James was 13 the first time I treated him in A&E. He was rushed in after being hit on the head with a metal bar, but he wouldn’t tell us what had happened. Some others had seen him, rushed him, started beating him with bats and bars – that was all he said he remembered. It was clear that James was already deeply involved in the world of gang violence, and it was equally clear that if he wasn’t saved from it soon this world would destroy him. We tried to get James to stay in A&E long enough to hear the results of his scan, but as soon as he got a chance he slipped out and back onto the streets. My fear was that before long the streets would deliver him back to us, only this time he wouldn’t be able to walk out again.
What bothered me most about James’s case was not the nature of the injury – as an A&E nurse, I see that kind of thing every day and I’ve learned to endure it. What really bothered me was that despite my efforts, I couldn’t get him to trust me. I pleaded with him to stay until the results were ready. I tried to let him know that I cared about his life and that I was there to help him. But it didn’t work. James saw me as just another hostile authority figure – a person in a uniform who viewed him through the same prejudiced eyes that boys of his age and appearance are viewed by much of the public.
When I left work that evening I couldn’t get the thought out of my head that I’d failed him. What was the point of what I was doing, if I couldn’t help a 14 year old boy understand that his life was worth living? And I couldn’t help but feel that there was some truth in his perception of me – what reason did he have for thinking that I was any different from the police officers who stop him on the street or the officials who threaten him with referral to a Pupil Referral Unit?
After all, James’s distrust of NHS staff was not a simple mistake. The view that ‘if you’re in a car crash you’re a victim, but if you’re stabbed you’re a perpetrator’ penetrates deeply into how ordinary people, including myself and my co-workers, can sometimes view the lives of people like James. There was a dynamic there, a vicious cycle of mutual suspicion which put him at greater risk, and made it harder for us to do our jobs properly. The more I thought about it, the more important it seemed to me that this cycle had to be broken.
The next day I did some research – what could I do, as a nurse, to scale this wall of distrust and bring both James and my fellow medical professionals to see that we were on the same page?
That’s when I found out about the social enterprise Catch 22. Among many other things, they set up educational sessions with young people in prisons. After talking with the organisation, we agreed on the idea of a group from my A&E department visiting a Young Offender’s Institute to deliver emergency life support training.
It was a cold November day when myself and a few colleagues from the hospital met outside Feltham railway station. We shivered in silence, too nervous to chat, as we waited for our contact from Catch 22 to arrive. One of us clutched a model torso close to her body. All we knew about prisons had been gleaned from TV shows. We worried about how they would react – that the hostility and distrust that I’d seen in James’ eyes would be amplified by the concrete walls of the prison, that Catch 22 would hurry us out and never ask us to come back.
The reality was a lot different. After being led through a gloomy passageway plastered with incongruous images of cartoon characters separated from the walkway by iron bars, we met a group of 13 young men, aged 17-21, in a classroom. The next two hours were spent talking to them, teaching them about emergency life support and learning about their lives and hopes for the future.
WeWe were amazed by how enthusiastically the young people responded to the training, and the ease with which they connected it to their own lives and experiences. All of them had been exposed to horrific violence, had seen friends seriously injured or killed, had been close to having their own lives taken away from them, or had enacted such violence themselves. The training helped them to view these experiences differently – as moments of crisis and medical emergency requiring life-saving support, not something they should ever get used to or learn to take in their stride.
At the end of the session we asked for feedback, anything they had learned that day or that we could have done better. One boy put his hand up. Earlier in the session he’d told us about his friend being stabbed to death – instead of running away like everybody else, he’d stayed and held his friend in his arms. He said that before that day he was unsure if this was what he should have done – maybe it was stupid and he’d simply risked being arrested by the police without being able to do anything worthwhile for his friend. But today, he said, he had learned that he had done the right thing and could be proud of it. Not only that, but he’d learned that he could do it again – if it ever came to it – and do it better. And as much at it pained him to think back on that experience, he was happy to know that he was capable of something that filled him with pride: saving a life, rather than taking one. And what skill can be more important, more affirming, than that. As Dr David Scott of the Open University notes in a recent article, “[p]risons are places which generate a sense of hopelessness: children and young people can become convinced that there is no way out, that things are not going to change for the better”. In this context, it is crucial that children feel that they can loved, be loved, and that “they can give something back in return”. Your Stance, by equipping young people with socially beneficially skills directly relevant to their lived experiences, can answer to this need – teaching young people to believe in themselves and what they can achieve.
But the purpose of the programme that we launched that day, Your Stance, is not just about. It’s also to help bridge the divide between healthcare professionals from the young people we so often treat.
Many of us employed in the NHS, working under highly pressurised conditions and with limited resources, are confronted by burnout and find ourselves struggling to show the compassion and understanding we would like to patients. Too often, I find myself focused on simply ‘getting the job done’ – reducing the backlog of people sitting in the A&E waiting room as quickly as possible – rather than taking the time to get to know patients and concern myself with their lives. Under these conditions, insensitive attitudes can take root and resentment can grow towards those who are perceived to be ‘taking advantage’ of the system or as somehow responsible for the predicaments they find themselves in.
Your Stance can help to counteract this. By bringing health professionals and those affected by serious youth violence together outside of A&E, learning about one another’s lives, and discussing the forces and pressures that have driven young people down pathways in which their bodies are frequently endangered, medical professionals who participate in Your Stance will find their understanding deepened and their attitudes towards people like James radically shifted. Where we don’t already, we can learn to understand those threatened by severe youth violence as often brilliant and compassionate people who have been on the wrong side of poverty and social inequality their whole lives; as people victimised by racial discrimination; as people all-too-acutely aware of the numerous social barriers blocking their way towards comfortable and dignified lives; as people scarred by trauma and battling with untreated mental health conditions; and above all as children and young adults, who need support, love and understanding, rather than hostility and distrust.
A year after walking out of A&E without waiting for his scan, James returned. This time he was a trauma call. The baseball bats and bars had been replaced with knives, and he had been stabbed three times in the stomach, causing an internal haemorrhage. James ultimately survived, but he had been unconscious for hours, his skin was riddled with scars, and he needed a stoma. My initial reaction to this was not sadness but anger. There had been a moment, a year before, when A&E staff could have potentially intervened in his life and changed it for the better – helped turn the initial encounter with violence into a stimulus for transformation. But we hadn’t been able to. We had been prevented by time pressure, by a lack of resources and support, and by a wall of stigma and mistrust which authorities is felt by most, are doing nothing to help dismantle. In my view, Your Stance can help break these barriers down. And while it is only a small project – with a limited roster of volunteers and a handful of prison visits under our belt – it is sustainable, resource-light, and can be scaled-up easily. It doesn’t take much to arrange a teaching session in a prison, but I believe it can go a very long way.
In the appalling absence of real solutions to the youth violence crisis from the current government, the only option is for programmes like ours to step into the breach.
This post was written with the help of Sam Stroud.