A guest blog by Christine Goodall, co-founder of Medics Against Violence
When we founded Medics against Violence (MAV) I remember someone saying to me 'you'll do yourselves out of a job' and I replied 'yes that's the idea' somewhat flippantly but really, that was the idea.
In 2008 I had worked in Maxillofacial Surgery, a speciality dealing with diseases and injuries to the head and neck, for 12 years, had just finished my higher specialist training and got my first consultant job. During those 12 years I saw thousands of facial trauma patients, mostly young men from deprived areas, involved in interpersonal violence, usually while drinking; that's your typical facial trauma patient. Many were quite big characters with colourful language, but some were wee boys, separated from their gang, no longer the big hard man, worried about the wrath of their mother, the prospect of an operation, the involvement of the police, scarred, scared and sore. Being admitted to hospital as an emergency is a great leveller and the 'Badge of Honour' thinge is rarer than you might think. We are really good at patching them up, Scotland has some of the most experienced facial trauma surgeons in the UK, but the trouble is some of them are never the same again because it really is more than just a sore face.
You face is a great thing, the home of all your senses, it is also a fantastic crumple zone, like a series of matchboxes, and the fact that it is, often protects the brain from more serious injury during a fight. But there is something really personal about hitting or slashing someone's face and something really traumatic in more ways than just physical about being on the receiving end.
When I give talks about MAV I always show some photos of patients because no matter whether the audience have inflicted the injury, work in violence prevention or are just interested, most have never really looked at the damage done by violence and many flinch and look away when I show these photos. But this is the reality of life in hospitals and the reality of life for the victims of violence and it's important to see that because these horrific images are what one human being can do to another, and for what? The one thing I can't bring into the room is that smell of blood and alcohol mixed together, it's a really evocative smell and one you never forget if you work in a hospital, the smell of trauma.
Many facial trauma patients require surgery, to fix broken bones most often, and a straightforward operation will cost about £4.5K and take a couple of hours. The other extreme are people who need very extensive surgery and can spend up to eight hours in the operating theatre having all the pieces painstakingly put back together and then often a period of time in intensive care until the swelling goes down, the cost of that, both financial and human, is much more. We fix fractures with titanium plates and screws and even a simple fracture can need two metal plates and up to eight screws, something more complex can require many more.
Walking along the steel enclosed walkways within HM Polmont, I listened to the governor reflecting on what, in her opinion, could have made the biggest difference to the lives of the young people in her care. ‘Bereavement counselling,’ she stated.
So many of those currently serving custodial sentences, not just in Polmont but in all of our prisons, have faced the traumatic loss of people that they love at a very early age. And for a significant proportion, this has happened not just once but again, and again and again. The death of a parent. The death of a brother. The death of grandparents. And then, to cap it all, the removal from a succession of foster parents or kinship carers. At some point you give up loving for you are too afraid of being hurt – again.
If effective bereavement counselling might be an important ingredient which could reduce the number of young men coming through the doors of our prisons then enabling them to build good relationships is pretty foundational to reducing the likelihood of them re-offending on release. And here, too, Polmont seems to be trying to get things right. The work carried out by Barnardo’s and others to support young men to work on building relationships with, for example, their young children is inspiring. The brightly coloured bus outside the prison which is the recently opened Family Visitors’ Centre, is another important part of the jigsaw. We know that prisoners who have a secure relationship to focus on when they leave prison are much less likely to end up back inside.
So if we are serious about trying to reduce the population of our prisons, proper bereavement counselling and care is a pretty good place to start. It’s not hugely expensive and the sort of incredible work undertaken by organisations like Child Bereavement UK and Richmond’s Hope is utterly transformative.
For some, of course, release is a long way off. One of the young men we met is only part way through a long-term sentence. Graham, not his real name, was inspirational. He was studying for a youth work diploma alongside one of the wardens. He was already trying to practice his youth work skills and although I was in his company for little more than 30 minutes, I am sure that he is, and will be, one of the best youth workers in the country. He has tried to face up to the awfulness of his crime. He is determined to make amends.
Recently I met someone who works within the Scottish Prison Service. He told me that he believes in redemption. As a Christian minister the word ‘redemption’ can be a word with deep religious undertones. But in this case, it doesn’t need to be a religious word at all. It is simply about mending things, making things better. Much of what I saw in HM Polmont made me hopeful that it can be a place of redemption and not just retribution. That has to be good for all of us as we strive to make Scotland a safer and better country.
Martin is Secretary of the Church of Scotland’s Church & Society Council. Until recently he was Chief Executive of Faith in Community Scotland and coordinator of Scotland’s Poverty Truth Commission.
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