

general population• Most prevalent conditions: mental health including

personality disorders, learning difficulties, substance misuse and physical health (BBV, musculoskeletal, respiratory)

• 80% smoke• 60-70% have a personality disorder• Higher rates of suicide• Exacerbated by the wider determinants of health-

poverty, lack of education, training and employment• Difficulty accessing services due to chaotic lifestyle• Inappropriate use of A&E services

Work with Integrated Offender Managementworking with IOM to reduce reoffendingOverall crime:

Year 1-41% reductionYear 2- 35% reduction

Year 3 (as at Q3)- 24% reductionSerious acquisitive crime:

Year 1- 63% reductionYear 2- 53% reduction

Year 3 (as at Q3)- 41% reduction

Work in progress

• Improving links between GP practices and probation offender managers

• Implementing a pilot of nurses working in probation centres to identify unmet need, give advice, signpost into appropriate services and develop closer links with local health services

Domestic Violence and abuse Some Risk factors for domestic violence/abuse

• Gendered • Young age• Current/imminent separation• Stalking• Escalation – frequency/severity• Living in areas of high physical disorder• ‘Toxic Trio’ - MH or substance dependency • Suicidal thoughts/intent, depression• Pregnancy• Controlling and jealous partner – isolation• Weapons• Child(hood) abuse (perpetrators and victims)• Cultural norms tolerant of violence

Police recorded DV crimes and non-crimes

Crimes Non-Crimes Total DV Total DV

2012/13 2011/12 2012/13 2011/12 2012/13 2011/12

Broxbourne 377 439 753 751 Broxbourne 1130 1190

Dacorum 421 353 1034 978 Dacorum 1455 1331

East herts 325 351 680 531 East Herts 1005 882

Hertsmere 311 311 944 856 Hertsmere 1255 1167

N Herts 409 445 750 763 N Herts 1159 1208

St Albans 291 346 697 739 St Albans 988 1085

Stevenage 518 527 936 1007 Stevenage 1454 1534

Three Rivers 193 234 587 608 Three Rivers 780 842

Watford 330 325 931 930 Watford 1261 1255

Welwyn Hatield 360 466 1141 1165 Welwyn Hatield 1501 1631

Totals 3535 3797 8453 8328County

Totals 11988 12125

Source: Hertfordshire Constabulary

What are we doing in Hertfordshire• Awareness training for front line staff – mulit-agency;

GPs• Sharing of recommendations from Domestic Homicide

Reviews• ilearn training for HCC staff, and partners• Campaigns

– Anti rape campaign; ‘True Love’; ‘Are you Ok?’

• Herts Sunflower Partnership– MARACs, IDVAs, SDVCs, Sunflower drop-ins, helpline and

website, SARC

• Community Perpetrator pilot in Stevenage about to start• IDVAs in A&E pilots – work in progress

Some links from data

• British Crime Survey, – 47 per cent of victims of violent crimes believed that

their offender was under the influence of alcohol – 17 per cent believed that the offender was under the

influence of drugs. – Another survey suggested that about 30 per cent of

victims believed that the offender attacked them because they were under the influence of drugs or alcohol.

– only 1 per cent of victims believed that the violent incident happened because the offender had a mental illness. 

Systems thinking

The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)

The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)

The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)

•Our health and our offending occurs in a system•Criminology and public health/epidemiology share some concerns in the literature

Health and crime is a system issue, health of offenders is a system issue

• Pervasive health inequalities and poorer outcomes in offender communities

• Multilevel issues – requires interventions across all levels of public health

• Partnership across new responsibilities

• Links between health and offending behaviour

Levels of Public Health Action

•Social

•Environmental

•Biological

•Behavioural

•Legislative

•Structural

Ways of addressing these

• Example – Public Health is funding outreach nurses in probation settings to get offenders into NHS and drug and alcohol and mental health services– Addresses access issues directly– Identifies target population

Ways of addressing these 2

• Extremism and mental health pastoral care, Birmingham

Shared Ambitions/Initiatives

• Health Needs Assessment of HPT Caseload - D Moorish (2011)

• 23.8% reported a chronic health condition

• 69% men & 53% women – alcohol misuse

• 32% reported substance misuse

• Offender Health questions included in service user survey 2013

• Access to GPs• Chlamydia tests available• MDO Panel/ court

diversion• Smoking cessation groups• Vol. Drug testing• ?Access to Dentists?• Shared community safety

strategies

Personality Disordered OffendersService Commenced July 2013 screening entire caseload. Specialist team in place1 x clinical psychologist/forensic experience & 0.5 x probation officerService includes:

case consultationFormulationlimited joint casework

Training needs analysis • PD awareness training for staff and partners• Specialist training to be delivered by PD team

Benefits already realised• Increased confidence in working with personality disordered

offenders• More successful referrals to Mental health

The Opportunities “Local government holds the ring on health and

well being boards, which will be a genuinely joint forum , bringing together clinical commissioning groups and elected members. Between them they know their local populations inside out and so are best placed to assess their needs and decide together what needs to be done to meet them – not just in health but right across housing education, transport., planning etc everything that can make a difference”. Guardian 29 November 2012

‘Everybody’s Business’

• Police and Crime Plan• Community Safety Board• Monthly ‘cabinet’• Shared ownership and

delivery of strategies

“Across service boundaries, we are working with the same communities, with the same victims and with the same offenders. We are trying to tackle the same causes and to manage the same effects”

David LloydPolice and Crime Commissioner

Health System

• Offender Health• Wider Determinants• Thriving Families • Shared

Data/Intelligence• Shared Outcomes• Shared Responsibility• Local Accountability

www.hertsdirect.org/your-council/hcc/partnerwork/hwb

Making it Happen in Herts

• Community Safety Board– Reducing offending and reoffending strategy

• Health and Wellbeing Board– Health and wellbeing strategy

• Criminal Justice Board– Criminal Justice strategy

• Informal ad hoc Grouping already– PCC, Probation, DPH, CCGs

Work under way• Drugs and Alcohol Programme

– Easier access Thriving Families Programme– Easier access

• Custodial Settings– Smoke free prison, drugs/alcohol services

• In-reach– Nurse led access to primary care and health checks

• Resilience and Strengths Psychology– Health Trainers for cohort

• Partnership and Grants Funding• Shared strategies on safety and reoffending• Mental Health Access

Some tools for going forward

• Three domains model

– Control and enforcement– Prevention (and diversion?)– Care, Treatment and Support

ExampleLead Enforcement and

ControlPrevention Support,

Treatment and Care

Community Safety

County Community Safety Unit

County Community Safety Unit?

Probation, NHS, Public Health

Domestic Violence

County Community Safety Unit

Domestic Violence partnership

?Childrens Services

Drugs and Alcohol

County Community Safety Unit

Both working together

Public Health

Alcohol related violence

County Community Safety Unit

Multi agency NHS Acute Trusts

People with learning disabilities who are victims

County Community Safety Unit

Multi agency LD Partnership

Where next?

Over to you

Thanks

[email protected]