Through my work with the Youth Violence Commission, I have spoken with many young people whose friends have been stabbed; with the grieving families of victims; and with the traumatised friends of perpetrators. If we trace the lives lost to violence, or to long prison sentences, back to childhood, we hear familiar stories of domestic abuse, neglect, childhood trauma and school exclusions.
Let us take one child, who I will call Jack. Jack’s father is unpredictable and often violent. His mother self-medicates to cope. She has few friends in the area where they live. She does not know her neighbours and she is financially dependent on Jack’s father. From an early age, Jack witnesses his mother being beaten and abused by his father. As a small child, he is withdrawn, anxious and has trouble sleeping.
When Jack starts primary school, his teacher notices that he struggles to concentrate most days. Sometimes he seems utterly sleep deprived. He is often late in the morning and falls behind with his school work. Jack struggles to keep up with his classmates, and feeling anxious about that, he starts to become more disruptive.
By the time Jack starts secondary school, things have become worse. The police have been called to the house on several occasions, and Jack has been referred to social services. At 13 years old, things have become so bad at home that the courts grant a court order and Jack is taken into care. He is placed with a foster family, which costs the council approximately £27,000 a year.
Jack struggles at school. He finds it hard to concentrate and he is behind his classmates, so he increasingly skips school. When he is there, he has a reputation of being disruptive and aggressive. That behaviour leads him to be suspended on numerous occasions until, at the age of 14, he is permanently excluded from school and sent to a pupil referral unit, which costs an average of £17,000 per pupil per year.
Shortly afterwards, Jack assaults a boy who ends up in hospital with various injuries. He is now known to the police and receives a warning. The cost to the police and the criminal justice system of responding to a single such crime is approximately £2,500. The immediate cost of health services for the victim is nearly £900. Jack is then referred to a youth offending team, which costs about £1,500. For a while, things get better. After moving placements several times, he settles with a foster family and he does not reoffend for a year.
Shortly after turning 16, however, he goes to a party and a heated argument quickly descends into a fight. Jack struggles with how to handle his emotions, and he stabs another boy. He did not expect this to be fatal, but two days later the victim dies in hospital from his injuries. Right now, at this point, we have lost two young lives. The devastating loss of these two lives is felt not just by the families but by the whole community and across society as well.
The overall cost to the hospital is more than £2,000. The cost of services to the victim’s family is about £6,000. After a trial by jury, which costs upwards of £150,000, Jack is sentenced to 15 years in prison. The average cost per place per year in a young offenders institution is £76,000. The average cost of a single homicide to the police is more than £11,000, and to the criminal justice system it is more than £800,000. Then there are the further hidden costs of a homicide. They include the lost earnings of the victim and the perpetrator and of their families, as well as the cost of the impact on the victim’s family and friends’ mental health, and the cost of the fear of violence and the trauma of the wider community. In total, the Home Office estimates that one homicide costs society more than £3 million. We have one boy dead and another boy in prison. By the time he is 18, Jack has cost the state nearly £4 million in interventions from the police, social services and youth offending teams, and in costs to the NHS, the local council and the criminal justice system.
Now, let us start the story differently. Let us add in some true early interventions. Imagine that we have another child in similar circumstances: let us call him John. When John’s mother is pregnant with him, she attends a Sure Start centre in her local area. The family centre gives her advice on family health, parenting, employment and training, and it is a good place for her to meet other expectant mothers. When John is born, she continues to attend the centre regularly, to see her friends and to get advice on parenting and child health. On average, the programmes cost around £1,000 per year per child.
Things at home are not easy. John regularly witnesses his father being physically abusive to his mother, and he is an anxious toddler as a result. At the children’s centre, one of the health visitors notices that John’s mother has signs of physical abuse and reports this to social services. The centre is aware of this and keeps an eye on her, and the group of friends that John’s mother has made at the centre are supportive. Unfortunately, she ends up in hospital, but the centre still supports her in leaving her partner. It refers her to a refuge, and the training on offer at the centre helps her to find a part-time job. The place in the refuge costs £52 a day, and the training costs £1,000.
The children’s centre is connected to a maintained nursery school, which John attends when he is old enough. At nursery he develops his communication skills, and by the time is four he is seen as school-ready. He is more independent, and has strong social skills for his age. As a result, he settles in quickly and makes friends, and he can keep up with his peers throughout primary school. Generally, things with John and his mother are much more settled by the time he starts secondary school. His mother is working full time, and after having had to move several times between friends and temporary accommodation, they have now been living in the same place for a year. The secondary school that John attends has a school nurse and strong mental health support, meaning that the teachers have time to work with and support all the children. The school has a zero exclusions policy as a result. The school nurse costs the school around £40,000 a year.
John’s mother works late, so after school he attends the youth centre down the road with his friends. As he gets older, the youth centre is also able to provide him with skills training and advice on work experience. The school has a dedicated police officer attached to it, who John and his friends occasionally play football with at lunch and confide in if they are concerned about something. The partnership between the local police force and John’s school has also been beneficial for the police. In building up trust with the pupils and their parents, they are able to obtain information about vulnerable children who are at risk of being groomed by gangs. This partnership usually costs about £50,000 a year.
John still suffers with anxiety and occasionally has problems controlling his temper, but the school has the internal resources to support him and he receives mental health support for managing his temper.
When he reaches the end of year 11, John leaves school with five good GCSEs. He has a part-time job and has got into a local college to do business studies. He has also become a peer mentor in his youth centre and supports other young people. Based on the crude estimates I have outlined in this story, the cost of that early intervention is about £170,000. The cost of failure for Jack is more than 20 times that amount.
An early intervention approach will not only save money; it also has the potential to save many lives. We know that early intervention is key. A strategy based on very early intervention and wraparound support would not only reduce violence but have wider benefits for society and the economy.
Research shows that adverse childhood experiences or traumatic incidents in childhood can have a lasting impact in adulthood. Compared with people who have no ACEs, those who have four or more are seven times more likely to be involved in violence, four times more likely to have a low level of mental wellbeing and 11 times more likely to be incarcerated. As MPs, we need to be far more aware of this. In an attempt to raise the profile of that, I am writing to all MPs to ask them to complete a short online survey on how many ACEs they have. I hope that that will focus some minds.
We have to stop just talking about early intervention and start genuinely resourcing and delivering it. A true public health approach should focus on that, because every life is precious and our young people deserve the best start in life.