By Dr Chih Hoong Sin
In an article published in Community Care in June 2014, I argued that it is important for care agencies to recognise their role in preventing hate crime, and not to see it purely as a criminal justice issue. In a subsequent blog for the International Network for Hate Studies, I said that health and social care agencies can play three critical roles in relation to hate crime:
- To provide treatment and support to hate crime victims.
- To help prevent hate crimes by identifying and acting on the early indicators of repeat victimisation.
- As potential offenders, particularly in institutional care settings.
In the latter half of 2014, I started working with Leicestershire Partnership NHS Trust and its partners on developing a hate crime care pathway. Leicestershire has been at the forefront of efforts to respond to the challenge of getting health and social care services to acknowledge their multiple roles in relation to hate crime. It is heartening that others, such as NHS Greater Glasgow and Clyde with Glasgow City Council and Police Scotland, have a similar commitment to develop joined-up approaches. There is a real desire to learn and share which is why I want to describe some of the key steps we have been taking in Leicestershire and explain the rationale behind the approach.
Hate crime care pathway
It is a curious fact that cross-cutting social issues often get compartmentalised by the various agencies that have a role in dealing with them; evolving their own sets of terminology, structures and processes with which to make sense of that same issue. At the same time, each agency will have its own culture and organisational behaviours; working in specific contexts to different sets of policy and legislative drivers. Developing a hate crime care pathway, therefore, requires an understanding of the various ways through which the relevant agencies perceive the issue and the conditions they work under.
As a first step, we mapped out the key issues from three different perspectives: (1) hate crime perspective; (2) victim perspective; and (3) care perspective. These are not meant to be exhaustive.
Hate crime perspective
- Definition of hate crime is victim-centred, and is not about evidencing ‘hate’ as the motivation.
- Hate crime can often be an escalation of hate incidents.
- It is overly simplistic to think of hate crime as ‘stranger danger’.
- Victims may not be aware that what they have experienced is hate crime. They may not talk about their experiences using the language of hate crime.
- Hate crimes do not just happen to people whom we may think of as ‘vulnerable’.
- Victims need to feel that they have choice and control over the type of support they are provided with and the types of actions that may be taken to tackle the issue.
- Past experiences of the agencies they come in contact with can often influence whether or not victims will come forward and their expectations.
- Providers of care can sometimes be perpetrators of hate crime.
- Effective care is more than simply treating the condition or symptom that a patient or service user may present with. It should be about working to secure well-being holistically for the individual.
- Effective care is not simply about individual practice, but is also influenced by the structural issues around how care services are commissioned and delivered which may, in some cases, exacerbate power imbalance and ‘vulnerabilities’.
- It is the responsibility of care agencies to work together to provide seamless care, rather than expect victims to navigate a highly complex system to access relevant services and support.
- The terminology of ‘abuse’ and ‘care failing’ can mean that effective redress through the criminal justice system does not take place. This is because the language of ‘abuse’ and ‘care failing’ within care settings can lead to people thinking that these are not criminal incidents. Criminal justice agencies often express concern that the terminology used in care settings downgrades the incidents into the non-criminal realm. In care settings, it is common to find that staff are not aware that incidents are criminal in nature, they look at the issue through the lens of ‘care failing’ which requires improvement in procedures and training.
- While there are drivers for better integration between health and social care, other forces may lead to greater fragmentation (for example, diversification in the service provider market). The logic of better integration is that this should mean that support provided to hate crime victims is more seamless. However, fragmentation, means that health and social care agencies find it increasingly difficult to be aware of different services, the capacity of providers and the quality of services. This has an impact on effective referral and signposting.
The implications of all the above are then drawn out for health and social care professionals and agencies so that the issues are ‘made real’ for them. For example, raising awareness that we should never expect victims to talk about symptoms and causes using the language of ‘hate crime’. Many may not even know that is what they have experienced. Professionals need to understand that victims will present not because they are seeking redress for their experience but because they are seeking treatment for physical or mental conditions; they need to talk to the individual to understand the underlying causes of the symptoms.
A conceptual framework
Building on the above, we developed a conceptual framework for potential solutions. This framework is underpinned by the following considerations:
- Using a ‘victim journey’ approach, we clarified where and how hate crime victims may come into contact with care professionals and agencies. Victims tend not to go directly to the police. Instead, they often go to primary care and/or social care agencies to seek support, as well as mental health services.
- We clustered these likely ‘points of entry/contact’ into acute, primary, community and specialised.
- Within each of these we highlighted the fact that care professionals and agencies may play more than a treatment and support role, they also have a preventive role. Usually hate crime victims have already experienced ‘low level’ incidents such as verbal abuse. These often escalate into hate crime. Care agencies can pick up signs and work with the individual and other agencies to put strategies in place to stop the cycle of repeat victimisation.
- We drew attention to how victims may present with physical and/or mental conditions/symptoms, and that these could look different across the different settings.
The framework then had input from representatives from Leicestershire Partnerships NHS Trust and its partners:
Services Prevention Support Acute Physical eg A&E, ambulance trust, paramedics, single point of contact (SPOC) social work team Mental eg inpatient mental health units, SPOC social work team, dynamic psychotherapy service Primary Physical eg GP, practice nurse, walk-in centres, pharmacist, locality social work teams eg GP, practice nurse, walk-in centres, pharmacist, locality social work teams Mental eg GP, practice nurse, walk-in centres, tiers 1 and 2 Camhs, intensive community support team, mental health social work teams eg GP, practice nurse, walk-in centres, tiers 1 and 2 Camhs, intensive community support team, mental health social work teams Community Physical eg community/district nurse, (care homes and day centres), locality social work teams, day services, recognised charities offering advice and support, domestic care, personal assistants eg community/district nurse, (care homes and day centres), Leicester Care, integrated crises response service Mental eg community/district nurse, (care homes and day centres), tier 3 Camhs, locality social work teams, day services, recognised charities offering advice and support, domestic care, personal assistants, Leicester Care, integrated crisis response service eg community/district nurse, (care homes and day centres), tier 3 Camhs, community mental health services Specialised Physical Mental eg Improving Access to Psychological Therapies (IAPT), tier 4 Camhs eg IAPT, tier 4 Camhs
As a result of this, we came to the following recommendations:
- Key points of entry/contact for prioritisation should be community and primary care.
- Within these, there are potentially more agencies with a prevention role, although they are not likely to be aware of this. We will need to raise awareness amongst these agencies of their potential role in preventing hate crime (for example, recognising signs, asking relevant questions).
- Mental health appears to be particularly important as a point of intervention. We suggest, in the first instance, to target relevant agencies.
Work is underway to clarify procedures for detection, referral, assessment, signposting, following-up, and reporting on to the police. This involves working in collaboration with a plethora of agencies and individuals to co-produce solutions. An effective hate crime care pathway will provide better prevention and more holistic support, which will prevent people from requiring repeated, and often urgent, service use. At the more extreme end, it will avoid the incidence of serious cases that take up a huge amount of resources and damage public trust.
Dr Chih Hoong Sin is director of OPM, an independent research organisation and consultancy