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Gangs: Taking the clinic to the streets

Alex Davis talks to an award-winning RCN member who is providing innovative health support to young people involved in and on the fringes of London gangs.

Westminster is one of the wealthiest boroughs in Britain. In the iconic setting of Parliament, Downing Street and Big Ben, house prices regularly fetch over £1 million. And yet, alongside the prestige, the city has a serious problem: gangs.

Dorcas Gwata is an expert in these matters. A clinical nurse specialist, she works within Westminster Council’s multi-agency Integrated Gangs Unit (IGU), providing physical and mental health support to young people and families affected by gang culture.

Following the 2011 riots, a Home Office report identified unmet mental health needs among gang members in London. Crucially, many were unable to access traditional mental health services. “You have to consider the geographical nature of ‘beef’ between gangs,” Dorcas explains. “Some gang members cannot travel freely across London without putting their lives at risk. As a result, many vulnerable young people don’t access health services. We’re also observing high levels of parental mental and physical health conditions associated with stress, poverty and deprivation, all of which contribute to poor health and social outcomes.” The solution? An experienced clinical nurse specialist working alongside other professionals within the IGU.

The unit operates in partnership with social services, the police and community protection. It is made up of a range of professionals, including gang workers who work at grassroots level and engage innovatively with young people in their homes, for example, as well as youth clubs, prisons and hospitals.


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Complex needs “Visibility is really important,” Dorcas notes. “We work with children and young people, mostly aged 10 to 21, and their families. Most of the young people have complex needs such as substance misuse, anxiety and trauma – from stabbings, for example. “The IGU is very much about early intervention because these things can have a huge impact on people in later life and behaviours are often copied by younger siblings.” As a result, much of her job is outreach work. Dorcas regularly delivers talks to young people in schools and youth centres, and provides “street clinics” where she visits local areas and speaks to young people and their families. In other words, she integrates.


A powerful suggestion

Prior to becoming a qualified nurse, Dorcas worked as a health care assistant until a young patient with anorexia encouraged her to go into nursing. “We established a good therapeutic relationship and I always felt that it was a powerful suggestion, coming from a patient,” she explains.

After undertaking nurse training at City University School of Nursing and Midwifery, Dorcas worked in Hackney and Hammersmith, before spending many years in the A&E department of St Mary’s Hospital in Paddington. In many ways, it was this frontline work which intrigued Dorcas and set her up well for working with marginalised and hard-to-reach groups. But what of the danger of working with gangs? “Working in A&E is much more dangerous as there is a regular risk of being attacked by a drunk and disorderly person,” Dorcas says. “We work very closely with the police and we carry out thorough risk assessments before engaging with any young people. We have a well-structured system.”

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Since joining the IGU in 2013, Dorcas has worked with approximately 80 families and up to 100 gang members. One of her current clients is a 17-year-old boy on the fringes of a gang. His parents are very concerned for their son’s welfare which escalates into shouting during a meeting. Dorcas, though, highly experienced in dealing with families, remains calm and puts the room at ease. “Parents want the best for their children and I find they’re often tired of hearing how badly they have raised their child,” she reflects. “To help a child you need to improve the relationships within the entire family.” Dorcas is sensitive in tone and especially careful in the language she deploys.


“We would never use the word gang in front of parents. Instead we would talk about peer groups or healthy relationships,” she says. The IGU’s achievements have not gone unnoticed. The unit won a national nursing award for innovation in 2015 and was the Metropolitan Police team of the year in 2013. Dorcas acknowledges the support she has received from her team but has herself won impressive accolades. In 2015 she won the Nursing Standard Mental Health Nursing Award and was nominated for the Zimbabwe International Women’s Award the same year. And yet, despite her achievements she insists the biggest reward has been changing the lives of young people. “Keeping young people on the right track is what matters most to me. There’s no feeling quite like it.”

 Dorcas Gwata

Director of Tribal Sands

November 2016


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