By Catriona Harwood, Social Worker and Restorative Practices Lead at QHVSS
I have experienced restorative approaches from a variety of lenses in the UK and Australia – as a victim liaison support, as a youth justice convenor, and in my current role of coordinating a restorative approach in a secure mental health unit and community mental health team. I am passionate about the limitless possibilities of how much better our world can be when we adopt this relational approach. I also acknowledge the practice wisdom and pioneering work of restorative practitioners to make this work possible.
I’m grateful to be asked to reflect on my current restorative perspective for the RPI blog. I’ll start by acknowledging First Nations practices and storytelling that have sparked the origins of true restorative approaches, of sharing voice and accountability in communities before non-indigenous people sought to adapt these into western education and justice systems.
What draws me to a restorative approach is self-determination and empowerment. As a social worker these elements are core to my work. In the mental health field, a restorative approach recognises people’s experiences of being marginalised, stigmatised, and often denied opportunity to have space to repair harms they have caused, or address harms caused to them. Like many institutions, health care systems minimise the reparative needs of people with mental illness., Communities also often ignore these needs, even while recognising the growing prevalence of serious mental health issues. Viewing conflict and harm as a potential opportunity (Christie, 1977; Zehr, 2015) is core to restorative approaches, as is being more explicit regarding our boundaries, expectations, and supports available.
How we are developing a restorative approach in mental health settings
The Restorative Practice project in Mental Health at The Prince Charles Hospital in Queensland initially focused on offering restorative meetings in cases of assaults against staff by consumers (wording used as opposed to ‘patients’ in our service). This involved collaboration with the Adult Restorative Justice Conferencing team in Queensland, in addition to creating a provisional process for our Police-linking stakeholders. This aimed to encompass a trauma-aware mental health approach, utilising overarching restorative goals as per traditional conferencing approach, whilst also recognising the nuances and complexities post-Covid19 of supporting our changeable health context. Dr Gerard Drennan (2021), a pioneer in UK restorative mental health work, has noted psychotherapeutic work can “enable access to the additional powerful benefits of a restorative justice intervention,” both from having the person harmed central to the process by developing self-worth and resilience, and the person who caused harm, by addressing past traumas, developing insight and compassion.
The restorative inquiry framework of a past/present/future focus can engender hope and agency following harm. It can also enable people to regain some control after a harm or loss has occurred. Importantly for people harmed (in our healthcare setting predominantly family or staff), it can provide opportunity where there was none prior. Family and staff often face a challenging balance of self-care, while also supporting those who have harmed them that have been or are unwell. For this “forgotten party” (Dickson; 1983) having the opportunity and choice to participate in a way that is meaningful can promote empowerment and healing. I appreciate the use of a restorative enquiry approach to self in the first instance, knowing that even the act of asking restorative questions following harm can reduce negative affect and potentially have a positive impact.
Over time, our team at The Prince Charles Hospital came to further understand and explore the restorative continuum. Whilst restorative meetings can be powerful and transformative, we are also learning that in a mental health context “informal practices have a cumulative impact because they are part of everyday life” (McCold & Wachtel, 2001; 2016). We have thus slowly but deliberately aligned our approach to more informal and proactive restorative daily practices and relationships, through building a restorative culture by focusing on relationships, while still appreciating the opportunity for formal restorative meetings where suitable.
Specifically, staff use the social discipline window, advocating for a reflective and collaborative ‘WITH’ box approach (McCold and Wachtel; 2003). This involves intentionally collaborative work to recognise what boundaries and expectations are set, and these are matched with support and encouragement. On our healthcare wards and/or in community settings, we use restorative inquiry to build relationships and reduce negative affect by supporting voice and contextual understanding to change behaviours (e.g., supporting consumers activities of daily living or when conflict has occurred to self or others). We encourage circles for check-ins, to relationship build, and to address problematic issues or more serious harms.
These informal processes have had a more restorative impact for staff and consumers in the context of our healthcare setting, whist also noting the smaller number of referrals for a more formal approach have additionally had wholly positive feedback from participants. We have aimed to equip staff and consumers with collaboratively created restorative reminder resources, training opportunities, and ongoing encouragement in my role as the Restorative Practice Lead. For me, a restorative culture starts with a shared language and understanding of collaborative focus on impacts of harm within our relationships. It then seeks to ensure those more directly impacted have voluntary opportunity to have a voice in repair and in changing harmful practices. A restorative culture for me has all stakeholders understanding the aims and, following an incident of harm, responding by automatically considering using the restorative approaches by involving those most directly involved to have a say in needs, impacts, and meaningful repair.
Barriers and Enablers to Restorative Practice in a Mental Health Context
As a restorative practitioner and fledgling implementation scientist, my own growing and learning for sustainable long-term change includes the importance of context assessment to really understand capabilities/enablers alongside barriers as a core focus in moving forward for embedding restorative approaches. As Drucker noted, fittingly within my experience, “culture eats strategy for breakfast” (in Dekker et al; 2022). Restorative implementation requires the often initially uncomfortable experience of reflecting on how we do things NOW. How true are we in having a collaborative approach with patients/consumers, let alone when things go wrong? How often are we attentive to the power dynamics we hold as staff within a healthcare institution, whether as leadership to other staff, or to our consumers and families? These are especially challenging within a secure mental health setting.
Restorative approaches in such institutions require us to lean into the discomfort of a cultural shift and recognise the limitations of a medical model and hierarchical system. This means we must acknowledge where our punitive processes and procedures often silently sit. The challenges are multiple – staff readiness, leadership support, complex issues within a mental health context, as well as additional tasks/new program fatigue. For a successful restorative culture, O’Connell notes the three things required within a restorative lens are “leadership, leadership, and leadership” (2018). Enablers within mental health now are an executive team across the healthcare service with an enthusiasm for Restorative Just and Learning Culture. This is in addition to evidence-based experience of restorative approaches in relation to blame, following adverse incidents within regulatory frameworks (Turner et al, 2020; Wailing et al, 2022).
Dugan’s theory of conflict (1996) articulates the different nesting spaces where conflict exists such as sexism, racism, and ableism amongst other forms of discrimination. These are a useful learning tool in identifying structural systemic attitudes and biases that need to be addressed when trying to create a more restorative culture. This is no small task. There are layered complexities requiring patience and discomfort to spotlight the current systems we work within that sometimes harm the very people we aim to support. A strong staff wellbeing and consumer focus is an enabler to this work, as is having organisational values that align with the “why” for the work we do. Having partnership with the peer recovery team, those with lived experience of mental illness supporting our consumers, in addition to strong cultural supports is essential to help develop our restorative direction and learning. From a mental healthcare perspective, the restorative approach aligns well with a recovery approach and trauma-informed framework. It aims to prioritise self-determination and voice. Asking “what happened” rather than “why” can support a less judgemental approach and allow a less defensive response.
If we want to be truly restorative as an organisation we must continue to reflect on our “with” box by working and building on our 4 pillars of restorativeness (Re-Engage; in O’Connell; 2018). These include prioritising firstly our relationship with ourselves, our colleagues in our workspace, our consumers, and community. We also must have recognition of the value of prioritising restorative approaches at a workplace level for all employees. Leadership and human resources have historically been spaces where policy is blame-focused. This can override other organisational goals and cause further harms. Pioneering work within Mersey Care in the UK demonstrates the potential benefit of restorative approaches in workforce within a healthcare setting (Oates; 2021)
Setting the scene for a restorative workplace will promote more effective and cost-efficient organisations. This includes staff wellbeing and client experience, both paramount for the needs of all people that work or are served by organisations such as mental health hospitals. This is preventative work in healthcare, and not just responding to client or staff needs after the fact. Economically, we already know preventative work gives us more sustainable improved outcomes (though this isn’t where our funding always goes). As Smith and Spencer (2019) have noted, “Restorative practice supports emotionally intelligent leadership, reduces formal grievances between staff and ultimately supports a positive organisational culture which has the potential to increase productivity and happiness at work.” I agree wholeheartedly from our initial experiences. However, restorative practice across a workforce is long haul, not a quick fix. Over time, it can have some amazing gains if organisations truly consider and thoughtfully implement such practices.
Thanks to the various RPI members, international restorative practitioners, Youth Justice, and Queensland Health Metro North Mental Health staff and consumers for their ongoing support for this work. Here’s our restorative poem, as I think things can stick a little better when they rhyme.
It’s sounds a little abstract, how do we do restorative?
It’s how we interact with others, a more peaceful way to live
Using boundaries and support, to work “with” and alongside
Solutions by those most impacted, use the questions as a guide
Asking more “what happened?”, rather than the “why”?
The evidence shows strongly we should really have a try
Make your statements more affective, introducing impacts too
Use the window to be reflective, confronting as it is to do
Ask the questions, be intentional, see an issue? questions out
Building social capital is what RP is about.
Lending ears to those in circles, helping all to have a voice
And emphasising voluntarism, supporting it’s by choice
So when we talk of conflict, hear of harm, or disagree
Remember there’s an option to use our skills within RP
Christie, N. (1977). Conflicts as Property. The British Journal of Criminology, 1-15.
Dickson, B. (1983, September 17). The forgotten party: The victim of crime. doi:http://dx.doi.org/10.14288/1.0102909
Dekker, S., Oates, A., & Rafferty, J. (2022). Restorative just culture in practice: Implementation and evaluation. New York: Productivity Press.
Drennan, G (2021); Restorative Justice, A Role for Psychotherapy; New Associations Issue 35.
Dugan, Maire. (1996). A Nested Theory of Conflict. Women in Leadership. 1. 9-20.
McCold, P and Wachtel, T. In Pursuit of Paradigm: A Theory of Restorative Justice. In Proceedings of the XIII World Congress of Criminology, Rio de Janeiro, Brazil, 10–15 August 2003.
Oates, A; and NHS Employers (2021), Implementing a just and learning culture. Oates, A. (n.d.). Retrieved November 30, 2022, from https://www.nhsemployers.org/case-studies/implementing-just-and-learning-culture
O’Connell, T. (2018). The best is yet to come. Routledge International Handbook of Restorative Justice, 422-441. doi:10.4324/9781315613512-29
Turner K, Stapelberg NJ, Sveticic J, Dekker SW. Inconvenient truths in suicide prevention: Why a Restorative Just Culture should be implemented alongside a Zero Suicide Framework. Aust N Z J Psychiatry. 2020 Jun;54(6):571-581.
Wachtel, T. (2016) Defining restorative – IIRP. Available at: https://www.iirp.edu/images/pdf/Defining-Restorative_Nov-2016.pdf (Accessed: November 29, 2022).
Wailling, J., Kooijman, A., Hughes, J., & O’Hara, J. K. (2022). Humanizing harm: Using a restorative approach to heal and learn from adverse events. Health Expectations, 25(4), 1192-1199.
March 9, 2023, 9:11 pm
Bravo for highlighting the pioneering work you are doing in bringing restorative approaches to mental health in Queensland. Your piece beautifully describes how thinking restoratively links with so many contemporary currents in mental health, patient safety, trauma-informed approaches and restoring the connection with family and community. Your roadmap of accessible everyday skills that help to resolve and avert conflict are invaluable to people whose histories make them vulnerable in some way, and for whom unresolved conflict can be so destabilising. It is great that the RPI have given the mental health arena space in this way, it would be excellent to see mental health services look more closely at what Restorative Practices have to offer.