Restorative practice in a forensic mental health service: three case studies

Author | Cook, A. (2019), The Journal of Forensic Psychiatry & Psychology, 30(5), 876-893

Overview

Use of restorative practices within mental health settings is increasing, there are clear parallels between the principles of restorative justice and the dual aims of mental health settings within the therapeutic treatment of offenders in reducing risk and improving mental health. Early studies have found restorative practice within forensic mental health settings complements and positively contributes to the therapeutic journey. Three case studies were analyzed regarding the use of a restorative intervention following the assault of staff members by forensic patient, using a model of care based upon understanding of attachment and trauma with the aim of supporting patient recovery and staff wellbeing. The studies offer insight into how success of these interventions might be measured and key components of these interventions. Victims gained insight to patients mental health conditions which may have otherwise been forgotten, this allowed them to continue working on the ward while the patients explained their thoughts and feelings at the time of the incident and were provided the opportunity to apologize and move forward, this allowed for powerful therapeutic relationships to be rebuilt by speaking of repairing trust broken. This contributed to the clinical work with patients and positively to the experience of staff support within organizations, highlighting the need to establish trust and containment through careful preparation. Restorative meetings progressed smoothly with strong emotions held at a tolerable level, demonstrating importance of facilitators in managing the emotional temperature of such interventions and enforcing the appropriate structure to allow for genuine dialogue within listening and appropriate timing of questions. The role of the facilitator parallels with therapeutic roles in ensuring a sense of safety and emotional activation are achieved within the patients capacity to ensure an effective intervention. Engagement in the restorative intervention may also contribute to an alternative story of self against the problem saturated narrative in promoting wellbeing and desistence from violence consistent with patients new identity, this influences future behaviour by impacting patients sense of self and sense of others allowing for a transformative effect and hope for the future. Although, different measures may be needed when working with those with a high level of past trauma or mental health problems due to difficulties in mentalization, empathy and entrenched histories of aggression. Overall, restorative approaches can be used as an additional tool for staff support and are an excellent complement to patient treatment as they contribute to maintaining therapeutic atmosphere of wards and effective for the wider treatment regime.

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Resource themes: 
Mental health
Resource categories: 
Policy and research