Sore throats and false nails – the ambulance call-outs that cost millions

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Brian A Jackson/Shutterstock

Keegan Clay Shepard, Edge Hill University

Ambulance call-outs are increasing, resulting in services operating under enormous, and probably unsustainable, pressure. While most calls do need an emergency response, far too many don’t. A study of 300 consecutive emergency ambulance arrivals to an accident and emergency (A&E) department in London, England, found that only 54% of the patients legitimately needed an ambulance.

The tabloid press are fond of reporting daft ambulance call-outs, like one to revive a dead pigeon, and another to see if McDonald’s had run out of chicken nuggets. Funny though they are, these kinds of calls put a strain on services and take paramedics away from emergencies that are genuinely life threatening.

These calls can also be truly disheartening for paramedics who see themselves as health professionals who are there to treat people and save lives. Research has found this to be a common concern among paramedics who are obliged to respond to patients no matter how silly they perceive the call to be. In my ongoing study of the perceptions of patient safety in three English ambulance service NHS trusts, an emergency operations centre supervisor told me of her frustration:

I have questioned one drunken man’s request for an ambulance because he had a sore throat, and this is when there were 23 calls waiting to get through, and I was angry about that.

Her anger at situations like these is both understandable and common, with one paramedic involved in my study discussing his concern for other patients with legitimate emergencies, when having to respond to calls they find to be ridiculous:

You laugh, but when I started I got a call-out to a girl because of false nails. She’d been playing with her boyfriend, bent her nail, bent back and the nail come off … And while I’m dealing with that, there could be a cardiac arrest somewhere, someone could be stuck under a lorry.

Not an emergency. CRM/Shutterstock.com

As well as tying up resources that could be used to treat genuine medical emergencies and increasing the waiting times at A&E departments, these calls can be expensive for the ambulance services. In the UK, each call costs about £7, £180 if an ambulance is sent to treat a patient and £233 if the patient is brought to the emergency department. Given that a significant portion of calls are seen as not requiring an emergency response, this can add up to millions of pounds every year.

24/7 culture

Although the rise in the rate of demand for ambulance services, at 6.5% each year, is relatively recent in the UK, inappropriate call-outs have been documented in research going back at least two decades. One study proposed a couple of reasons why patients phone the emergency services for conditions that could be treated in primary care, including difficulty getting a GP appointment and a perception that they will be treated more quickly.

The high number of inappropriate calls could also be attributed to a 24/7 culture, where people expect immediate treatment for any condition, no matter the severity. A paramedic in my study considered it to be a generational problem, with millennials making the most of these calls:

It’s a great generation, but young people today don’t understand what the services are for, and we didn’t have this problem as bad some decades ago. They will call us for just about anything.

Public awareness

With demand projected to increase in coming years, it is clear that the ambulance services need to address the issue of inappropriate call-outs soon. Many things can be done to lessen the pressures of demand and to allocate the resources of the ambulance services more efficiently. However, to reduce the number of silly call-outs, it’s clear that public perception of what the ambulance service is for, needs to change.

Awareness could be spread through educational campaigns, using social media to reach the patients online, such as South Central Ambulance Service’s 999 Misuse Costs Lives campaign, which informed patients of when it’s appropriate to dial 999 and when it’s appropriate to use a different service, such as a GP clinic.

The ConversationAlthough changing people’s expectations is essential, a more holistic approach will also be necessary – one that gives patients appropriate access to alternative care settings, such as their GP or walk-in centres. Until this is done, some people will continue to rely on the ambulance service to treat minor ailments.

Keegan Clay Shepard, PhD Student and Graduate Teaching Assistant, Edge Hill University

This article was originally published on The Conversation. Read the original article.

‘As a gay man, escaping the North was a matter of life and death’

By Billy Cowan, Senior Lecturer in Creative Writing.

In April 1998 when Tony Blair and Bertie Ahern were signing the Good Friday agreement at Castle Buildings, I was just coming to the end of a degree in Creative Writing and Theatre Studies at Liverpool John Moore’s University. As a young, gay, Northern Irish man from a staunchly loyalist background, I had willingly left the armoured vehicles and the red, white and blue pavements behind for a more peaceful life in England.

For me as for lots of other young, Northern Irish people who grew up during the Troubles, getting out was an existential necessity. As a gay man it was even more a matter of life and death. Staying would have meant the subjugation of my sexuality and desire, the negation of my identity.

Growing up in a household ruled by a homophobic, bigoted matriarch who had pictures of the Reverend Ian Paisley mounted on her walls, also meant that my home-life was just as much a warzone as the one outside, and I desperately needed to escape.

From the age of about twelve to seventeen, daily battles with my Ma felt no less as terrifying and bloody as the tit for tat battles taking place in the rest of The Province. I remember clearly the “screaming matches” we used to have during the time of the Anglo-Irish Agreement (AIA) and the Ulster Says No protests. I thought the AIA was a step in the right direction; an opportunity for dialogue with all sides concerned. Ma thought it was one step closer to a united Ireland and the erosion of her Protestant identity.

When I used to challenge her about this Protestant identity, highlighting the fact she never set foot in a church or appeared to have any Christian values, she’d retort that she was a Protestant politically not religiously! You could never win with my mother.

The effect of this upbringing was to make me quite apolitical; completely apathetic to the situation in the North. I didn’t really care whether Ireland was united or if the six counties remained part of the UK. I didn’t really feel Irish, and I didn’t really feel British. I didn’t care what flag flew above my head except, maybe, the rainbow flag.

The one thing I did care about, though, was peace. I wanted the killings and the pain to stop. So, when the agreement was mooted I was full of hope. Here was a real chance of peace, and I wanted it to work out.

Ma, of course, like the DUP, was against it. The very mention of the word “peace” would cause her to fly into a rage, barking like a rabid dog about us Protestants being sold down the river Lagan and into the South, and how we’d soon be controlled by Rome. She hated the idea of the Republic having any say in the future of Northern Ireland; not even the Nineteenth Amendment that rescinded the Republic’s irredentist claim on Northern Ireland could appease her.

Paramilitarism

The negative responses of the DUP and my mother infuriated me and for the first time in my life I was compelled to respond to the political situation. Making use of my three years study of theatre and creative writing, I decided to write a play. Inspired by Queer Theory and Judith Butler’s idea of “queering” I was going to take the situation in Northern Ireland and turn it into a queer farce.

It was going to be outrageous and provocative; it was going to subvert the usual macho, heterosexual Troubles narrative that always focused on paramilitarism; it was going to be personal, a way to come to terms with my mother and my upbringing; and, most importantly, it was going to end on a hopeful note of reconciliation and peace to reflect the tangible hope that I, and many others, felt in April 1998.

I set about writing the play. My mother became Peggy Morrow and I was her son, Kyle. When Kyle comes out to Peggy, on the eve of the Good Friday agreement, she demands he leave the house. Instead Kyle barricades himself into his bedroom and goes on hunger strike until she changes her mind and accepts him for what he is.

The divided household and the “war” that ensues was the perfect metaphor for the conflict in the North. Peggy represented Unionism, Kyle Nationalism. Once this central conceit was in place, the play practically wrote itself. By the end of three or four weeks, Smilin’ Through was born: a mad-cap play with song and dance numbers; dream sequences; fellatio; dead terrorists; members of paramilitary organisations called Ulster Against Faggots and the Irish Queer Liberation Army; religious leaders called Reverend McMillan and Cardinal Dainty who come together to persuade Peggy to keep up her stance against Kyle and homosexuality.

I even had a singing Canadian Mountie who appeared to Peggy in fantasy sequences and is the one who helps her see the error of her ways. This character was based on one of my mother’s favourite Hollywood stars from the 30s and 40s, Nelson Eddy. To me, it was the perfect way to represent the former US Senator George Mitchell who was mediating the peace talks at Stormont.

Power-sharing

Ironically, like the road to peace, the road to production of the play was long, and there were many hiccups and milestones on the way. In 2002, three years after it was written, it won the Writing Out award for best new gay play, organised by Finborough Theatre London, and then in 2004 it won Contact Theatre’s Flip the Script slam.

This led to John McGrath of Contact commissioning the play and finally co-producing it in 2005 with Birmingham Repertory Theatre. Although the play was produced almost seven years after the Good Friday agreement it was still relevant because peace in Northern Ireland at that point remained tenuous; the IRA’s decommissioning of its weapons wasn’t fully achieved until September 2005 and the devolved government at Stormont had been suspended because the unionists lacked the trust needed to enter the power-sharing Executive. My play, with its happy ending where Peggy and Kyle are reunited in a rendition of Smilin’ Through, one of my mother’s favourite songs, offered some much needed positivity.

On the opening night at the Birmingham Rep, I sat at the back of the auditorium and cried as the audience responded with riotous laughter and rapturous applause. I didn’t cry because I felt proud or relieved that it had finally been produced. I cried for Peggy and Kyle, for me and my mother. I cried for all those who had suffered in the years preceding the Good Friday agreement. And I cried for Northern Ireland, its past and its future.

 

Billy Cowan is Senior lecturer in Creative Writing at Edge Hill University. Smilin’ Through went on to be nominated for best new play at the Manchester Evening News theatre awards 2005. It is published by Playdead Press.

Why the age of sexual consent continues to be a worldwide challenge

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shutterstock/MIAStudio

Michael Richards, Edge Hill University

France is considering changing its legal age of consent so that sex before the age of 15 is automatically considered rape after recent child sex cases raised serious concerns. At the moment, prosecutors have to prove that the underage sex was non-consensual to obtain a rape conviction.

The change is being proposed as a way to tackle issues with the laws in France that mean if no violence or coercion has taken place or been proved, offenders can only be charged with sexual abuse and not rape. In fact, sentences of this nature are the same for sexual assaults of minors and non-minors.

The debate around the age of consent is still as relevant and as serious as it ever was. In the UK, the age of consent is 16. But in Germany and Italy it is 14, whereas in Turkey the age of consent is 18. Yet, if we consider that one in three teenagers are having sex before the age of 16, does that mean the age of consent needs to be considered again in the UK?

 

Children and the law

It is an issue that emerges time and time again in the UK and it always remains at deadlock. But does UK law ensure that our children are always on the edge of being a “sex offender”?

In the UK, under the Sexual Offences Act 2003, it is illegal to engage in sexual activity with someone under the age of 16. In some cases, it may be a defence to say that it was reasonable that there was a belief that the person was 16 or over. But, ordinarily, a “sex offender” is likely to be imprisoned for around five years if someone was under 18 at the time. The sentence increases to ten years to life if the offender is over 18 at the time of the offence.

In effect, it does not matter what your age is. But if you have sex with someone under 16, you become a sex offender. That is despite half of all UK teenagers having their first sexual experience by the age of 14, according to the National Survey of Sexual Attitudes and Lifestyles. So is it right to see young people hauled before the courts, convicted and put on a sex offenders register alongside adult rapists and paedophiles?

This is the reality but the law is there for a reason – to protect the vulnerable and less experienced. Although this does not always happen. The NSPCC says five child sex offences are reported every hour. It is no surprise then that people have expressed concerns that some sex offenders would see any change in the law on consent as an opportunity to focus their sexual intentions on young teenagers. The worry is it could lead to an increase in abuse cases and increasing pressure to have sex at a younger age.

Some are concerned that it might lead to a further increase in STI rates and unwanted pregnancies (the UK has some of the highest rates of teenage pregnancies in Western Europe).

There are wider issues relating to the sexualisation of childhood and the culture that we live in. Can we not just let children be children?

There is also the issue of education – or lack of it – in schools and at home relating to sexual consent and behaviour. So lowering the age of consent is not necessarily the answer.

A confusing global picture

While 16 remains the average age of consent in Europe and beyond, there are dramatic differences globally. This ensures there are confused messages about when it is right to have sex or not. In some countries, you have to be married before you have any sexual relations (Iran, Pakistan and Saudi Arabia). In other countries, you can have sex from the age of 11 (Nigeria) and quite a few countries allow the age of consent to be 13, including Japan and Niger. For many, for the age of consent to be so low is unthinkable. But it may reflect the traditions, religion, culture and history of a particular country.

Perhaps the laws of consent need to be more flexible and realistic to ensure that young people are protected. At the same time, there must be an appreciation that many reach sexual maturity quicker than others and therefore are able to make choices about their own bodies. For example, in Canada, while the age of consent is 16, the legislation is constructed in such a way that older sexual predators would be prosecuted rather than young teenagers who might be in established relationships, even if they have not quite reached the age of 16. This also alleviates some of the pressure associated with having sex at a younger age.

The issue of consent is an emotive one that may never be fully resolved. But it is an important issue for people of all ages. France is having that debate once again. Perhaps it is time the UK joined in?

Michael Richards, Lecturer in Applied Health and Social Care, Edge Hill University

This article was originally published on The Conversation. Read the original article.

Inclusive medical schools are a must

Edge Hill Vice-Chancellor John Cater explains why the new non-Russell Group medical schools are so vital:

Two and a half decades ago, in my first full year in the day job, I am on the Euston Road in London. Half a mile away, 17 universities are meeting in the Russell Hotel.

Edge Hill did not qualify for university title in the early 1990s. Although it had recently merged with three schools of nursing and midwifery, it was, at best, what estate agents euphemistically call a “development opportunity”.

In 2006 it acquired full university status, and this week it was granted one of the five new medical schools.

The NHS is in difficulty. Unwise cuts in commissions early in the coalition government years have been compounded by budgetary shortages, the need for safe staffing levels and policy changes that are making the UK a less attractive destination for professionals from overseas.

In response, the cap has been lifted on nursing recruitment, although negative perceptions of the new tuition fee regime are stifling demand for less popular programmes, and last year the secretary of state announced plans to recruit 1,500 additional trainee doctors.

The first 500 places were allocated in the autumn to existing medical schools, and every such school has also participated successfully in the second bidding round, taking up a further 590 places.

But just over 400 places have been allocated to five new schools. Partnership arrangements between Nottingham and Lincoln and Kent and Canterbury Christ Church have been rewarded with just under half of this number, with three new free-standing schools being approved, in Chelmsford, Sunderland and, smallest of all…Ormskirk.

Geographically disparate, the three new schools all have something in common: resonance with the Department of Health’s clearly expressed commitment to widen participation in medical education.

Edge Hill University was founded in the 1880s with a mission to provide access to higher education, and it has sought to remain true to that vision for the past 130 years, working closely with schools and colleges as the regional lead for Aim Higher, the sponsor of the local lifelong learning network and the national host of Action on Access.

To twin-track excellence and accessibility has not always been easy, but the prize is worth fighting for. It is half a century since we pioneered innovative programmes that qualified graduates as both teachers and nurses of children with learning disabilities, and today we train individuals to qualify both as nurses and social workers, recruiting heavily from Merseyside, the overspill estates and the former mill and mining towns of the north west.

This integration is important to us. Hospitals and communities operate better when individuals bring skill sets, and parity of esteem, and work together in teams. The challenges in our region are substantial; my office is on the outskirts of one town and four miles from another. The difference in average life expectancy between the two, just 10 minutes’ drive away, is 10 years.

This also influences what our new medical school will do. We have eschewed the opportunity to start before 2020 because we intend to start in other ways before 2020; we begin today, raising awareness and ambition with Year 9, 10 and 11 pupils in schools and colleges in less privileged parts of the region, offering a foundation programme in 2019 for those with less conventional qualifications, before taking our first intake of medical undergraduates the following year.

Our specialisms will be different, too. While covering the full curriculum, we will have a particular focus on general practice, on primary care, health promotion, nutrition, psychiatry, palliative care, on the ability to treat patients at home not in hospital, and to help prevent preventable ills.

And we want our locally trained doctors to return to and work in local communities, communities where recruiting trained medics is challenging but where the healthcare needs are greatest.

Will it be tough? You bet. Will it cost us money? It will, as we invest in new staff, new equipment and a brand-new clinical skills centre, as well as outreach facilities in our hospitals and our community.

We are starting small, making sure that we get it right, but building on our experience in providing master’s of surgery and master’s of medicine postgraduate programmes for qualified doctors over the past decade.

Should we be doing it? Undoubtedly. Of course the perceived reputational benefits matter, but the fit is right – clinicians alongside our trainee nurses and midwives, social workers and nutritionists, paramedics and operating theatre staff.

More important, the fit is right ideologically, too. Universities have had a bad press over the past year, but we are here to improve life chances and to educate and train those who can improve others’ life chances.

A community-focused medical school on the fringes of areas of multiple deprivation is a wonderful opportunity to take that commitment, that ideology, and put it into practice.

Virtual reality experience helps demystify the family court process

As part of the Greater Manchester Court plan, a new virtual reality court experience has been designed to help demystify the family court process.

The project, supported by government and the judiciary, has been described as pioneering – claimed to be the first of its kind in the UK. The purpose is to help children, involved in vulnerable care or protection proceedings, understand what is happening and feel less intimidated or fearful of the court system. It can help children to understand how decisions about them are being made. The technology could also be beneficial for helping vulnerable adult witnesses providing evidence.

The project, devised by legal experts from the University of Salford, involves children watching a video with a virtual reality headset to get a clearer picture of how the courts work. The video can help children to understand what it is like entering the building and going through security. Crucially, it shows what it is like in a court room as the process of a court hearing is captured on film for children to watch. This innovative virtual reality experience could also be beneficial for those attending the youth court. Many young people in the justice system often find court a disengaging experience. The language used by magistrates is often complicated legal jargon. Power inequalities exist and they often only provide basic information, feeling, at times, their views are rendered invalid. Using this technology with children, prior to attending the youth court could potentially result in them feeling less anxious and increase their willingness to participate in proceedings.

To digress slightly, it is worth remembering, meaningful participation – where children influence change and shape decision-making processes – has the potential to be an empowering and life-changing experience. This was discussed at a Clinks event I attended with Peer Power, Everton in the Community and Beyond Youth Custody. The purpose of the event was to share best practice and discuss the challenges associated with youth participation. It was argued participation should not be tokenistic but rather young people should be treated as assets to the service.

Similarly, at a Peer Power event at Edge Hill University last week, it was argued youth justice and children’s services should prioritise building empathic relationships – creating a sense of mutual respect, trust and belonging. In addition to creating an emotionally safe workforce, Peer Power advocated shared decision-making and children’s voices being listened to and acted upon throughout systems.

However, children attending the youth court continue to find it a disempowering experience. They are often unsure of requirements and processes. For example, many of my PhD participants described the court process as scary and confusing.

The new virtual reality court experience could be adapted and used with children who are required to attend the youth court. It could help to demystify the process and make children feel more comfortable and relaxed about proceedings.

Sean Creaney is a Lecturer in Psychosocial Analysis of Offending Behaviour in the Faculty of Health & Social Care at Edge Hill University. He is a former Trustee at the National Association for Youth Justice. He is currently an advisor at the social justice charity Peer Power, and a PhD candidate at Liverpool John Moores University. He also writes The Youth Justice Blog in Children and Young People Now.

How it feels to be diagnosed with autism later in life

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Michael Richards, Edge Hill University

“He is wired differently to you and me, this child of mine. He doesn’t like loud noises, or dark spaces, or strangers touching his head”. These are the first lines from a poem a mother penned about her son 11-year-old son who has Asperger’s syndrome.

Sophie Billington goes on to explain how her son Tristan’s brain works differently: “He can see in an instant the pattern, the layout, the solution to a puzzle”, but that “the world judges” and “sees only the outbursts and over-reactions”. It seems the poem struck a chord – going viral after being posted
on Facebook.

Although autism is predominantly diagnosed in childhood, increasing numbers of adults are finding out that they too have autism. This issue, of later life diagnosis, was brought to light recently after nature photographer and TV presenter, Chris Packham, went public with his experiences.

About 1% of the adult population has been diagnosed as on the autism spectrum – with more people diagnosed with autism than ever before. And yet, generally, the focus on who has autism is still mostly on infants, children and young adults.

This is despite the fact that autism can be defined as a lifelong neurodevelopmental disorder – characterised by differences in social communication and interaction with people and wider society – making it very much a label for people of all ages.

Not just for children

There are currently about 700,000 people in the UK who have been diagnosed with autism, in some form or another. But of course, there may well be many more who meet the criteria of autism but have not been diagnosed.

For these people, they will not have received the care, benefits, support or advice that people with a diagnosis are given. Instead, the judgements made about their behaviour may well have led to marginalisation, anxiety and insecurity and self doubt about who they are and how they fit into society.

Mental illness can also be more common for people on the autism spectrum – with higher rates of anxiety disorders and depression. These issues may well have developed from experiences of bullying, at home or the workplace, and from being seen as “being a bit odd”.

Then there is also the issue that since 2013, definitions of autism have changed. Now, Asperger’s Syndrome – one of several previously separate sub-types of autism – is no longer diagnosed separately, but amalgamated into “Autism Spectrum Disorders”. This may make some adults feel alienated and unsure about what their diagnosis actually means – as well as what support they may receive.

Diagnosed as an adult

For some adults who are diagnosed later in life, it is likely they have already found ways to cope and be resilient in the face of discrimination and stereotyping.

But this is not always the case. Some adults with autism still face daily and lifelong battles to cope in their day-to-day lives. They may also find things like getting a job, meeting new people and having personal relationships really difficult.

The NHS website highlights that it might be a positive step to be diagnosed with autism as an adult – presumably because you may receive support, care and benefits. To what extent a person will actually receive this additional help is another issue. And given the increasing rates with which children and young people are being diagnosed with autism, it is likely that adults who are diagnosed later on, are going to struggle to access the support they really need.

Celebrating differences

Even when adults do get referred for an assessment for autism they are likely to face lengthy waits and processes – with clinical language being used that can be misunderstood. It can also tend to focus on the deficit rather than the skills of autism – such as creativity, expertise and talents.

Without support, autism can make people feel isolated and vulnerable. Shutterstock

In this way, then, people who come to an autism diagnosis later in life are likely to continue to experience mental health issues, alongside the stigma, prejudice and discrimination associated with people with learning disabilities.

There are of course many different viewpoints to understanding autism – whether they be from a purely medical perspective, or from a social perspective that takes into account cultural and political factors.

The ConversationBut rather than seeing autism just as a deficit or something that is “not normal” we need to see it as a way to think about how different people are. Because after all, it is through difference that we learn more, achieve more and add more substance to day-to-day life in society.

Michael Richards, Lecturer in Applied Health and Social Care, Edge Hill University

This article was originally published on The Conversation. Read the original article.

Some Christian groups still promote ‘gay conversion therapy’ – but their influence is waning

Chris Greenough, Edge Hill University

The idea that to be gay is to be sick and in need of a cure might seem archaic and bizarre by mainstream standards, but among a few fundamentalist Christian groups, it lives on today.

Recently, one such group, the Core Issues Trust, booked a cinema in London’s West End for a film screening event which advocated conversion from homosexuality. The film, Voices of the Silenced, promotes the idea that people can be “rescued” from homosexual impulses and practices, and was also supported by representatives from Christian Concern. After an outcry, the screening was ultimately cancelled by the cinema, where the group staged a public protest on February 8.

This was an unusually conspicuous appearance by what remains a relatively fringe organisation. Core Issues Trust, Christian Concern and similar groups claim that people identifying as non-heterosexual can be “converted” into heterosexuals. Presently, there is no ban on gay conversion therapy in the UK. But whereas “ex-gay” ministries have received plenty of coverage in the US, it’s unusual to see a Christian group like this operating visibly in the UK.

For many, non-heterosexuality and Christianity are still hard to reconcile. This is largely due to the long history of negativity towards non-heterosexuals from Christian groups. Today, the Church of England’s position is much more promising: in 2017, the General Synod voted in favour of not continuing with its ban on blessing or marrying same-sex couples – a major rubicon in its journey towards full inclusiveness. What’s more, the Church of England General Synod has also called for a ban on gay conversion therapy.

But while it might sound like a sea change is underway, there’s still a way to go. While the Core Issues Trust’s values and actions are clearly out of date and largely out of favour, they still find enough of an audience to sustain themselves.

Clash of identities

Some Christians find it hugely difficult to reconcile their non-heterosexuality with their faith. This often leads to negative feelings of fear, anxiety, loneliness, confusion and self-hatred. Conversion therapies recognise and exploit the resulting negative emotions and internal conflict, and offer to resolve the clash of identities by “freeing” people from homosexuality.

In my book Undoing Theology: Life Stories from Non-normative Christians, I spend a chapter exploring the emotional roller coaster of one individual’s journey with Christian “conversion” therapy. Desiring release and repair from negative, internalised feelings, non-heterosexual people essentially find themselves forced to bargain – challenged to accept such a “cure” in exchange for a better life.

While being involved in communities which offer such a “cure” can provide a space for the two incompatible identities of non-heterosexual individuals to temporarily coexist, the long-term consequences are damaging. Of course, throughout history, similar non-religious based “therapeutic” methods have been tried, among them extreme physical medical procedures: castrations, lobotomies, clitoridectomies and shock treatments. Then there are “psychiatric” procedures to deal with the mental state of the “sick” gay person, chief among them hypnosis.

As the protagonist in my book affirmed after spending 18 years within the ex-gay ministry, these extreme physical, psychological and spiritual attempts do not work. They are highly destructive and often painful – and their failure indicates that the very possibility of conversion is a lie.

Pushing back

Even for those who don’t undergo therapy themselves, the lie has pernicious impact. Proposing to “cure” or “convert” non-heterosexual people is a form of delegitimisation. It is wholly unethical. It is a denial of human rights. It encourages internalised homophobia and self-hatred. In the UK, both religion and sexuality are included in equality legislation as protected characteristics – but the screening in London shows that extreme religious views on sexuality are still being asserted in public.

Fortunately, a large proportion of both the clergy and the faithful who remain in the pews share inclusive, accepting attitudes more in step with the mainstream. And inside many Christian communities, efforts are underway to improve the situation further. Open Table offers an inclusive worship community and a safe sacred space for non-heterosexual and non-cisgender Christians. Many more groups offer bespoke opportunities for people to come together and practise their faith without negating their identity.

While the small minority of Christian groups spreading this negativity has not gone away, thankfully there are fewer examples of such hostility. (The Student Union at my own university recently celebrated pride week, and the Christian Union group publicly announced its solidarity.) Sexuality remains a controversial issue for the churches, but it also serves as a measure of inclusivity.

The ConversationEvidently, some fundamentalist Christian groups remain obsessed with non-heterosexuality, and put considerable energy into railing against it wherever they can. The cumulative impact of their actions is highly damaging and toxic to the people they reach. A broad ban on conversation therapy – whether relating to sexuality or gender identity – is long overdue.

Chris Greenough, Senior Lecturer in Theology and Religion, Edge Hill University

This article was originally published on The Conversation. Read the original article.

The James Bulger case should not set the age of criminal responsibility

Sean Creaney

Sean Creaney, Edge Hill University; Roger Smith, Durham University, and Stephen Case, Loughborough University

On February 12, 1993, two-year-old James Bulger was abducted and murdered by 10-year-olds Jon Venables and Robert Thompson. It was a crime that stunned the world and the shadow of it still looms large over British culture and the English justice system. In her new book about the killing, James’ mother, Denise Fergus, talks about how she believes the legal system failed – and continues to fail – her family following the subsequent release of the child murderers. And just this week, the story was in the news again after one of the killers – the former Jon Venables – was jailed for 40 months for possessing child abuse images.

The Bulger case fed into a political, media and – as a result – public climate of opinion that young offenders were wicked, irresponsible, immoral and evil. But these perceptions are based on an extremely rare crime and invalid presumptions of an unfit system, fuelling more general stereotypes and knee-jerk responses.

The case has continued to generate strong feelings and fervent debate about how the two offenders should have been treated and this is as much a moral argument as it is a matter of rational reflection on rights, responsibilities and what the evidence tells us. For example, this one case is still highly pertinent to discussions around the age of criminal responsibility.

Out of step

Despite repeated criticism from the United Nations Committee on the Rights of the Child, in England and Wales the age of criminal responsibility has remained at ten since 1963 – one of the lowest in Europe. But this is incompatible with what we know of children’s “evolving capacities” (the way children mature).

With the average age of criminal responsibility being 14, the UK is out of step with the rest of Europe. This does not mean that other countries ignore crimes committed by younger children. Instead, they deal with them through the child protection and welfare systems, as in the Norwegian case which bore some notable similarities to that of the James Bulger murder.

Repeated calls to raise the age at which children can be prosecuted have never been taken seriously, at least partly because of the James Bulger case, as it continues to trouble the hearts and minds of the British public. Venables and Thompson were described as “cunning” and “wicked” and their behaviour as an act of “unparalleled evil and barbarity”. Although incredibly serious and shocking, this was a very rare crime. But it continues to influence how young children who cause harm are dealt with in general.

The persistence with which the law seeks to criminalise children contravenes international rights and is unfair, illogical and contradictory. At the age of ten, children are deemed capable of criminal intent yet not “mature” enough to seek paid employment until the age of 13. They cannot marry without parental permission until the age of 16, drive until 17 or vote in a general election until they are 18.

The UK government claims it is common sense to assume that 10-year-old children know the difference between right and wrong and to prosecute them for offences is perfectly legitimate. But this is much too simplistic and flies in the face of the available evidence. It runs counter to all we know about the processes by which children learn and develop the capacity to make fully informed moral judgements and behavioural choices.

Headlines v evidence

Despite recurrent headlines such as “Rise of the child offender? The under 10s linked to drugs, sex and violence crimes on Merseyside”, offences by young children of a seriously violent or sexual nature are very rare. Those who do commit such offences have often been harmed themselves and come from chaotic backgrounds, with histories of poor mental health, dysfunctional families and backgrounds of emotional, physical or sexual abuse.

Most offending by young people is relatively low-level, constituting only one part of a much broader and more complex identity. Subjecting young children to criminal justice intervention is counterproductive and developmentally damaging. A criminalising, stigmatising and labelling course of action prevents the child from pursuing a “good life” – one of purpose and meaning. Justice systems do not help to promote a non-criminal identity as the evidence confirms. In fact, contact with the justice system reinforces a criminal identity, making it harder for the children to escape the criminal path.

The ConversationDespite the evidence and the claim that society would be better served if the age of criminal responsibility was substantially increased, reform is unlikely. Government will not contemplate raising the age of criminal responsibility in England and Wales while the shadow of James Bulger looms large over any such discussion. If there is no change, children will continue to be denied justice appropriate to their age and maturity.

Sean Creaney, Lecturer in Psychosocial Analysis of Offending Behaviour, Edge Hill University; Roger Smith, Professor of Social Work, Durham University, and Stephen Case, Professor of Criminology, Loughborough University

This article was originally published on The Conversation. Read the original article.

Why we need to review joint enterprise laws

Joint enterprise is a controversial common law doctrine. It was claimed – in a recent debate secured by the Labour MP Lucy Powell – joint enterprise has ‘produced one of the biggest and most widespread miscarriages of justice ever to face our justice system’. Many MPs backed calls for a review.

Put simply, joint enterprise is when two or more people are deemed criminally liable for a single crime. You can be deemed criminally liable by being associated with a crime even if involvement was peripheral. In other words, they don’t have to have shown intent or have delivered the ‘killer blow’.

Joint Enterprise not Guilty by Association (JENGbA) co-founder Jan Cunliffe recently delivered an inspiring guest lecture at Edge Hill University, arguing that joint enterprise is an outdated, prehistoric law that draws innocent people – especially vulnerable children and Black Asian Minority Ethnic (BAME) individuals – into the criminal justice system.

At the Edge Hill event, Jan discussed her son Jordan Cunliffe’s case, explaining how he did not witness the murder of Gary Newlove as he was blind. Thus, Jan said he could not have understood what was happening let alone encourage what he could not see. Despite this, the jury found him guilty of murder and as Jan alluded to this was because of joint enterprise, or the notion of ‘possible foresight’ being applied.

It has been argued Jordan Cunliffe has one thing in common with others listed on the JENGbA website – they have not been found guilty ‘beyond all reasonable doubt’ but rather on the basis of a ‘possibility’.

The government need to take the JENGbA campaign seriously. I urge you to support the brave and persistent JENGbA campaign and help to address wrongful convictions of, according to JENGbA and acknowledged in the recent debate in the House of Commons, hundreds of innocent people.

Sean Creaney is a Lecturer in Psychosocial Analysis of Offending Behaviour in the Faculty of Health & Social Care at Edge Hill University. He is a former Trustee at the National Association for Youth Justice. He is currently an advisor at the social justice charity Peer Power, and a PhD candidate at Liverpool John Moores University. He also writes The Youth Justice Blog in Children and Young People Now.

Banning piercings for under 18s may be medically a good idea, but it takes away choice and self-esteem

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Shutterstock

Michael Richards, Edge Hill University

It is now an offence for under-18s in Wales to get any intimate piercings – meaning tongue, genitals and nipples. One of the main arguments for this ban is that young people under 18 are still physically developing and that these kinds of piercings can stifle that development and lead to infection.

It’s a fair point – but this also feels like a frustrating barrier for young people who want control over their own bodies – and the reaction from young people in Wales has been mixed. Some think their peers rush into getting a piercing too quickly, while others say it should be about what makes you happy.

When teenagers hit 16, they can (among other things) consent to medical and surgical procedures, drink alcohol, have sex, and join the armed forces. So it’s hard to see what the problem is with a little stud, bar or hoop when they are legally grown up enough to do all these other things. If young people can do all this before they reach 18 years old, surely they can alter or enhance their body in any way they like?

The ban, particularly for 16 and 17-year olds, may feel like nothing more than just another barrier to those who want to, and feel ready to, take responsibility for their own bodies.

Piercings, not problems. Shutterstock

Teenagers are going to rebel, experiment and try new things. In the USA, more young people over 18 than ever before are getting piercings as well as tattoos. In the UK there has been a similar boom in young people getting piercings over the past 20 years – and having piercings has become a rite of passage for many. Something to get excited about – no different from a first alcoholic drink, or finally being able to call themselves an “adult” when they reach 18.

The problem is that there can be serious health effects when getting a piercing. Even non-intimate ear piercings can result in keloid scars, while piercings on all parts of the body, can give rise to serious infections and even disfigurement. Researchers have found that young people who get piercings are likely to experience swelling, infection and bleeding, particularly in intimate areas of the body. In a 2008 study of piercings in England – which has been cited by the Welsh government – 28% of people who had body piercings experienced complications, while 13% had serious problems. In addition, one in 100 piercings among 16 to 24-year-olds saw them being admitted to hospital.

Risky business

The health risks of getting an intimate piercing appear to be high. So when the medical perspective on piercing is considered, there appears to be complete justification for the ban. There is also the issue of children being placed in potentially vulnerable situations to consider. Giving evidence to the Welsh government, the Chartered Institute for Environmental Health said this:

If you go to a doctor for an intimate examination, you’re entitled to have a chaperone there, and the doctor, or whoever is involved, will have had a criminal record check at some point.

We have practitioners who have had no checks at all around sexual offences that they may have carried out, or assaults that they may have carried out. But people are putting themselves, and children are putting themselves, in an extremely vulnerable position.

Another valid point – there are child protection issues at play here. But surely that is the case for any adult who may get an intimate piercing too?

For many people, making choices over their own body is empowering, makes them feel good and helps them to feel that they look good, which lifts self-esteem, positivity and confidence. This is so important for young people today, with so many experiencing negativity about their bodies, having suicidal thoughts and urges towards self-harm.

The ConversationYoung people are always striving for control over their own minds and bodies – so being able to feel good about themselves is likely to overwhelm any common sense relating to the health risks that come with piercings. If a young person who can legally do many things wants to feel good about themselves by having a piercing, is it really so bad? This is about about choice – and the ban takes away choice for people who feel happy to have piercings on their body.

Michael Richards, Lecturer in Applied Health and Social Care, Edge Hill University

This article was originally published on The Conversation. Read the original article.