Public health approaches to youth involvement in violence: Examining stakeholders’ perspectives in Australia and the United Kingdom

Constructions of young people's involvement in violence

The constructions of ‘youth gangs’ are typically used in mainstream media to instil fear and justify harsh punishment and zero tolerance policies towards young people (White, 2016). Media outlets across Australia and the UK consistently use phrases such as ‘youth crime crisis’ or ‘youth crime epidemic’ to describe youth involvement in violence, which can position young people in conflict with the law as convenient ‘folk devils’ (Cohen, 1972; Scraton, 2008; Gordon, 2018; White, 2007). For example, mainstream media typically focuses on young people's involvement in violence as ‘out of control’ (Zillman, 2020), and the interview findings from this study suggest that there has been increased reporting of violence. However, the reality is in fact very different (Gordon, 2018).

In fact, the recorded crime figures in both Australia and the UK demonstrate that there has been a downward trend in young people's involvement in crime. In illustrating these trends, the latest official reported statistics released from the Australian Bureau of Statistics (ABS, 2021) reveal that in 2019–2020, the rate of young people entering the criminal justice system has decreased by 3% since the previous year, with a rate of 2230 per 100,000 persons; the lowest since the time series began in 2008–2009. Similarly, in England and Wales, the number of offences committed by young people has also declined (Youth Justice Board & Ministry for Justice, 2021). In the year ending March 2020, there were only 49,100 offences committed which resulted in a caution or sentence in court; this was a decrease of 75% from the year ending March 2010 when there were approximately 198,400 offences (ibid).

Fear and panic are also reinforced by one-sided images of groups of young people framed as ‘gangs’, either perpetrating violence against one another or other social groups. From 2016 onwards, media outlets, particularly the tabloid press in Victoria, have played a central role in the creation of young people as ‘folk devils’ demonising young people (Cohen, 1972; Gordon, 2018; Benier et al., 2018; Gordon et al., 2021). This is typically accompanied by frequent negative pronouncements by ‘moral entrepreneurs’ such as politicians, who identify and target particular groups, including Indigenous and South Sudanese young people, and calling for the ‘crackdown on offenders’ via the creation of punitive measures, including overly strict bail limitations and building more youth detention precincts (VCOSS, 2017, p. 3; Gordon, 2018, p. 92). However, Lee et al. (2021) assert that the media attention and socio-political discourse, which constructs certain groups of young people as ‘dangerous’, did not result in less offending, but it escalated tensions and increased the level of surveillance by police.

Although groups of young people gather and socialise together in public places, just as they have for centuries, contemporary constructions of ‘anti-social’ behaviour are often presented as gang activity (Ashton & Bussu, 2020, p. 284; White, 2007). In the UK, young people's involvement in violence has also been frequently associated with ‘youth gangs’, which have received significant media attention and are often described as the key factor behind knife crime (Haylock et al., 2020). Portrayed by mainstream media outlets as the ‘new epidemic’, knife crime has become one of the most pressing social issues in the UK (specifically London), particularly given its known link to gang involvement and gang activity (Allen & Audickas, 2018). However, while governments and policymakers tend to focus on youth gangs as a contributing factor to knife crime, there is still limited understanding of offender motivation, whether a young person is a gang member or not (Harding, 2020). To support this idea, Bailey et al. (2020) argue that knife-related offences in the UK are usually not gang-related (less than 20%), and instead, they tend to occur between strangers, with the altercation typically being a one-off event. With this in mind, the existing research on media portrayals demonstrates how negative or inaccurate reporting can not only have a damaging effect on young people, but also on the community within which they reside (Gordon 2018; Hertsmere Young Researchers, 2011; Lohmeyer, 2020).

Impact of the public health approach in responding to violence

It should be noted that the use of a PHA for violence and other forms of offending, is not a new approach. In fact, this approach has been circulating since the 1990s (see Mercy et al., 1993; Moore, 1993). According to a recent report by the UK Youth Violence Commission (2020, p. 12), a PHA is based on three main stages: understanding the nature of the problem, through data; implementing what works, with a focus on young people's experiences and input; and improving policies based on evaluation and experience. In its report the Commission suggest that framing the model in this way may prove to be a useful conceptualisation; however, it also does not preclude the possibility of there being other effective ways to define a PHA. For example, England's adoption of the PHA takes an epidemiological approach, like the US’ CURE Violence (CV) prevention model, which employs medicalised language and views violence as ‘a disease’ that can be treated (Brown, 2019; Slutkin et al., 2015). Furthermore, it must be recognised that there is no single PHA being used across the UK, and that other areas including Scotland and various regions of England have differently governed Violence Reduction Units which employ distinctive strategies to reduce young people's involvement in violence.

Scotland's Violence Reduction Unit (SVRU) was established in 2005 by the Strathclyde police to reduce high levels of serious violence within the community through a PHA (Pepin et al., 2018, p. 3). The SVRU is directly funded by the Scottish Government, and its team consists of serving police officers, civilian police staff, experts and people with lived experience of violence; all of whom work closely with various departments, including health, education, and social work. Working in partnership with Police Scotland and the Scottish Government, the SVRU program was originally conceived using the World Health Organisation's public health terminology to prevent violence found on the streets, in classrooms, homes and in workplaces (WHO, 2002). Since its establishment, the SVRU has been shown to reduce young people's involvement in knife crime by diverting them away from the criminal justice system through community-violence prevention programs (Williams et al., 2014). This outcome has also prompted other parts of the UK, including England and Wales, to learn from the approach and outcomes in Glasgow by tailoring their approach to meet the needs and challenges of their locations.

As part of its development, in 2008, the SVRU set up a project to tackle gang violence in Glasgow's east end called the Community Initiative to Reduce Violence (CIRV). With a primary focus on deterrence, this multi-faceted, community-based project involved a range of sectors, including the Strathclyde Police, Glasgow Social Work Services, Glasgow Education Services and Glasgow Housing Association, as well as a host of community and voluntary groups, and third sector organisations (Graham & Robertson, 2021). Overall, the CIRV aimed to prioritise the needs of young people and address the social determinants of violence by providing sheriff court self-referral sessions, multi-agency and individualised client support and strategic police enforcement (Williams et al., 2014). Although the CIRV had only tentative findings of its success, it was clear that policy transfer models were used to develop, frame and carry out what was considered a ‘successful’ program transfer of the Cincinnati Initiative to Reduce Violence (US CIRV). However, as Graham (2016, pp. 157–158) identified, the Glasgow CIRV failed to fully replicate this model, which may explain why it ceased operations in July 2011.

Indeed, policy transfer can play a significant role in shaping the youth justice systems within different jurisdictions (Muncie, 2012, p. 159). To date, many scholars have analysed a growing similarity in criminal justice across western societies, driven by neoliberalism and the growth of penal policies (Goldson et al., 2020; Jones & Newburn, 2021; Muncie, 2012; Newburn et al., 2018). It has also become increasingly common for jurisdictions to discover ‘what works’ in preventing youth involvement in crime and to reduce reoffending (Muncie, 2011, p. 45). For example, the findings obtained from Scotland's PHA have prompted the establishment of London's Violence Reduction Unit in September 2018, which has similar objectives that are ultimately rooted in prevention and early intervention (Pepin et al., 2018). However, policy transfer is rarely straightforward and direct, and it is partial and mediated through national and local cultures which themselves are rapidly changing and developing in this space (Jones & Newburn, 2021). Therefore, to enable successful policy transfer of a PHA, other jurisdictions must consider the four components of adopting a PHA, which include: the underlying factors of violence and why it occurs; the magnitude and scope of violence; ways to prevent violence; and, applying a range of interventions to reduce violence (Conaglen & Gallimore, 2014).

As previously established, Australia has not yet fully adopted a PHA in response to violence. While there have been some data-driven strategies and evidence-based programs, including the Justice Reinvestment Project in New South Wales and the ‘Communities that Care’ intervention in the 1990s (Toumbourou, 1999), the concept of a PHA to young people's involvement in violence in Australia is currently not part of the criminal justice discourse. Instead, most of these references to a PHA are placed within the context of child welfare and protection services, risks to young people's safety and well-being, as well as early prevention and intervention measures (see, for example, AIFS, 2014; COAG, 2009). In terms of the existing literature on the PHA, previous scholars have analysed the connection between human rights, legal and economic issues, as well as the public health dimensions of domestic and family violence (McCarthy, 2003; Walden & Wall, 2014). However, there is limited contemporary, comparable literature which focuses on utilising a PHA to respond to young people's involvement in violence in Australia. Furthermore, this article addresses the gap in the research-based literature by analysing the perspectives and expert opinions of youth justice professionals in Australia, who are strong advocates for a PHA.

Defining a public health approach

In the context of young people's involvement in violence, the definition of a PHA appears inconsistent and inconclusive in the available literature, existing policy documents, and in the current youth justice and criminal justice approaches (Gordon et al., 2021, p. 38). While there has been evidence of violence reduction, particularly in Scotland, there is confusion over what a PHA is, what evidence supports it, and the conditions under which it can be applied (Grimshaw & Ford, 2018; PHYVR, 2021). As a result, the implications of a PHA remain vague and uncertain, despite its significant potential. Moreover, due to these inconsistent applications and definitions of the PHA, the participants in the study were not clear on what a PHA would look like in practice and what the approach actually consists of. They asserted that there needs to be more clarity on what the PHA is, and how it can be applied holistically in the context of criminal justice matters.

Certainly, there can be implications of having a single definition as it could potentially limit our understanding of and response to violence in different contexts. However, to achieve a PHA to violence, it is critical to obtain evidence as to ‘what works’, as well as the mechanisms that underpin successful policy transfer. Indeed, without meaningful evidence of ‘what worked’ in Scotland, there is a risk that limited resources will be directed towards ‘quick fix’ or ‘band-aid’ solutions that fail to address the underlying drivers of youth involvement in violence (UK Research and Innovation, 2020).

According to Rosier and McDonald (2011, p. 3), implementing a PHA to respond to violence, requires different governments and agencies to collaborate and cooperate to achieve shared goals for young people. As a general trend, interview participants agreed that holistic and collaborative approaches are required to successfully implement a multidisciplinary PHA. As an example, one participant identified that this approach:

…views violence as, not just a criminal justice issue, but a public health issue that can be reduced through problem-solving and through multi-agency approaches…. (Academic B)

Another participant also acknowledged that a PHA is essentially ‘inclusive of all parts of society…it's the bridge between our health, our police, our social care, the community and the children…it all works together…kind of like a spiral’ (Practitioner C). When discussing the definition of a PHA, a participant in Victoria stated that, ‘…a public health approach is one that looks at a more preventative, early response’ (Academic A). Other Victorian participants also held similar views that a PHA is a model that reduces and prevents violence:

My understanding of a public health approach is one that focuses on the cause of harm… a very strong preventative approach. (Practitioner B)

These findings echo the observations outlined in ‘The Youth Justice Strategy Review’ in Victoria which has set the foundation for many proposed reforms concerning the welfare of young people who come into conflict with the law (Armytage & Ogloff, 2017). The report shines a light on the significant challenges and issues affecting the Victorian youth justice system, and it provides an opportunity to create evidence-based responses to youth involvement in crime, like a PHA, which reflect the attitudes and needs of young people and the wider community (Legal and Social Issues Committee, 2018).

Although the PHA to violence is yet to be fully understood and embedded in Australia, England and Wales, the majority of the UK participants described the PHA using a medical analogy. For example, several of them highlighted that violence is: ‘viewed as a disease that can be inoculated against and prevented if the right interventions are put in place at the right time’ (Academic B). Another participant asserted that the heart of the PHA was the perception that violence is seen as ‘a disease’ or an ‘epidemic’ and that young people ‘can be cured’ (Academic F). Overall, the conceptualisation of violence as ‘an infectious disease’, was a dominant theme across the interviews:

[A] public health approach is one that treats violence and offending in a similar way to an infection or a disease…if you look at causes and try to stop the spread of it using treatment and looking at it that way. (Practitioner I)

However, as Greene (2018) highlights, applying violence to a disease model can often be misleading, and even harmful, as the underlying drivers of violence should not be regarded as some abstract violence germ. Instead, the violence that occurs in communities is primarily due to the severe oppression and deprivations that young people experience daily. Although the Scottish PHA was initially premised on the idea of violence being a disease and has previously been linked to reductions in violence, the association of the PHA with medicalised terminology can overshadow the holistic outcomes of the approach at a community level. Similarly, the CV model operates on the premise that violence ‘is a contagious disease’ (Slutkin, 2012, p. 111) that can be controlled and contained via epidemiological methods which are applied in infectious disease control. This understanding of violence as a medical diagnosis not only claims that a ‘science based’ epidemiological framework is superior to other approaches, but it also discounts the socio-economic factors and inequalities which are linked to youth involvement in violence (Riemann, 2019, p. 151). Furthermore, we argue public health should not focus on the contagious disease model, but rather on the effects and impacts of ‘toxic’ environments (Case & Haines, 2019).

Fortunately, there is some emerging public health research that considers the social and structural determinants of violence as crucial in developing preventative, community-specific approaches for young people (Nation et al., 2021; Ross et al., 2021, p. 1136; Roy et al., 2019). According to Greene (2018), these strategies focus on addressing socio-economic inequalities, including poverty, poor education, unemployment and social exclusion; all of which are linked to young people's involvement in violence. Although the participants strongly supported these initiatives, they were also concerned that often young people's needs are often overlooked in these settings:

Sometimes the agencies are doing such great work [but] sometimes their voices are not heard. (Academic B)

This was also recognised at an international level, as a participant from Victoria asserted that:

We need to get policymakers to be able to engage with young people alongside some organisations to figure out what young people want…we need to listen to their voices. (Academic M)

Certainly, the PHA in Glasgow in Scotland represents a promising step in reducing and preventing youth involvement in violence. However, we also need to ensure that young people are given the opportunity to participate in important decision-making processes that directly affect them. While the PHA may be ‘in its infancy’ (Academic C) in England, Wales and Australia, the consensus from the interviews was the need to implement more problem-solving strategies that are, ‘multi-agency and…multi-faceted’ (Academic D). Indeed, for this approach to be successful and gain significant traction in Victoria, both systemic intervention and application must be reflected within its youth justice policy frameworks.

Trauma-Informed responses to youth involvement in violence

A ‘successful’ PHA to youth involvement in violence places great emphasis on trauma-informed practices which recognise the contexts in which crime and violence occur (see Blakemore et al., 2021; Spacey & Thompson, 2021, p. 26). In this section, we argue that recognising previous trauma in young people is an essential component of the PHA, as it may help to develop prevention strategies, extend the reach of early intervention, and address the underlying socio-economic inequalities in communities (Campbell, 2020; Magruder et al., 2016). During interviews, participants acknowledged that advocates must continue to support young people, and that this must be a consistent approach that is applied throughout entire communities (Gordon et al., 2021). Trauma experienced during childhood is critical to take into consideration when exploring how best to respond to young people involved in violence, as it can have long-term impacts on a young person. Often, there is often a strong correlation between engagement in behaviours perceived as ‘criminal’ and the experience of trauma, which must be addressed through a PHA (Sacks et al., 2014). This concept is further exacerbated by the mainstream media's negative portrayal of young people, where the idea of childhood trauma is rejected by using inflammatory language to dehumanise and stigmatise, rather than identify the key risk factors for youth involvement in violence.

For example, several participants recognised the impact of childhood trauma and how it can be manifested in perceived criminal or ‘anti-social’ behaviours, which impacted the ways in which young people are perceived by the wider community:

The young people we hold in our custodial centres are themselves victims of abuse, neglect and trauma. (Practitioner B)

Previous researchers have argued that the link between trauma and young people's involvement in violence remains a significant public health concern (Oral et al., 2016; Ross & Arsenault, 2018). At the time that the interviews were conducted, the Royal Commission into Victoria's Mental Health System had been established for six months (January 2019). Delivering its final report on 3 February 2021, the Royal Commission produced 65 recommendations in addition to the nine that were outlined in the interim report (State of Victoria, 2021). Each of these recommendations provided a 10-year strategy for a future mental health system designed to improve the long-term outcomes for Victorians who experience mental illness. Drawing upon a public health perspective, the Royal Commission recommends that the Victorian government expand youth forensic mental health programs on a state-wide level, including across the thirteen Infant, Child and Youth Area Mental Health and Well-being Services (see recommendation 3(2)(b) and (c)), to provide specialised treatment and improve the mental health and well-being of young people in contact with, or at risk of coming into contact with, the criminal justice system (Royal Commission into Victoria’s Mental Health System, 2021, p. 347).

Currently, the field of trauma and trauma-informed responses is dominated by studies that explore treatment for young people who experience trauma in childhood. However, it is crucial that we do not overlook the key benefits of considering trauma through a public health perspective, particularly given the serious consequences of trauma exposure (Magruder et al., 2016). For example, physical and sexual abuse, has also been shown to have a significant impact on young people's brain development, causing long-term challenges in biological, psychological, and social functioning (Mueller & Tronick, 2019). To date, several reports and inquiries, particularly in Victoria, have provided credible, insightful research on neurobiology and developmental psychology (see Grover, 2017; Legal & Social Issues Committee, 2018; Sentencing Advisory Council, 2016). To support these findings, the UN's General Comment on child justice (CRC, 2019b) also urges States parties to acknowledge the recent scientific findings of brain development, as the neuroscience evidence indicates that young people's brains continue to mature even beyond the teenage years, which affects decision-making and the ability to control impulses. Consistent with these recommendations, interview participants from both jurisdictions believed that trauma professionals would benefit from adding a public health ‘lens’ when working with young people. Some also argued that if a trauma component of the PHA is not reflected in policy and practice, it can significantly curtail emotional, social and physical development opportunities for young people. As interviewees stated:

Trauma is impacting on their development and how they assess risk. (Practitioner F)

Interviewees also extended their analysis of childhood trauma when discussing the negative ramifications of young people's experiences of the criminal justice system. For example, a dominant review among advocates is that ‘trauma [is] only further compounded through that time in custody’ (Lawyer A). This finding suggests that there are often risks of re-traumatising and re-victimising young people when sentencing them to a youth detention facility, which contradicts the foundational aspects of a PHA (Wall et al., 2016). This has a disproportionate impact on Indigenous young people in contact with the criminal justice system. For example, Anthony (2018) emphasises that unless there is greater recognition of the wider social, structural inequities faced by Indigenous people, the pattern of ongoing colonial violence will continue to be a significant part of Australia's youth justice systems. Participants also echoed these concerns during interviews:

I think we have to have a stronger role of Indigenous culture in all of our sentencing of Indigenous young people. (Academic E)

There has been significant work by Indigenous communities which focus on implementing participative and preventative approaches, such as the Justice Reinvestment Project in Bourke in Western New South Wales, which is also based upon a public health perspective (White, 2015). This offers a holistic community approach with a direct emphasis on physical and cultural health to prevent crime and reduce marginalised young people's contact with the criminal justice system. However, despite these efforts, Australia still has a distinct lack of consistency in the language and framework for implementing trauma-informed models of care in child welfare services and in school settings, which demonstrates that there is also limited awareness of a PHA in this context (Berger et al., 2021; Wall et al., 2016). In line with this key finding, many Australian interviewees spoke of the complexities and challenges often associated with gaining support to implement such approaches designed to support young people who have lived experiences of trauma:

Getting [people] to talk about trauma-informed practice is incredibly challenging. (Academic I)

Furthermore, local governments and agencies within these jurisdictions must ensure that holistic and collaborative approaches are appropriately designed and funded. This is precisely what the PHA proposes; to recognise the prevalence of trauma, to recognise how trauma affects young people, to respond by putting this knowledge into practice, and to move away from potential re-traumatisation (Cleary et al., 2020). Moreover, Halsey (2018, p. 18) maintains that therapeutic approaches should focus not only on the needs of traumatised young people, but also on the histories of violence and abuse sustained by their parents or caregivers. Thus, having these structures in place will also ensure that a child's or a young person's needs are contextualised within the trauma and adversity they have experienced (Bush, 2018, p. 309) and can promote the need for ‘[t]rauma-specific services … designed expressly for the purpose of treating the symptoms and syndromes related to current or past trauma’ (Bargeman et al., 2021, p. 4).