Former top Doctor: Early intervention is crucial to changing lives

As a young doctor working in Glasgow Royal Infirmary, Sir Harry Burns saw first-hand just how devastating violence could be.

The tide of human misery was seemingly relentless, an intractable public health crisis where only the symptoms of the disease could be tackled, not the causes.

There was a fatalism that Scotland’s largest city would never shed its unwanted title as the murder capital of western Europe.

Harry Burns says early intervention is key.

But Sir Harry, who was Scotland’s chief medical officer until 2014, never shared in this negativity. He describes the idea of a “Glasgow effect” – a city forever destined to be stuck with low life-expectancy and high levels of violence – as “hokum”.

While there remains a long way to go in tackling some of Glasgow’s chronic health problems, the past decade or so has seen a transformation in levels of violent crime.

Much of the credit has gone to the Violence Reduction Unit (VRU), a police initiative set up to deal with violence as a public health issue. The VRU’s work has helped reduce the number of homicides in Glasgow by 60 per cent over the past decade.

Its success and its mantra of “do something different” has helped foster a new spirit of innovation in Scottish criminal justice circles, with the current focus on how Adverse Childhood Experiences (ACEs) can make someone many times more likely to go to prison later in life.

Sir Harry is clear that Scots are not somehow genetically predisposed to poor health and violence but rather have fallen victim to a set of socio-economic circumstances which uprooted communities and robbed generations of gainful employment and a sense of purpose.

“Glasgow basically got austerity 50 years before anyone else,” he says.

“All the jobs disappeared, the shipyards closed, the steelworks went and at the same time there was huge upheavals in communities, with people being shipped out to new towns or put up in high-rise buildings.

“They lost a sense of social cohesion.”

Now director of Global Public Health at Strathclyde University, Sir Harry points to research showing stressful experiences in a child’s early years can change the brain and have an impact on a person’s life many years into the future.

Studies have shown that the shape and size of a child’s brain can be altered by stress, with adults more likely to be depressed if they were abused or lived in poverty during childhood.

Analysis of ACEs, which include domestic violence, divorce, abuse or growing up with a parent who has a drug or alcohol problem, show that someone who has experienced four or more is three times more likely to develop health problems such as type 2 diabetes, four times more likely to become an alcoholic and 20 times more likely to go to prison.

“Politicians like to have a single policy that they can espouse, but actually you need to do lots and lots of things to tackle violence,” says Sir Harry.

“There are sugar taxes and all sorts of plans to make it harder for people to consume lots of sugar, but the evidence from Stanford University is that if children experience Adverse Childhood Experiences and have stressful early years, the centres in their brain which respond to eating are resistant to insulin.

“That means they eat lots of sugar, but their brain doesn’t get the message that they are full up.

“There’s a fundamental issue there that all of those policies aren’t tackling. You need a scientific approach to this kind of thing, which takes account of all the issues involved. I’m not saying tackling ACEs is the answer, but it’s part of the answer.”

But while Sir Harry is sure of the importance of prioritising early years, he is less confident about the effectiveness of prison.

Despite attempts by the Scottish Government to promote community sentences, figures obtained by The Scotsman last week showed the prison population is at its highest level for four years, driven by a 40 per cent increase in those held on remand.

“Clearly there are people who represent a threat to society,” says Sir Harry. “If we can be sure that they continue to represent a threat, then society must be protected.

“But there are a whole lot of people who end up in jail because of stupid mistakes and maybe they need a second chance.”

Asked about victims who want to see offenders punished, he says: “You have to be sympathetic to that, but sometimes you have to say that’s it’s not in everybody’s best interest or in society at large (to send someone to prison).

“Any crime is a tragedy for the victim, but you’re far less likely to be a victim of crime in future if people are handled appropriately rather than locked up.

“You’ve got to take each case on its merits, but if there’s an expectation that a person can be rehabilitated, then why wouldn’t you do that?”

Sir Harry has been impressed by the work of the Delancey Street Foundation in San Francisco, an organisation working with former prisoners which he saw up close on a visit to California.

With its motto of “Enter with a history, leave with a future”, the Foundation, which began in the early 1970s, provides a community where ex-offenders can live and work if they leave violence, drugs and alcohol behind.

“The best thing for Scotland would be for everybody to flourish, from kids doing well at school to people doing well in the workplace and others not going to jail.

“Lots of problems that young people have that end up in them having criminal records probably have their origins in early life, in chaotic family lives and the fact they’re not great at managing emotions.

“It’s far better to help these kids regain control of their lives rather than lock them up in jail.

“I’ve heard of young men being given community safety orders and in the first couple of days they’re surly, withdrawn and uncommunicative and then they begin to come out of their shells.

“They may be given 200 hours and for that time they’ve got a community – they’ve got other guys to work with and a job to do, a reason to get out of bed in the morning. Then when they get towards the end of their order, they become surly and withdrawn again.

“Give people a purpose, a network of friends and you’ll have far less trouble.”

Recorded crime is now its lowest level in Scotland since the mid-1970s, although recently published statistics showed a 1 per cent rise in violent crime during the past 12 months.

While Scotland, and Glasgow in particular, has made huge strides in the past 15 years or so, there are those in some of the country’s poorest communities who remain as likely to be a victim of crime as they were at the turn of the century.

Despite that, Sir Harry believes the situation has improved markedly since his days working as a surgeon to treat stab wounds.

“I’m very optimistic for the future,” he says. “We understand this problem far better than we ever did. I travel a lot, and part of the reason is that other places are looking to what we are doing here and want to know more. It’s gratifying but we’ve got to walk the walk now. It’s only taken us 30 years to work out what the problem is - the hard bit is now putting it into action.”

Sir Harry Burns is director of Global Public Health at Strathclyde University

Case Study: I can help others get a second chance like me

From the age of seven, James was in trouble.

“I’d be going to Children’s Panels to face 20 or 30 charges at a time. I never felt anyone understood me or cared.”

Aged 15, things got really serious when James received a custodial sentence for violent behaviour. He was locked up alongside other unruly kids, some serving life sentences for serious crimes including murder. For James, it only compounded his anger and anxieties.

Released from the secure unit, he returned to the nightmare of family life.

“It was just chaos. My dad was away with another woman and my mum was dying with alcoholism. I’d find her having alcoholic seizures or covered in blood because she’d fallen and split her head open. I can’t remember the number of times I had to take her to hospital”.

Angry and confused, James ran with the local gang. Violence was a daily feature.

This is not a unusual story. What is unusual is that, with support, relationships, the care of strangers, recognition of the trauma his young brain had experienced and the willingness from James to help himself, James has used his second chance and is now in a position to help others and is living a good life. His three children have a completely different world view compared to his own young life, due to healing and repair.

James was painkiller addicted, he self medicated to deal with the mental trauma and emotional injuries he had sustained as a child, unknowingly. “I never knew anything else, I had no frame of reference that my life as a kid wasn’t good, violence had always happened around me, to me, by me.”

Much has been researched and written about the developing brain and effects of adverse childhood experiences (ACE). When you look at the list of what ACE covers, James ticks almost all of them – abuse, neglect, parental separation, his mother’s alcohol addiction, depression...

“I went through EMDR therapy (eye movement desensitisation and reprocessing – therapy involves the identification of unprocessed traumatic or other distressing experiences continuing to drive psychological disturbance) and it was explained to me how the central nervous systems reacts to perceived danger – fight, flight, freeze or flop. My only response was fight. That was my auto response to trauma.

“The therapist created a safe space for me, and I dug deep into the trauma I had experienced and try to heal. It was really tough. I was lucky to have built some relationships – including my mentor. People that cared about me. I was surprised – having people care about me was confusing. I thought ‘why do these people want anything to do with me?’ but they did, and I started to trust and care too. Relationships are everything when you’re trying to get better.”

“I’ve never been the same since. The grief process I went through was like nothing else I’ve experienced in my whole life. I cried for weeks and they supported me throughout.”

James has a deep understanding of why his life started the way it did. He’s immersed himself in the research and the data and is passionate that, whilst this is his story, he is only one person – he wants people to listen to the vast body of evidence and results that demonstrates that society needs to rethink, to give people a second chance and support them to fulfil their potential. There’s a key quote from Buddhist monk and peace activist Thich Nhat Hanh that he believes should shape our approach to those who have had a tough upbringing.

“It’s where our collective power lies as a society – ‘creating the environments and providing the relationships that support people to recover and heal’.

“Blaming and punishing kids isn’t right. They’ve been punished and excluded all their lives. You cannot punish trauma or the symptoms of trauma – such as addiction – into a better way of being, its already a punishing enough experience. Writing them off, marginalising them – what good is that going to do?

“It isn’t easy walking away from a life that is all you’ve ever known. I was given a second chance, and now it’s my turn to help others use theirs. It works, but it only works in the context of relationships.”

“You need support. You do it for yourself, but it’s almost impossible to do it by yourself. Being vulnerable is the very thing that saves you, if you ask for help, people show up. People gave me a second chance and if it wasn’t for them, I wouldn’t be here today.”