UEMO Study on Violence in Young Men
As General Practitioners/Family doctors we may be in a good position to prevent some of the morbidity and mortality subsequent to violent behaviour in young men. We meet them as infants, accompanied by their families for routine examinations, vaccinations, and childhood illnesses. We have the opportunity to screen for causative factors that may lead to future behavioural problems. Increasing polarisation of rich and poor in society increases the frustration of the disadvantaged.
Genetic: Fragile X syndrome. Birth injury, low IQ, mild learning disability.
Environmental: Many single mothers cope well with support from family and partners, but some have difficulties with child care, creating a poverty trap. Depression may result in poor bonding between mother and child, leading to insecurity and attention seeking behaviour. Multi-parent families can cause identity issues and poor self esteem. Lack of a good male role model, and matriarchal society may lead to rebellion against maternal, educational, and civic authority. Disaffected male relatives may be influencing a lack of respect and therefore loss of control over undesirable behaviour.
GPs could identify these issues, support the mother, advise on modifying behaviour at an early age, and refer to appropriate care, child psychiatry, social worker, educational assessment and assistance
Social housing can create a ghetto effect, with young men in gangs, feeling peer pressure to increasing antisocial behaviour, and a culture of admiration for the “hard man”. Boredom and lack of sporting facilities are contributing factors, and GPs can prescribe exercise, and advocate for facilities.
Offensive weapons , carried by young men, will lead to increasing rates of stabbing, shooting, serious injury, and deaths. Over the summer the UK announced an amnesty to hand in such weapons, which was very successful. Ireland currently has an amnesty period, with a subsequent mandatory six month sentence if found in possession of a weapon.
Education . Attention deficit, dyslexia, literacy and numeracy problems. Many of these problems can be noted during consultations, for example inability to understand forms, or instructions on medications. Disruptive pupils cause burn out in teachers, and poor morale in local schools, to the detriment of all.
Role for young men is lost. No longer a bread winner, but a liability, who may father children but not get a role in parenting, leading to frustration and angry confrontation with mother of the child. GPs could identify possible depression, and also encourage young fathers to attend antenatal visits, and be involved in child care.
Addiction
Alcoholism is a major cause of family violence, gives a poor model to young men, and can continue through generations.
One in four deaths in males aged 15 to 29 years in Europe is attributable to alcohol. (55,000 each year) Transport accidents, poisonings, self-inflicted injury, and homicide. Reference: The WHO Global Burden of Disease 2000 Study.
GPs/ family doctors could be prepared to routinely screen for hazardous drinking, and to advise patients appropriately, or refer to treatment centres, and AA support. Also one should be prepared to try to influence societal attitudes on alcohol abuse through our National Medical Associations.
Prescription drugs can be a cause of addiction to the patient, or can be sold on the street, where abuse of benzodiazepines can lead to increasingly chaotic behaviour in addicts. GPs need to strictly monitor the quantity, and frequency of these prescriptions.
Non-prescription drug abuse can cause aggression during use, and withdrawal can stimulate violent behaviour in the need to access another fix. The financing of addiction leads to crime. The supply and distribution of these drugs involves major criminal activity, and many murders, as the financial rewards are so great.
Quality controlled methadone programmes in general practice have been shown to reduce convictions, reduce harm, and allow life style change, and gainful employment. It is possible to detoxify patients from benzodiazepines also.
Cocaine use is increasing, and cocaine related prosecutions have eclipsed those for heroin in Ireland in 2005. It is widely used recreationally and not seen as a hard drug, however it can cause aggressive behaviour, not to mention health hazards.
Cannabis is seen as a soft drug, but causes brain changes, and can cause psychosis, leaving users at risk to themselves and others.
GPs should routinely ask about recreational drug use, and take the opportunity to advise on associated health risks, and offering assistance to affect change. We should try to be aware of new substances that are being used in our communities.
Conclusion
We should partake in learning, training colleagues, informing society, influencing policy locally, nationally, and in Europe , to make our contribution to prevent the avoidable mortality and morbidity that results from violence in young men.
Bergen, 7 June, 2008
