Youth violence: a fighting chance

07 September 2018

Why is knife and other youth violence on such an upward trajectory, and can a public health approach, which is being hailed as the answer, really help? Journalist Phil Harris investigates.

Knife Head

Seventeen-year-old Chris Cave died while visiting his friend in Redcar, north-east England. He was killed in a knife attack by another youth, Sean Matson. Sean, who was drunk at the time, was trying to get into a block of flats to take drugs. Chris tried to stop him, but Sean produced an eight-inch kitchen knife and stabbed Chris repeatedly in the chest. Chris was pronounced dead by paramedics, and Sean was sentenced to life imprisonment for murder.

There’s perhaps nothing new about the current wave of knife crime against young people – Chris was killed in 2003. But his tale is no longer quite so unusual. Watch the news, go online and such stories of wasted lives are becoming heartbreakingly familiar. Newspapers list an ever-growing cycle of young victims of knife crime, and the latest official figures confirm a clear rise in such violence.

Hasan Özcan was just one of the teenage victims in 2018. He was 19 years old when he was stabbed to death in Barking, east London, in February. His father Abdullah said: ‘I cry every day. I think about him every day. His room looks so empty. My wife has completely changed, my kids’ lives have changed. My wife: she’s finished’ (Cobain, 2018).


Striking statistics

Police recorded 40,147 offences involving a knife or sharp instrument across England and Wales in the year ending March 2018, a 16% increase compared with the previous year (34,547 offences) (ONS, 2018).

This is the highest number of offences seen since the year ending March 2011, the earliest point for which comparable data is available. Moreover, the past four years have seen a surge in the number of recorded offences involving a knife or sharp instrument.

Figures obtained subsequently through a freedom of information request by The Independent revealed the number of knife incidents against under-25s in England and Wales had almost doubled, from 3857 in 2013-14 to 6503 in the year to March 2018 (Bulman, 2018). In London, it reported that the number of youth knife crimes soared 79% in that period, with the number of young people killed doubling from 19 to 40 (Bulman, 2018).

Recorded offences involving a knife or sharp instrument are far lower in Northern Ireland (see page 38), although of course still alarming. And possession of weapons offences reached 1000 in 2017-18: the highest level recorded there since 1998-99 (Police Service of Northern Ireland, 2018).


Metal Decetor
A public health approach

In sharp contrast to the situation elsewhere in the UK, Scotland has seen a dramatic improvement in recent years. In 2005, the country had the second-highest murder rate in Europe, leading the government to establish the Violence Reduction Unit (VRU), initially to work in Glasgow but then rolled out across the nation.

The VRU set out to take a public health approach; different agencies and professionals have all been involved and linked up to play their part in a ‘holistic’ strategy. (See page 40, Scottish solutions, to see how this was carried out).

As a result, the number of homicides in Scotland fell by 47% between 2007-08 and 2016-17, from 115 to 61, and no one under the age of 20 was killed with a sharp instrument in 2016-17 (Hill, 2018; Scottish Government, 2017).

The recent figures across England and Wales have prompted many calls for action – and fresh thinking. Sarah Jones MP, the founder and chair of the All-Party Parliamentary Group on Knife Crime, wrote on Twitter in July: ‘We don’t need more reviews from government, we need concrete action. We need a dedicated unit in government to work across departments to cure the growing epidemic of violence in our communities. Today’s figures confirm that this is a public health emergency’ (Jones, 2018).

Sarah’s comments echo the growing realisation that knife crime and other forms of youth violence, including gun use and acid attacks, should not be treated just as a criminal justice or police problem, but should be considered similarly to an infectious disease epidemic or population health issue such as teenage pregnancy or drug misuse.

For many years, campaigning and health groups along with researchers have called for a better coordinated ‘public health approach’, in which causes would be identified, ‘outbreaks’ would be investigated and treated, and preventative action would be taken to stop the issue before it starts.

Many literature reviews have also concluded that such approaches significantly reduce violence and weapon carrying (Sethi et al, 2010). And of course Scotland is well ahead in its strategy.

But there’s now a new impetus around this thinking in the rest of the UK. Earlier this year, the London Community Foundation (2018) published The violence virus. This set out an integrated community response to reducing youth violence in London based on public health interventions to examine the causes, prescribe appropriate treatment and invest in a long-term cure.

And the Youth Violence Commission recently released its interim report (2018), recommending that London should adopt a public-health-focused model similar to the approach that has been successful in Glasgow and across Scotland.

Following the spate of London stabbings at the start of 2018, the head of the Metropolitan Police, Cressida Dick, said: ‘We are all committed to the notion that prevention is better than enforcement, which is, after all, the public health approach.’

Of the approach in Scotland, she said: ‘The public health approach is well evidenced in Scotland. There are very different communities, very different dynamics and very different issues around violence and, indeed, youth violence but, nevertheless, there have been massive reductions in violent crime through a primary health lens’ (Townsend, 2018).

Then in April this year, the Home Office published its Serious violence strategy (HM Government, 2018), which included the creation of the Early Intervention Youth Fund to promote youth schemes including sports and mentoring programmes. In July, the home secretary announced the funding for this would be doubled to £22m.

There’s a growing realisation that youth violence should not be treated just as a criminal justice or police problem, but should be seen as a population health issue.


Counting the causes

So what are the reasons behind the latest figures, and the public health perspective? Knife and other violent crime is a complex issue and it is important to understand there are many reasons for it, says Dr Peter Traynor, an expert on knife and youth violence at Manchester Metropolitan University.

That said, Anthoulla Koutsoudi says adverse childhood experiences (ACEs) are seen as the root cause of violent behaviour. Anthoulla works for the WAVE Trust, a charity that supports victims and seeks to prevent the formation of violent personalities, and is also a member of the WHO Violence Prevention Alliance (VPA). She says attitudes to violence can start very early: ‘We know that the most aggressive three-year-olds are already, at so tender an age, 10 times more aggressive than their most peaceful counterparts.

‘We have to get all experts and professionals trained and working in a new way to understand baby brain development and understand that poor behaviour is often a product of ACEs.

‘As a result, the best option is to prevent the formation of violent personalities. We call this primary prevention. Our 2005 report Violence and what to do about it basically shows that to reduce violence in society we have to invest in supporting families when their children are very young.’

This view is supported by John Carnochan, who worked for many years as a Glasgow detective and was one of the founders of Scotland’s VRU. When asked about how to solve violent crime more than 10 years ago, he famously replied that he would rather have 1000 more health visitors than 1000 more police officers (Leask, 2015).

Despite this, low police numbers are often cited a cause. Peter thinks that while police numbers have an impact, it is nuanced. ‘Police have a role to play in tackling the problem and so it stands to reason that if there are less of them around then that will have a consequence, he says. ‘But it’s not about having lots of police arresting people. We don’t need heavy-handed policing. We need sympathetic adults to give young people support and to show them alternative ways of behaving.’

Peter adds that austerity policies across many areas of the public sector have had a significant impact. ‘Some of the most important people I have met in my research have been those in youth services and others who work with children. They are extremely important in preventing violence, but sadly these services have been cut back massively as funding has evaporated.’

Vicky Foxcroft MP, who established the Youth Violence Commission, said earlier this year that the government must provide ‘the necessary resources’ for ‘a genuine reduction in serious violence’ (Bulman, 2018). She continued: ‘That means sustainable funding for youth workers, community support officers, mental health support in schools; you can’t cut millions from youth work and schools funding and Sure Start and early childhood centres and not expect this to have a knock-on effect.’

Peter says that poverty is also a significant factor, with young people from the poorest backgrounds much more likely to be involved in violence. He also says that gang involvement raises the risk of being a victim and perpetrator of violent crime. Boys are more likely to be involved than girls because boys tend towards using violence as a means of resolving conflict. Plus social media can also play a part, through glamorising gang and violent behaviour, facilitating bullying and making young people feel unsafe.

So the latter is another key cause of knife carrying: bullying and the consequent sense of fear and need for protection that many young men in particular feel. Peter says: ‘Many young people don’t feel safe on the streets and so they make what is for them a completely rational decision to carry a knife for their own protection. This makes them feel safer, but it can obviously lead to situations where the knife actually gets used.’

So what would a public health approach mean in practice, and how would it help?


Joined-up thinking

Peter says a public health approach is fundamentally about moving away from a criminal justice model, in which the problem is tackled through tough policing, into one where we try to understand the pressures young people are under, and not demonise them or treat them as feral law-breakers in waiting.

‘We shouldn’t be saying young people are bad. We should be concerned for them and try to help them, in the way that we shouldn’t treat drug addicts as criminals,’ he says. ‘A good example is one young man I spoke to who was a good kid – but he was being bullied and was frightened, so he started carrying a knife in his bag in case he got attacked after school.

‘But someone told the school and then the police got involved, and suddenly he found himself being treated as a violent criminal. A better approach would have been to treat the cause of the bullying and try to educate everyone involved.’

In a public health approach, all relevant organisations and professionals – including the police, healthcare workers such as community practitioners, social care staff, teachers, charities and communities – would work together to tackle the issue from different angles.

There are four steps to this according to the WHO VPA, which shares an evidence-based public health approach to target risk factors leading to violence (WHO, 2018):  

STEP 1. DEFINE THE PROBLEM - Collect data systematically to discover the magnitude, scope, characteristics and consequences of violence.

STEP 2. INVESTIGATE AND IDENTIFY RISK AND PROTECTIVE FACTORS - Conduct research to find out why violence occurs and who it affects.  

STEP 3. PLAN AND TEST INTERVENTIONS - Prevent violence: what works and for whom?  

STEP 4. SCALE UP AND MONITOR THE INTERVENTIONS - Monitor effects of interventions, their impact and evaluate their cost-effectiveness.

The overall approach is similar to that which would occur in a planned vaccination programme.

Peter gives an example of how a coordinated and preventative approach has worked in tackling alcohol-related violence in the night-time economy (night tube, pubs, cultural venues). ‘Gathering and sharing data has identified “hot spots”, such as where fights break out at taxi ranks on Saturday nights and in the past have led to arrests and A&E visits.

‘Rather than just accepting this, treating victims and sending in the police after the event, it worked better to intervene earlier. Staggering pub closing times, for instance, and putting street wardens or police in place to defuse or prevent arguments breaking out in the first place has reduced occurrences of such violence. A similar approach could reduce knife-related violence.’


Scottish solutions

How did Scotland use a public health approach in practice? Intelligence and data was shared between police and others working in health, education, youth work and social work. In the early years of the scheme, young people considered more likely to offend, such as those suspected of gang involvement, were identified and targeted with education and information campaigns. They were also given a ‘way out’ through help with housing, relocation, employment and training.

Dr Christine Goodall is a maxillofacial surgeon in Glasgow. She says: ‘Over a decade ago, we were overwhelmed with trauma cases involving knives and young men, particularly at weekends. It was a common issue in Glasgow fights.

‘We’d patch them up and they would be back on the streets, but there was no attempt at prevention work. Yet this would be done with health problems such as smoking or alcohol.’

Frustrated with the situation, Dr Goodall founded Medics Against Violence to bring together health professionals and push for better prevention. The charity, which is affiliated to the VRU, goes into schools to show the consequences of knife violence to pupils from different perspectives, including perpetrators, victims and families.

‘We’ve now spoken to more than 35,000 young people in Scotland. This is mostly in the cities as that’s where you see the problems, rather than in rural communities. We’ve also trained older children to educate the younger ones, so the programme is self-sustaining.’

Dr Goodall believes there has been a real shift in thinking in Scotland over the past decade.

‘Scotland has really tried to understand the problem and deal with the causes,’ she says. ‘We know that often victims and perpetrators are the same group of people. We’ve been prepared to take a long-term view, and this has been backed by politicians who have supported the agenda and not tried to see it as something that will win them votes by promising short-term action.

‘There has been good work going on in the rest of the UK, but it’s not always joined up. And arguably the problems are easier to address in Scotland than in places like London, as it’s a smaller area with fewer people.

‘London has a complex situation, with competing politicians, many different boroughs with different financial situations, and a densely packed population with lots of poverty and inequalities.’


Playing your part

Healthcare professionals can play an important role in tackling youth violence, and may be more able to engage teenagers than people in other roles. School nurses in particular can be very well placed to lead education and early interventions.

Peter Traynor says: ‘There is lots of good work going on across the UK in schools, but some aren’t very good at dealing with [violence]. Some are in denial and see it as something that happens outside the school gates.

‘But school nurses can be a big part of the jigsaw. They can challenge difficult behaviour, help to educate young people and make sure data is shared effectively. Dealing with problems informally can be very powerful, and school nurses should be prepared to challenge young people on their behaviour.’

Feeling unsafe and having a fear of bullying are major causes of carrying weapons, but this is something schools can improve on, he says: ‘Schools need to challenge bullying and work harder to increase empathy and teach young people about conflict resolution.’

Donna Molloy, director of policy and practice at the Early Intervention Foundation (EIF), adds: ‘We know that effective forms of early intervention can be delivered both in schools – building vital social and emotional skills, such as managing emotions and regulating behaviour – and in the home, to support effective parenting, teach parents ways to manage their children’s behaviour and tackle family conflict.

‘These interventions can build the strong family relationships which are important protective factors against involvement in violence and can have an impact on highly relevant risk factors, such as aggression and conduct problems.’

Donna adds that building social and emotional skills in children has been shown to be more effective in terms of preventing violence than simply trying to scare them, for example through showing them photographs of knife wounds or taking them into hospital emergency rooms, and it is important that new resources being made available by the government will fund measures that are likely to work.

Figuring out the best joined-up approach in the UK may still be in progress, but there are numerous resources that practitioners can draw on for guidance, including from the EIF (see Resources, below).

Theresa Cave, whose son Chris was stabbed to death in 2003, set up the Chris Cave Foundation - it runs a POINT7 educational programme for schools on bullying and violence to help inform and support pupils and to help prevent further tragedies.

‘I was so ripped apart by the violent way we lost Chris. It’s the pain a mother feels, something I wouldn’t wish on my worst enemy,’ she says.

‘But if I can stop one more mother going through what I went through, that in itself is a massive achievement.’ 


Stopping the cycle

Navigator is a hospital-based intervention programme in emergency departments across Scotland. It engages with patients at a moment when they may be open to breaking free from the challenges trapping them in a cycle of violence.

Navigators tend not to work with anyone under 16 – instead the individuals they see are often missed by services or deemed to be non-engaging. At 16 plus, they can also have confidentiality agreements. Based on her work, Sam Fingland, a Navigator at Queen Elizabeth University Hospital, Glasgow, says:

  • Language is key in interventions with teens. A teen’s understanding will be far different from that of an older adult’s, and it’s easy to lose them simply because they think we don’t understand what they’re going through. So speak to them in a way that’s relevant to them. Social media dictates a lot of their understanding, so try to understand the pitfalls around that.
  • Help them see the implications. Our work involves helping young people to understand the implications of carrying a knife – the destruction and devastation it can cause – but in a way that doesn’t sound dictatorial or preaching. We offer a safe place to speak about and explore this, and we talk to them with empathy, non-judgementally.
  • What’s the answer? Most importantly we try to establish why they carry a knife. Often we lead them into making the connection themselves with open questions like ‘Sounds like a really difficult time, what do you think could happen if you were caught carrying or using a knife?’ Depending on their response, we tailor support.
  • Let them in. Often sharing our own experiences of pain, challenges and low times brings a bit of identity to their situation. If we can break a cycle, they get to believe that they can too. 



  • The Home Office has evidence-based advice for schools on preventing violence and gang involvement at bit.ly/HO_youth_violence
  • The EIF offers a guidebook of early intervention programmes for children and young people to prevent violence at guidebook.eif.org.uk
  • Redthread runs a Youth Violence Intervention Programme to reduce violence and support victims, with youth workers in hospital emergency departments. See redthread.org.uk
  • Navigator is a hospital-based intervention programme in emergency departments in Scotland. Go to bit.ly/navigator_VRU
  • The Chris Cave Foundation offers the POINT7 education programme. Go to thechriscavefoundation.org
  • Bullying UK offers advice and training for professionals at bullying.co.uk or 0808 800 2222.
  • Tools for young people and professionals at anti-bullyingalliance.org.uk
  • NI Direct offers overall advice for parents on keeping children safe from knife crime at bit.ly/NI_knife_crime 
  • NSPCC runs a website and helpline for children and concerned adults on gang activity at bit.ly/NSPCC_gangs or 0808 800 5000. 
  • Read the WHO VPA’s report on health and violence at bit.ly/WHO_VPA


Picture credit | iStock



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See: https://www.independent.co.uk/news/uk/home-news/knife-crime-young-people-unsolved-stabbings-soar-police-figures-a8410491.html (accessed 13 August 2018).

Cobain I. (2018) ‘I cry every day’: father of London stabbing victim speaks of devastation.
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Hill C. (2018) Scottish violence facts and figures. See: actiononviolence.org/news-and-blog/scottish-violence-facts-and-figures(Accessed 9 August 2018).

HM Government. (2018) Serious violence strategy.
See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/698009/serious-violence-strategy.pdf (accessed 21 August 2018).

Jones S. (2018) Sarah Jones MP on Twitter. See: https://twitter.com/LabourSJ/status/1019931523313754118 (accessed 9 August).

Leask D. (2015) Face to face: the detective who believed in crime-busting health visitors.
See: www.heraldscotland.com/news/13214219.Face_to_face__the_detective_who_believed_in_crime-busting_health_visitors/(accessed 13 August 2018).

Office for National Statistics. (2018) Statistical bulletin: crime in England and Wales: year ending March 2018. 
See: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/crimeinenglandandwales/yearendingmarch2018#some-weapons-offences-are-rising-but-this-type-of-crime-remains-rare (accessed 9 August 2018).

Police Service of Northern Ireland. (2018) Police Recorded Crime in Northern Ireland: Monthly Update 31 March 2018.
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Scottish Government. (2017) Homicide in Scotland 2016-2017: statistics 
See: https://beta.gov.scot/publications/homicide-scotland-2016-17-9781788512367/ (accessed 21 August 2018).

Serve Legal. (2018) Underage knife sale penalties fail to deter retailers. 
See: http://www.servelegal.co.uk/_webedit/uploaded-files/All%20Files/Serve%20Legal%20Press%20Release%20Knives%2016.5.18.pdf (accessed 9 August 2018).

Sethi S, Hughes K, Bellis M, Mitis F, Racioppi F. (2010). European Report on Preventing Violence and Knife Crime Among Young People. See: http://www.euro.who.int/en/publications/abstracts/european-report-on-preventing-violence-and-knife-crime-among-young-people (accessed 21 August 2018).

Townsend M. (2018) Knife crime needs public health strategy, says London police chief. In: The Guardian, 6 Jan. See: theguardian.com/uk-news/2018/jan/06/knife-crime-metropolitan-police-cressida-dick (accessed 21 August 2018).

The London Community Foundation. (2018) The violence virus: a community response to reducing youth violence in London. See: https://londoncf.org.uk/uploads/The-Violence-Virus-final.pdf (accessed 21 August 2018).

Wave Trust. (2005) Violence and what to do about it. See: www.wavetrust.org/sites/default/files/reports/migrate-wave-report-2005-full-report.pdf (accessed 21 August 2018).

WHO Violence Prevention Alliance. (2018) The public health approach. See: www.who.int/violenceprevention/approach/public_health/en/ (accessed 9 August 2018).

Youth Violence Commission. (2018) Interim Report – July 2018. See: http://yvcommission.com/wp-content/uploads/2018/07/Interim-Report-FINAL-version-2.pdf (accessed 9 August 2018).

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