News and Comment

Towards a hate crime care pathway: lessons from Leicestershire

Friday 30 January 2015

By:

It is Hate Crime Awareness Week, and I would like to take the opportunity to assert the importance of reframing hate crime beyond its narrow criminal justice focus. In a blog for the International Network for Hate Studies last year, I argued that health and social care agencies can play three critical roles in relation to hate crime: (1) to provide treatment and support to hate crime victims; (2) to help prevent hate crimes by identifying and acting on the early indicators of repeat victimization; and (3) as potential offenders, particularly in institutional care settings, where professionals may perpetrate acts commonly termed ‘abuse’ against inpatients.

In the latter half of 2014, I started working with Leicestershire Partnership NHS Trust and its partners on developing a hate crime care pathway. We hope to share learning in order to inspire and encourage others to develop joined up approaches to tackle hate crime and support hate crime victims.

Making it real for health and social care

As a first step, we need to understand the context in which health and social care professionals are working within. For example:

  • Effective care is more than simply treating the condition or symptom that a patient or service user may present with. It should be about working to secure wellbeing holistically for the individual.
  • Effective care is not simply about individual practice, but is also influenced by the structural issues around how care services are commissioned and delivered.
  • Holistic care requires seamless care pathways, with effective referral and signposting.
  • Health and social care agencies are working in a context of significant transformations while resources are increasingly scarce. While there are drivers for better integration (e.g. between health and social care), other forces may lead to greater fragmentation (e.g. diversification in the service provider market).

The implications of all the above are then drawn out for health and social care professionals and agencies so that the issues are ‘made real’ for them. For example:

  • Victims are not likely to be talking about their experiences using the language of hate crime. Instead, they will be presenting with a range of physical and/or mental health issues.
  • Self-harm, depression, anxiety, self-exclusion, hyper-tension, etc. may be proxy indicators of ‘something else’ happening in the lives of patients. Having conversations around the reasons behind manifest symptoms will be important.
  • Certain institutional care settings may exacerbate power imbalance between care provider and care recipient. This may lead, for instance, to care workers perpetrating ‘abuse’ against patients and service users.
  • The terminology of ‘abuse’ and ‘care failing’ can mean that effective redress through the criminal justice system does not take place.

A conceptual framework

Building on the above, we developed a conceptual framework for informing potential solutions. This involved clustering services into ‘acute’, ‘primary’, ‘community’ and ‘specialised’. Within each of these headings, we worked with partners to identify the types of services that played a supportive and/or prevention function, as well as whether service users are likely to present with physical and/or mental health conditions.

As a result of this, we came to the following recommendations:

  • Key ‘points of entry/ contact’ for prioritisation should be community and primary care.
  • Mental health appears to be particularly important as a point of intervention. We suggest, in the first instance, to target relevant agencies.
  • With the agreed focus, work is underway to clarify procedures for detection, referral, assessment, signposting, following-up, and reporting on to the police. This involves working in collaboration with a plethora of agencies and individuals to co-produce solutions.