THE CRIMEA

Rich Wurzel? Biology Teacher.
Owen Hopkin? Classic FM editor.
Dan Harris? Bank Clerk (possibly, or dead, or just married, same thing).
Davey Crockett? NHS nurse and all round health-based academic (and he can spell :o ).
Will “No 1 Guitar Tech” ‘Boz’ Boswell? Promotions extraordinaire Saatchi & Saatchi head of design?

Dear lord, I think it just hit me. Shit got freaky. Joe, Andy, you best be suitably crazed, drunk and homeless next month, else I’ll be sorely dissapointed. You’re the only hope we have left :( .

Hit more for another reason not to visit Camden town on a dark night, and why I’m more scared than ever of the self-harming, self-loathing, Mr Self-Destruct

Repost from http://www.facebook.com/#!/note.php?note_id=464365809027&id=698727413
Study by Davey MacManus, November 2010.

FEAR AND LOATHING IN CAMDEN TOWN

“Built on a swamp, running down to the canal in every stage of decay, it has a worn-out appearance, full of dark courts and gin palaces, cheap shops, patched windows, and passages teeming with children. It has a dense population, half buried in black hovels and sewer like alleys, whose way of life is steeped in ignorance, dirt and crime” (Hollingstead 1866)

INTRODUCTION

This is a health needs assessment (HNA) of the borough of Camden, London, United Kingdom. A HNA is “a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities” (NHS evidence, 2010). This study will introduce the borough of Camden, analyzing its population and identifying some of its health needs. The World Health Organisation (WHO, 2010) describes Health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This study is based on the centre of the borough, Camden town, looking specifically at crime and lifestyle in Camden town. It will focus on alcohol as a lifestyle factor, how crime and alcohol are intrinsically linked and how they affect the health of the community. It will analyze government and local policy relating to crime and alcohol. It will describe the role of the nurse, inter-agency working, and how the NHS and other agencies in Camden town use Health promotion. This HNA has found that no other borough in the U.K has to deal with such pronounced issues as those around alcohol and crime in Camden. In fact only in Rio de Janeiro or Moscow can comparable statistics be seen. There will be a conclusion summarizing the key points found in this study.

STUDY AREA

Map 1. The central boroughs of London (2010)

The borough has a population of 231,900; Camden town has 11,796, (Census, 2008). The author is very much part of the local community in Camden town, fishes in the canal and runs in the parks. The Oxford English Dictionary (2010 p. 95) defines community as “a social group of any size whose members reside in a specific locality and often have a common cultural and historical heritage”. Camden town serves as the hub and heart of the borough. The area is famous for its music and nightlife and infamous for its drug and homeless problems. 300,000 tourists arrive every weekend to visit the historic market, canal, zoo, Primrose Hill, Regents Park and to sample the nightlife. This influx of people places unprecedented pressures on local services. Camden town is served by UCL, St pancreas, Whittington and Royal free Hospitals.

Camden has traditionally had a shifting population as waves of immigrants pass through. Kings cross and Euston train stations and more recently the Euro star, bring people in from all over the UK, Europe and beyond. Over 120 languages are spoken in Camden schools (Camden Gov, 2010). The graph below shows that in the 2001 census, 26% of Camden residents were from minority ethnic groups. There are large communities of Irish, Bangladeshi and Black African. The NMC guidelines (2008) maintain that the nurse must “make arrangements to meet people’s language and communication needs”. According to census (2001), the markedly young mean age is 35.3 years and Camden has the highest number of full-time students in London (13.4%). This youthful population becomes highly significant when considering the two key factors, alcohol and crime.

Graph 1. Population mix in borough of Camden (census 2001)

Graph 1. This graph illustrates the population mix in the borough of Camden,

with major population groups defined by colour and exact number.

HEALTH OF LOCAL POPULATION

Throughout Camden there are areas of extreme wealth and areas of extreme deprivation. “More deprivation in an area means worse health”, (Marmot review, 2010). From the elegance of Hampstead to the eastern block high-rise flats of Somerstown, there is a 10-year variation in life expectancy for men, 79.6 to 69.7. (Census, 2001).

A selection of health related stories in the Camden New Journal (CNJ) over the last six months include a homeopathic clinic being investigated for alleged Witchcraft (Foot, 2009), a body discovered in the Regents canal (Foot, 2009), Camden council handing out sandals to drunken late night revelers who have lost their shoes (Chambers, 2009) and “a gang of youths using rope stretched across a Georgiana Street cycle path to fell cyclists, and then relieving the dazed victims of their personal belongings”. (Camden Gazette, 2008)

A local healthy profile by Department of Health (DOH, 2009) found that overall the health of people in Camden is worse than the England average. Tuberculosis, deaths from smoking and alcohol, child poverty, violent crime, road fatalities, heart disease and stroke are higher than the U.K average, as can be seen in the graph below. In the 2001 census Camden has the highest suicide rate for females in the UK, and the second highest for male.

Graph 2. Health summary for borough of Camden. DOH health profile (2009)

Graph 2. This graph illustrates the health of the population of Camden in relation to the

regional and English average. A colour scheme is used to show significant

differences to the norm.

CRIME

“Crime is an act punishable by law; usually considered an evil act” (Princeton Online Dictionary, 2010). It is described by the Oxford English Dictionary (2010, p. 214) as “An unjust, senseless, or disgraceful act, especially one in violation of morality.”

“Camden is currently running at 12 murders per 100,000 of the population while Moscow is at 18.2. London as a whole is at 2.3.” (Johnson, 2008). Recent high profile stabbings of teenagers have resulted in convictions amongst Somali and Ethiopian immigrant gangs vying for the lucrative drug trade in Camden town. The teenagers often come from violent backgrounds in war torn countries. “There is a sense of a disaffected youth.” (Ravish London, 2010). “In 2009, 288,000 people were stopped and searched in London, with 5,400 knives seized, resulting in a 30 per cent fall in serious stabbing injuries.” (Hughes, 2010). Knife crime is estimated to cost the NHS 500 million a year (Times, Telegraph, 2010)

Camden town has unusually high crime rates compared to the national averages. This is due to the large youth population, deprivation, transient population, substance abuse and alcohol. Camden is in the top three boroughs in the country for drug related crime. It is also above the London average for violence, robbery, theft and burglary as can be seen in the graph below.

Graph 3. Crime figures for NW1, Metropolitan Police (2008/09)

Graph 3. This graph illustrates offences in Camden compared to London as a whole, during

the year 2008/2009.

.

LINKS BETWEEN CRIME AND HEALTH

The trauma of crime goes beyond physical and psychological injury, “it robs us of the very faith we have in the human world.” (Miller, 2008, p.19). A 2004 survey of local residents showed that 22% felt unsafe during the day and 59% at night. ((Camden Crime and Disorder Audit 2004). A new study from UCL (2010) has shown that people with a strong fear of crime are almost twice as likely to show symptoms of depression and that fear of crime is associated with decreased physical functioning and lower quality of life. “There are many links between crime and health. Some of the most obvious are the effects of personal violence and assault.” (London Health Observatory, 2010). In Camden the nurse also comes into contact with crime in cases of abuse, domestic violence, prostitution, sexual violence, alcohol misuse, drug misuse, knife crime and murder.

There are many different ways to help victims of crime in Camden town including the bizarre, such as a Psychic who uses her powers to heal victims of child abuse. Lucia Nella claims her spiritual system of “Emotional Timeline Healing” helps those suffering from serious trauma. (Foot, 2010). A selection of the organizations working with victims of crime in Camden town includes an NHS Traumatic Stress Clinic, Victim Support-line and Survivors for victims of child abuse and rape.

LIFESTYLE – ALCOHOL

“Lifestyle generally means a pattern of individual practices and personal behavioral choices that are related to elevated or reduced health risk” (McGinnis and Foege, 1993, p.89). “Lifestyle choices are a set of values by which a person lives their life”. (Handbook of Adult Nursing, 2010, p.76). Lifestyle choices can be positive or negative. In Camden town negative lifestyle choices include smoking, drug misuse, failure to exercise, poor diet. Dunn and Rollnick (2003, p.13) explain that “Morbidity and mortality are inextricably linked to unhealthy patient behaviour.” One of the most visible lifestyle choices on the streets of Camden town is alcohol misuse.

“Alcohol is a direct multisystem toxin that causes drowsiness, in-coordination, sudden mood changes, aggression, grandiosity and uninhibited behavior. Taken in excess it can also cause stupor, coma and death.” (Smelter and Bare, 2000, p.97) “Alcoholism is any use of alcohol beverages which causes damage to the individual or society or both.” (Zimberg, 1982, p.11). It is estimated that the cost of alcohol related harm to the NHS in England was £2.7 billion in 2006/07. (NHS Stats, 2009).

Alcohol misuse is widespread in England. 33% of men and 16% of women drink alcohol at levels that are hazardous to their health, (NHS Choices, 2010). The local alcohol profiles for England (LAPE) (2009) shows that the borough of Camden has an estimated population of more than 22,000 problem drinkers and an alcohol-related death rate of 19.3 people per 100,000 compared with a London-wide average of 12.3. LAPE (2009) shows a mortality rate of 79 from a population of 11796, due to alcohol in Camden town. The graph below shows how alcohol related deaths have risen in the UK between 1991 and 2008

Graph 4. Alcohol deaths by sex in UK (2001-2008)

Graph 4. This graph illustrates alcohol related death rates by sex per 100.000 population

throughout the UK between 2001-2008.

LINKS BETWEEN ALCOHOL AND HEALTH

Alcohol misuse causes illnesses such as liver disease, heart disease, stroke and cancer, which make pressing demands on Camden NHS. “Around 6% of UK cancer deaths could be avoided if people did not drink.” (Cancer Research, (2010). “Psychological problems caused by alcohol misuse include violence, loss of memory and impaired judgment. Social problems include violence, domestic abuse, loss of employment and child neglect”, (NHS Choices, 2010). “There is evidence of a high level of alcohol use among people who are sleeping rough in London, often existing in combination with a mental health problem.” (Pleace and Guilgars, 1996, p.241)

Alcohol accounts for 1.2 million violent crimes per annum in the UK (BBC News, 2010). “Often drinking seems to be responsible for disinhibition and release of violent or sexually violent behavior”, (Edwards et al, 2003). The British Crime Survey (BCS) (2010) shows that 47% of violent crime is alcohol related. There are an estimated 75,000 alcohol-related violent incidents in London each year: every seven minutes there is an alcohol-related violent incident in the capital, (BCS, 2010).

In Camden town binge drinking is a particular problem. “Binge drinking is integral to the social life of many young Britons.“ (McNeill, 2010). “Drinking at least double the daily guidelines is classified as binge drinking” (Prime Ministers Strategy Unit, 2003), However most people classify binge drinking as “drinking to excess or drinking to get drunk.” (Dingwall and Willan, 2006, p.42). ‘Binge drinking is a hazardous activity both because of the health risk it carries and in terms of crime and disorder.” (Bondy and Rehm, 1998. P.7).

Research by Camden Safetynet (2007) established that 47% of respondents reported the level of aggression in domestic violence was 11 times higher on the days that the partner was drinking compared to days when not. Heavy drinking also raises the risk of sexual assault. A UK study by the Lilith Project (2002) found that 58% of rapists reported drinking beforehand. Compared to the rest of the U.K the borough of Camden has a high rate of alcohol related harm, Hospital admissions, hospital treatment, alcohol related mortality, and alcohol related violence are all higher than the UK average as seen in the graph below.

Graph 5. NHS profile of alcohol related harm in the borough of Camden (2007)

Graph 5. This graph illustrates alcohol related harm in the borough of Camden (2007). It

compares rates of harm to the regional and England average. A colour scheme is

used to show significant differences to the norm.

Camden’s accident and emergency (A&E) departments play a hugely demanding role and are sometimes understaffed. “Sometimes we have not had enough appropriate nursing staff in A&E.” (UCL Statement, 2005). “60% of assault victims attended Camden A&E departments between the hours of 10pm and 4am.” (Sheers, 2001, p. 387). Camden town has one of the highest rates of call outs for alcohol related injuries in London, as detailed by the map below. In 2007 the local NHS introduced an ambulance service specifically to treat victims of alcohol at the scene, in order to take pressure off the local A&E departments.

Map 2. NHS Ambulance call-outs for alcohol-related injuries in London.

Map 2. This map illustrates alcohol related injuries by London borough (2001-2003). The

darker the area the greater the number of ambulance call outs.

Services working with people who misuse alcohol and their families in Camden town range from the national such as the Alcoholics anonymous (AA) phoneline to the local such as Eastern European Alcohol group based at St Emmanuel’s church. a young peoples drop in alcohol outreach programme, and 2 alcohol drop in centres.

ALCOHOL AND ETHICAL ISSUES

In a story that made headlines across the world (Evening Standard, 2009). A young alcoholic who began binge-drinking at 13 died in a Camden hospital after being denied a life-saving liver transplant. NHS health chiefs ruled he should not be exempt from strict transplant criteria that require a “dry” spell of at least six months before organs are donated. In August 2010 the UK government proposed that benefits should be cut to alcoholics who made no effort to reform. This was widely condemned in the media as encouraging crime and prostitution. (Brown, 2010)

KEY GOVERNMENT POLICIES IN RELATION TO ALCOHOL

One of the most well known UK government policies in relation to alcohol is the minimum age requirement. One must be over 18 to buy alcohol in a shop or licensed venue (Licensing act, 2003). Another is the labeling policy, whereby each beverage openly displays the amount of alcohol units it contains. This in theory should make people drink less. The legal limit for drivers in the UK is 80 milligrammes of alcohol in 100 millilitres of blood. Despite this drunk drivers cause one in six fatal road accidents. (Drink Drive Stats, 2010)

The UK and local government are constantly initiating new policies to tackle alcohol misuse, such as the 24 hour drinking policy which is meant to minimize the traditional closing time spike in alcohol related violence. Hattersley (2010) calls 24-hour drinking “Labour’s ghastly mistake”. With 112 pubs in some 20 acres the licensing laws in Camden town are a much-debated subject in local council meetings and letters pages. In July 2010 David Cameron backed a proposed government ban on cheap alcohol. “I want to try and end the deep discounting on alcohol”. (Lister and Leroux, 2010) The national institute for health and clinical excellence (NICE) suggested that setting a 50p minimum per unit of alcohol would prevent 3393 deaths and 97,900 hospital admissions per year.

The Camden Community Safety Partnership (CCSP) brings together Camden council, the police, community groups and consultants from Kings College Hospital A&E. The CCSP work together to reduce and prevent crime and antisocial behavior across the borough. In 2005 they set up a dispersal zone around Camden town underground to tackle problems with drugs, alcohol related violent crime and to ban intimidating groups of people (including street drinkers). In 2006, crime in the zone reduced by 18% compared to the previous year.

HEALTH PROMOTION

Ewles and Simnett (2003) identified that “health promotion was a way of equipping people to have more power enabling them to make choices in regard to improving their well being”. “Nurses are the leaders in health promotion.” (Maville and Huerta, 2002, p.86). Rosenstock’s Health Belief Model (1996) focuses on “the belief in one’s competency to take appropriate action.” This makes sense in the context of recovering alcoholics. The patient must, “Believe that the benefits of taking action will outweigh the costs or barriers.” (Nutbeam and Harris, 2004, p. 22).

From posters in doctors’ surgeries, to newspaper adverts, open days, leaflets handed out at the market, radio and internet adverts and the NHS websites, no form of health promotion goes untried in Camden. When free smoke detectors were handed out in Somerstown in 2007, a reduction of 97% was noticed in deaths by fire in 2008. Health promotion plays a key role in the work of the nurse and prevention of crime and alcohol misuse in Camden town. There are all styles of health promotion aimed at reducing alcohol misuse in Camden town. They range from a cartoon for adults on YouTube, to an alcohol ageing simulation game (see below).

Fig 1. NHS alcohol ageing simulation game (2010)

Fig 1. This figure shows how alcohol can age and deteriorate the face of a young woman.

ROLE OF THE NURSE IN WORKING WITH ALCOHOL AND CRIME

Berridge and Liddle (2009, p.58) define the roles of the nurse as a teacher, advocate, leader, change agent, discharge planner and researcher. Campbell and Humphreys (2003, p.63) found that “advocacy raises the patients profile and champions their needs where they lack a strong voice and experience marginalization.” National guidelines recommend that men drink no more than three to four units per day and women no more than two to three units per day (Camden alcohol strategy, 2009). But how does the nurse police this when it is essentially a lifestyle choice. The Nursing Times (2010) speaks of behavioral change. “Success was measured by patients’ degree of compliance and self-management. This was achieved through teaching and raising awareness”

“The role of the nurse today has expanded with specialization. The nurse now has prescriptive authority to dispense medications.” (Maville and Huerta, 2001, p.98). In England in 2007, there were 134,429 prescriptions for drugs for the treatment of alcohol dependency. This is an increase of 31% since 2003. (NHS information centre, 2010). “Alcohol use takes the form of a struggle between the polarities of abstention and indulgence.” (Plant et al, 1997). Alcohol detoxifications take place in Camden at the Royal Free Hospital and University College Hospital. The Camden Alcohol Harm Reduction Strategy (2010) reports that in 2008/09 1555 detoxifications took place. “Nurses have been a major component of the workforce in alcohol treatment units since they were established and developed in the late 1950s” (Kennedy and Faugier, 1989, p.87).

“A&E Nurses are increasingly dealing with both the victims and perpetrators of crime.” (Hitchen, 2008). In Camden this may involve husband and wife, father and child, victim and aggressor. “Nurses are in an excellent position to prevent, identify or intervene against family violence”, (Dingwall and Willan, 2006, p.177). “Adults who normally wouldn’t hurt a child may become irrational when drinking, or they may be too involved with drinking to care for a child.” (Schornstein, 1997, p. 322). Lupton and Gillespie (1994) say “the nurse’s knowledge of child abuse and neglect can often provide invaluable information and assistance to the investigating officer”. “It is important to remember that patients generally trust nurses. They look to them for help, comfort, support and guidance” (Campbell et al, 2003, p. 112). “Some kind words and a little information may be the first steps towards the victims reclaiming their own lives.” (Lupton and Gillespie 1994)

Along with treating patients the nurse in Camden also has an important role in inter-agency working. The NMC guidelines (2008) state that the nurse must “work with others to protect and promote the health and well being of those in your care.” Inter agency working as defined by the UK Audit Commission (2008) is “A joint working arrangement, where otherwise independent bodies cooperate to achieve a common goal; this may involve the sharing of relevant information, risks and rewards.” Nurses in Camden town communicate daily with police officers, community support workers, mental health team, crisis team, social workers and many others in order to achieve their goals.

CONCLUSION

The health problems generated by alcohol misuse and crime are almost as old as mankind itself. Short of reintroducing prohibition and locking up half the country it is difficult to imagine a definitive medical or practical answer to these two key factors. The author has read many letters criticizing the police, council and NHS in Camden town and seen at first hand how crime and alcohol misuse affects the health of its citizens. However public confidence in Camden’s police is 78.24 per cent. (Green Flags, 2010). Dudman (2008) reported in the Guardian that Camden has become the first English council to achieve top marks from the local authority watchdog in priority areas such as cutting crime and antisocial behavior, economic regeneration, older people and health”. Could Camden town provide better resources to target alcohol misuse and crime?

This HNA has found that the NHS and a multitude of other local government and charity services are doing their best with the funds allotted. Within this HNA it has been proved that Camden town has worse health than the UK average, higher crime rates and higher rates of alcohol related harm. This HNA has shown how alcohol and crime are intrinsically linked. This study has explained how the nurse works with victims of crime to help them move forward with their lives and how the nurse plays a key role in micro management of alcoholics and prevention of escalation of alcoholism. It has been ascertained that within Camden town, nurses, the NHS, police, local council and charities are constantly changing their strategies, always striving for better results. All these organizations are working in tandem towards a joint aim in an incredibly difficult environment.

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