Tag Archives: Domestic Violence

Gangs and Mental Health Interventions


Dorcas 1

Clinical nurse specialist Dorcas Gwata was awarded Mental Health Nurse  of the Nursing Standard Nurse Awards 2015 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.

The award ceremony was held at the Savoy Hotel, London, on May 1.  Dorcas attended the event with her colleague Joseph Amuah, Senior Gangs Worker in IGU.

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.

’‘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.’


Cultural Context Of Domestic Violence Amongst Africans In The Diaspora

What covers the house is the roof” Shona Proverb

Relationships and family lives are often glossed up by society and the media as though that is the reality for everyone, yet if we really held the mirror closer against our own society, a disturbing picture of abuse and sometimes violent reality emerges. In the midst of all this, are children who in the absence of any structured and meaningful love and guidance at home, go on to develop mal-adaptive behaviors that will shape their lives and personalities as they develop.

In turn parents may develop poor, authoritative parenting skills, or plain abuse and neglect as the ripple effect of this trauma begins to manifest itself into complex family problems. Some of the effects of this trauma will have lifetime effects and reproduce themselves in future generations.

Over the years I have heard comments such as, ‘why doesn’t she just leave’ or stereotypical comments such as ‘that’s how African men treat women’. Some of these comments are silent; some are internalized, and some come from within our own African communities. Although there is a wide body of initiatives and guidelines to further our knowledge on domestic violence, in fact very little is known or has been explored about the context in which African women and men suffer domestic violence.

The reasons some African women in particular may take time to disclose if at all, may well be embedded in the context of their cultural values and beliefs, which further fuels anxieties about seeking help. Most worry that others will not understand how and why they are bound by these values and beliefs. There are further fears about who to disclose to and the impact of the disclosure if the abuser is the breadwinner.


For example women who are breadwinners may suffer from domestic abuse as the role reversal dynamic may leave some African men disempowered, masculinity being so culturally relevant in our African culture. Equally there is a cultural stigma within our society against women who choose to leave relationships and become single. This stigma further isolates them from close families.
The process of dowry/lobola is deemed as a respectful process that binds families, and has traditionally worked well in most African cultures; however vulnerable individuals might be compelled to stay within the relationship because of the cost of the lobola. Abusers may sometimes use this against them, ‘I paid a lot of money for you, so you have to stay’ and so some women feel compelled to put up with the abuse as it escalates.

There are some prevailing and deeply rooted beliefs and values within some African people that one should stay within the marriage, regardless of the levels of domestic violence because that was the tradition in the past. Women before them stayed so that the children could have a meaningful family structure, and therefore become more socially accepted, so they carry these beliefs with them. It is this very aspect of dependency along with other social variables such as poverty, low income, low education levels, underlying physical and mental health problems which increase their vulnerability and fuels domestic violence and there begins the cycle of violence.

It is most important to acknowledge that African men too suffer from domestic violence, and their experiences are less understood as they are less likely to disclose and seek help. If they do seek help they are less likely to be supported within their communities, indeed they may even be mocked for not being ‘man enough’

Some abusers strategically pick their partners well; they are attracted to particularly vulnerable individuals who may have underlying disabilities and social issues such as immigration problems, some with poor language and employable skills, or poor family support. Some are bound by strong cultural bonds to stay in relationships, and there may even be religious reasons as to why others stay within marriages. Witchcraft beliefs and witch craft brandishing are real issues within African communities and in desperate situations some may try to find causes and meaning of events in the context of witchcraft. Children in particular are vulnerable to being accused of being witches and therefore being the cause of disturbance in the home and family life. Other abusers may threaten to use witchcraft on victims if they leave them, and this becomes the reality of their beliefs and experiences.


Young vulnerable girls who associate with gang members are experiencing violence and sexual exploitation and some will be exposed to domestic abuse within and outside the home. A large proportion of these vulnerable girls come from the black community. This is particularly concerning.

The door may be left ajar, but it takes time, bravery, sometimes extreme intolerable sufferings before sufferers call an end to the violence. Some have paid the ultimate price of death by domestic violence. For those who do call it an end, the long journey of traumatic recovery begins and some may have to walk this long road alone, due to cultural isolation, because some in our society will continue to ask ‘why did you leave your husband’. Some family members view this as deviant, rebellious and uncultured.

Some will seek advice and support, however it is most important that those who provide that support, fully understand the cultural context of which domestic violence occurs within African families. Professionals must develop culturally adapted interventions that validate these women’s experiences and are responsive to African communities’ needs, particularly in safeguarding children and vulnerable individuals affected by domestic violence in our society.

Author. Dorcas Gwata

Tribal Sands.

All rights reserved.