Treating violence as a network problem

A long and fascinating read.

Since the VRU was launched in 2005, the murder rate in Glasgow has dropped by 60%. The number of facial trauma patients passing through Glasgow’s hospitals has halved, Goodall says, and now stands at around 500 a year.

The VRU’s strategy is described as a “public health” approach to preventing violence. This refers to a whole school of thought that suggests that violent behaviour itself is an epidemic that spreads from person to person. One of the primary indicators that someone will carry out an act of violence is being a victim of one beforehand. The idea that violence spreads between people, reproducing itself and shifting group norms, explains why one area might see fewer stabbings or shootings than another – even if it has many of the same social problems.

Since the VRU was launched in 2005, the murder rate in Glasgow has dropped by 60%. The number of facial trauma patients passing through Glasgow’s hospitals has halved, Goodall says, and now stands at around 500 a year.

Changing behavioural norms is far more effective than simply giving people information. To change behaviour – whether it’s using rehydration solutions, avoiding dirty water or using condoms – credible messengers are essential. “In all of these outbreaks we used outreach workers from the same group” as the target population, says Slutkin. “Refugees in Somalia to reach refugees with TB or cholera, sex workers to reach sex workers with Aids, moms to reach moms on breastfeeding and diarrhoeal management.”

After more than a decade working overseas, Slutkin returned to his native Chicago in the late 1990s. “I wanted a break from all these epidemics,” he says. But he returned to a different kind of problem: a skyrocketing homicide rate. Wanting to tackle this, too, he gathered maps and data on gun violence in Chicago. As he did so, the parallels with the maps of disease outbreaks he was accustomed to were unavoidable. “The epidemic curves are the same, the clustering. In fact, one event leads to another, which is diagnostic of a contagious process. Flu causes more flu, colds cause more colds, and violence causes more violence.”

In 2000, he launched a pilot project in the West Garfield neighbourhood of Chicago. It replicated the same steps as the WHO takes to control outbreaks of cholera, TB or HIV: interrupt transmission, prevent future spread, and change group norms. Within the first year, there was a 67% drop in homicides. More neighbourhoods were piloted. Everywhere it launched, homicides dropped by at least 40%. The approach began to be replicated in other cities.

Violence interrupters use numerous techniques, some borrowed from cognitive behavioural therapy: “constructive shadowing”, which means echoing people’s words back to them; “babysitting”, which is simply staying with someone until they have cooled down; and emphasising consequences. Interrupters’ ability to be effective depends on their credibility. Many, like Cole, have served long prison sentences and can speak from experience. Most also have a close relationship with the local community.

A lot of people come into A&E plotting revenge and it’s very important that they leave not doing that,” says Goodall. In the violence prevention industry, this is referred to as a “reachable, teachable moment”, when someone is more receptive than usual to help. “Pain is an incredible motivator for change,” says Linden. After an initial conversation, the navigator follows up by helping the person get drug or alcohol treatment, job opportunities or therapy. They try to move quickly. “When someone wants to change, you have to be able to adapt and move,” says Linden. “In six or 12 weeks, they’ll be in a different mindset. We make sure if we refer someone, they’re not in a queue.” This requires significant cooperation between different agencies.
http://www.bbc.com/future/story/20180723-why-we-should-treat-violence-like-an-epidemic