Gang Membership, Violence, and Psychiatric Morbidity

Abstract

Gang members show inordinately high levels of psychiatric morbidity, placing a heavy burden on mental health services. Traumatization and fear of further violence, exceptionally prevalent in gang members, are associated with service use. Gang membership should be routinely assessed in individuals presenting to health care services in areas with high levels of violence and gang activity. Health care professionals may have an important role in promoting desistence from gang activity.

Design, development and validity testing of the gang affiliation risk measure (GARM)

“…These fitted the emergent meta-narrative from the systematic review (Raby & Jones, 2016), linking a failure to safeguard young people with gang affiliation, and identifying increased violence exposure and associated psychological consequences, namely developmental trauma or PTSD (cf. IoP, Gangs Conference, 2015;Coid et al, 2013;Coid, personal communication, 2015). Consistent with this, neurodevelopmental studies of early attachment difficulties and complex trauma have associated a historic lack of safety with ongoing hypervigilance and increased threat perception (Meloy, 1992;Rogers, Harvey & Law, 2015;Shore, 2005).…”

“…Although conduct disorder (CD) (Lahey et al, 1999;Howell & Egley, 2005;Madden, 2013) and antisocial personality disorder (Coid et al, 2013;Valdez et al, 2000) (given that violence exposure and violent victimisation distinguished this group from the nongang affiliated group) that antisocial behaviour has manifested as a fear-based post-traumatic reaction to perceived threat, or due to reduced emotional awareness (Lambie & Marcel, 2002) which is a known deficit resulting from developmental trauma and insecure attachment (Van der Kolk & d'Andrea, 2010;Ford & Courtois, 2013). Social modelling of problem solving using instrumental violence must also be considered.…”

“…Promisingly, evidence suggests that gang affiliated individuals are more committed to treatment than non-affiliated individuals (Coid et al, 2013). However, postcode territories, the stigma of mental health difficulties, the risk of being perceived as weak, and an inherent lack of trust in authority could make accessing help challenging.…”

“…Whilst the heterogeneity of gang structures currently makes gang membership challenging to measure (Coid et al, 2013), Esbensen (2001) and Klein (1995) offer evidence of selfreporting being a sufficient methodology. Tapia's (2011) approach demonstrates how intelligence records can be additionally utilised, overcoming potential criticisms of self-report bias.…”

“…Furthermore, it has been demonstrated that this risk exposure journey begins at pre-school age and continues throughout childhood to a point of gang affiliation in mid-adolescence (Howell & Egley, 2005). Coid et al (2013) argue that gang affiliation represents a major UK public mental health concern, and that violent victimisation is directly related to psychiatric consultation, admission and morbidity.…”