What the UK knows about violent crime that the US can't figure out

The GOP is ignorant of the link between alleviating child poverty and crime reduction, despite mounds of evidence

Published July 17, 2021 2:00PM (EDT)

Person's hands holding prison bars (Getty Images)
Person's hands holding prison bars (Getty Images)

Is it possible that Republicans are unaware of the intrinsic link between alleviating child poverty and crime reduction, despite a wealth of evidence from around the world?  This week, the Internal Revenue Service (IRS) began rolling out President Biden's new child tax credit as part of his $1.9 trillion American Rescue Plan. The expanded benefits aim to lift half of the country's smallest citizens out of poverty. As a British forensic psychiatrist and psychotherapist, this caught my attention.  Although an outsider looking in, I was surprised the legislation passed without a single Republican vote in support, especially in light of their 'tough' stance on crime.

Poverty is a form of "Adverse Childhood Experience" (ACE) which affects future life outcomes. This is not a new idea: American researchers first highlighted the importance of ACEs in a major study in the 1990s. Their construct has since been universally adopted and supported by the global community; the WHO has even developed an 'ACE international questionnaire' to guide social investments and interventions. It is easy to grasp that poverty may cause problems such as malnourishment and chronic illness. But physical deprivation is only half the story. Having socially and materially deprived parents can also be a form of ACE, as can conditions in your community. Your ACE "score" is based on one point for every kind of negative influence: including the obvious, such as direct abuse and material neglect. Along with parental mental illness and parental substance misuse, parental incarceration is another ACE of particular concern in the US, given the high incarceration rate. 45% of the American population have had a family member incarcerated, which rises among minorities to reach 63% in the Black community.

Over the last 30 years, I have worked within the UK's National Health Service, which includes the provision of mental health care to offenders in our prisons and secure psychiatric hospitals. I provide expert testimony about the roots of violence in criminal and family courts and have studied the research evidence about the link between poverty, social inequities, mental health issues and different types of crime. I have seen firsthand in our prison population that the majority of convicted offenders are from poor backgrounds, including a disproportionate number of economically disadvantaged minorities.

The same is true in the US, albeit on a larger scale. Recent data from the CDC and others demonstrate how a child exposed to 4 or more kinds of ACE is at increased risk of criminal violence. A study of 20,000 offenders in a Florida prison found that the higher the ACE score, the more likely the offenders carried out repeated violence from an early age. The authors termed this "downstream wreckage," demonstrating how someone's chance of becoming a serious, chronic, and violent offender increased with each additional ACE point. Half of all prisoners they studied had been exposed to four or more ACEs.  Their report concludes with this warning: "the prevention of ACEs in future generations is critical and a key factor in the prevention of crime."

In my work, I have found that ACEs regularly interact with other known risk factors for violence to make cruel states of mind more likely. We are all capable of cruelty to others, just as we all have the capacity for compassion; thankfully, most of us never get to the point where we act on our darkest emotions. For someone to reach that tipping point, several elements must combine, which I compare to the way numbers align in a combination bike lock. When it comes to serious violence, the first two variables tend to be actuarial, such as being young and male. The next two include familiar ACEs, like parental substance misuse and neglect. But the final number that causes the lock to spring open, releasing sometimes fatal violence, is idiosyncratic. I've found it to be an individual experience of an intense and painful feeling with deep roots in someone's early life, very often related to early childhood trauma and unresolved feelings of horror and shame. Shame, defined by Carl Jung as a "soul-eating emotion", is central to the experience of poverty because of the impact on social status and the sense of social exclusion that attends it.

Some will protest that a simplistic correlation between poverty and violence is unfair to the majority of people who, despite being poor, are honest and pro-social; I wholeheartedly agree. The original ACE researchers knew this too, citing a range of positive influences which could neutralize a person's harmful childhood experiences, including having nurturing people to care for them, access to a good education, and social programs that support their family.  The casualties tend to be those people who lack such nurturance and access. It's also important to understand that risk identification through ACEs is not the same as prediction; there will be people who have been exposed to several ACEs who don't become criminally violent. They may be more resilient in ways we don't fully understand, or they may just be lucky. But overall, the association between high exposure to childhood adversity and later criminal violence cannot be ignored.

I understand that economic conservatives will always oppose increasing public expenditure and will likely not be interested in the observations of a British doctor coming from a "socialist" health system. Rather than debate ideologies, I would point to data, such as the UK's proportionally far lower violent crime rate relative to the US, including for homicide. I suggest the British government's introduction, in 1977, of a similar and permanent child benefit measure to Bidens' has had some impact on violence rates (alongside other factors, including our very different laws on gun possession). I also recognize that the UK has its own severe problems with incarceration and socio-economic inequity, both of which have risen sharply in the last few decades. Nor is the UK the highest social spender in GDP percentage terms; in 2019, the World Economic Forum report ranked the UK 8th, well below countries like Belgium, Spain, and Japan, and closer to the US, ranked 10th. There is much more to be done.

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The next legislative proposals from the Biden administration advocate for an even deeper investment in social programs, including making their child tax credit permanent. I wonder if resistance to this from the right can be challenged using the argument of crime reduction, which has been such a vaunted plank of Republican policy. Such a tactic could be especially potent at a moment when the right is doubling down on portraying Democrats as 'soft on crime' and deliberately warping some constructive ideas about reforming law enforcement in the wake of the George Floyd murder. How can they condemn 'defunding police' while rejecting funds for a permanent social program that could be so transformative in the fight against crime? There is also a useful analogy to the Covid pandemic. Right now,  governments around the world are racing to vaccinate their citizens against this deadly virus that has overturned all our lives. I believe the Biden Administration's rollout of the child tax benefit today can be framed as comparable and equally urgent: a kind of 'vaccination' against increased violent crime now and in the next generation.

Suppose this enhanced "Social security for children" is made permanent. Americans could see a profound impact on ACEs in the near and long term, as greater economic security plays its part in reducing anxiety, abuse and criminal behaviour in parents. Their enhanced well-being contributes to a more secure future for their children and the whole of society. The fractured global response to the pandemic has demonstrated our frailty when we are divided in the face of a threat that knows no party. We should not have to ask if we can convince each other that a society's safety and well-being depend on protecting and nourishing children as they grow. The real question may be whether, in the US, the UK, or the broader global community, we can afford not to act. 

By Gwen Adshead

Dr Gwen Adshead is one of the UK's leading forensic psychiatrists and psychotherapists. She has spent thirty years working in Broadmoor, England's largest secure psychiatric hospital, with groups and individual patients convicted of serious violent offences, as well as with people in prisons and the community. Her new book, "THE DEVIL YOU KNOW: Stories of Human Cruelty and Compassion," co-authored with Eileen Horne, will be published by Scribner on July 20, 2021. 

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Commentary Health Health Care Poverty Social Welfare United States