Why should health agencies refer to restorative justice?

‘Victim wellbeing’ is a phrase often linked to restorative justice, but what does that look like in practice? In this article, Greg Smith (restorative justice development manager at Thames Valley Restorative Justice Service (TVRJS)), Diana Batchelor (PhD researcher at Oxford University, and independent evaluation researcher for TVRJS) and Becci Seaborne (assistant director for restorative justice at TVRJS) consider why – and how – restorative justice could become a default option for health service providers.

“Restorative justice gave me the key to functional life”

TVRJS has been delivering restorative justice in the Thames Valley for 15 years now, and we’re still learning from those around us about the impact it can have. When one woman told us: “Restorative justice has not only given me the tools to resolve a lot of pain, but it gave me the key to a functional life,” she really meant it. She’d regained a healthy weight after a significant physical illness. This was linked to the psychological trauma she experienced as the result of a serious offence in her childhood. After meeting her offender, she was newly able to open the curtains, leave the house and walk her children to school.

So, common sense tells us that health agencies should be a good source of referrals for restorative justice services. We see through our work that many victims suffer with poor mental and physical health because of the crimes committed against them. We also witness the positive impact restorative justice has, especially in reducing negative health effects of crime. Restorative justice can build resilience into recovery, avoiding relapse and repeat visits to a GP or other services.

The proven health benefits of restorative justice

And it’s not just our 15 years’ experience that demonstrates these benefits – the research is also clear. Evidence from randomised control trials shows clear links between restorative justice and reductions in fear and anxiety, and fewer symptoms of post-traumatic stress disorder (PTSD) (Angel et al, 2014; Strang, 2002).

The victims in these studies agreed to take part in restorative justice, but were then ‘randomly’ allocated to either participate or not participate in a restorative process. This is important because it means that the change in fear, anger and PTSD symptoms cannot be explained by a ‘self-selection’ bias. In other words, the difference between the groups cannot be explained by saying that people who were less fearful chose restorative justice in the first place. Nor can it be explained by people simply becoming less angry over time because fear would have fallen equally for the people who didn’t participate in restorative justice.

There is also plenty of evidence that participating in restorative justice results in outcomes that are in turn associated with improved health. For example, restorative justice results in increased satisfaction with the justice system (Shapland et al, 2007 – based in part on our own contribution to this study), empathy and forgiveness (Strang et al, 2006), and an increased sense of control (Van Camp and Wemmers, 2013). Satisfaction, forgiveness and control are known to benefit health and wellbeing (Griffin et al, 2015; Kunst, Popelier and Varekamp, 2015; Massad and Hulsey, 2006). There are also numerous studies with individuals or small groups of victims that demonstrate the transformative effect that restorative processes can have. Beck, Lewinson and Kropf (2015) and Walters (2015), for example, provide powerful examples of the potential for restorative justice to improve the psychological wellbeing of older adults and families of murder victims respectively.

We have several years’ experience of offering restorative justice processes with people who have experienced serious sexual violence, and bereaved family members of homicide victims. We’ve been struck by how many have told us that they’ve tried everything else available to move past what has happened to them, but they are still ‘stuck’ with the traumatic psychological effects. Many have been receiving ongoing medical and psychiatric care for many years. The transformation they discuss with our facilitators after meeting with the perpetrators – described by one woman as like the “flipping of a switch” – is incredible.

So, why do we find it so hard to get referrals from health agencies? First, it’s complicated. It’s a bit like standing at the foot of an Egyptian pyramid – huge and impressive, but how do you get in? Second, there are many competing priorities for professionals in the health sector, as there are in most other fields. We have, for some time, been providing leaflets to GP surgeries in Thames Valley, hoping to encourage self-referrals, but with very little success. Many practice managers are cautious about displaying leaflets unless there is an obvious health link, as there are simply too many leaflets for them to manage.

A strategic approach

Getting an understanding of the structure of local health services and the current priority areas is a good place to start. With a little persistence you can find a helpful person at the local Clinical Commissioning Group (CCG). This can identify where restorative justice can fit with health objectives, but also helps in learning the language that will ring bells for local providers. Talking to a GP practice or practice manager about reducing the likelihood of repeat visits by enabling a referral to restorative justice will give them a good reason to listen. Talking about building resilience into recovery and reducing the likelihood of deterioration or relapse will strike the right note for an organisation working with people in crisis. But make sure to emphasise that restorative justice helps them target people with vulnerabilities and works within the overall strategic framework on tackling inequalities, building personal and inter-personal resilience.  

Many health providers are working with victims of crime but either don’t know it or don’t recognise its impact. Prioritising agencies that are most likely to be working with people who may also be victims makes good sense. This includes practice staff at GP surgeries (health visitors etc), the local Improving Access to Psychological Therapies (IAPT) service, community mental health teams, mental health screening services such as Liaison and Diversion, drug and alcohol service providers and agencies dealing with people in crisis. A discussion with managers about referral pathways can lead to restorative justice being included as a resilience-building, community reintegration objective in patients’ treatment plans. Initial assessments could include patients’ experiences of being a victim, leading to the inclusion of restorative justice as a treatment objective. This would mean that patients can access restorative justice at the time that is right for them, and we don’t have to keep reminding busy staff of its importance.

A vision for the future

We’ve made some good headway recently, and Oxfordshire CCG has uploaded our guidance and briefing sheet for health professionals onto their website, so the message is starting to reach a wider audience. We’re beginning to see a future for links between restorative justice and social prescribing, and are lucky to be working with one such project in Reading. The project is funded by Berkshire West CCG’s Partnership Development Fund, and is run by Reading Voluntary Action. We’re beginning to explore these links, which we see as a fundamental part of community-based GP hubs. As well as traditional GP appointments and medical prescribing, these resource centres should enable access to a wide range of non-medical services which can offer health benefits.

We also recognise the overlap between victimisation and offending behaviour, and believe that primary care and other health agencies often work in areas where these can cross over, such as mental illness and substance misuse. They also have the potential to offer a core referral pathway into restorative justice for anyone who has been affected by crime – victim, offender, family member, friend or witness. This demonstrates a need to break down distinctions between 'offender-initiated’ and ‘victim-initiated’ restorative justice. Many practitioners and service providers will identify the need to work without such constraints, where the needs and safety of all participants are key.

Criminal justice, health agencies, and local authorities all have a vested interest in the positive impact of restorative justice. A co-commissioned model could enable restorative justice services to focus on delivering maximum access to good quality restorative justice without having to juggle the semantics in order to keep the needs and interests of victims and offenders at the core of their work. In a world of limited funding, restorative justice can offer outcomes that everyone benefits from – after all, the notion of community, in its smallest and largest senses, is core to good restorative justice.

Diana Batchelor’s research examines victims’ experiences of restorative justice, including motivations for taking part, and outcomes relating to wellbeing. For more information or to find out how to be involved, please email diana.batchelor@psy.ox.ac.uk

For more information on TVRJS email rjenquiries@tvrjs.org.uk

For full references, please visit www.restorativejustice.org.uk/TVRJS-article

Angel, C.M., Sherman, L.W., Strang, H., Ariel, B., Bennett, S., Inkpen, N., Richmond, T.S. (2014). Short-term effects of restorative justice conferences on post-traumatic stress symptoms among robbery and burglary victims: a randomized controlled trial. Journal of Experimental Criminology, 291–307. http://doi.org/10.1007/s11292-014-9200-0

Beck, E., Lewinson, T., and Kropf, N.P. (2015). Restorative Justice With Older Adults: Mediating Trauma and Conflict in Later Life. Traumatology, 21(3), 219–226.

Griffin, B.J., Worthington, E.L., Lavelock, C.R., Wade, N.G., and Hoyt, W.T. (2015). Forgiveness and Mental Health. In Forgiveness and Health, 77–90. Dordrecht: Springer Netherlands. http://doi.org/10.1007/978-94-017-9993-5_6

Kunst, M., Popelier, L., and Varekamp, E. (2015). Victim Satisfaction with the Criminal Justice System and Emotional Recovery: A Systematic and Critical Review of the Literature. Trauma, Violence, & Abuse, 16(3), 336–358. http://doi.org/10.1177/1524838014555034

Massad, P.M., and Hulsey, T.L. (2006). Causal attributions in posttraumatic stress disorder: Implications for clinical research and practice. Psychotherapy (Chicago, Ill.), 43(2), 201–15. http://doi.org/10.1037/0033-3204.43.2.201

Shapland, J., Atkinson, A., Atkinson, H., Chapman, B., Dignan, J., Howes, M., Sorsby, A. (2007). Restorative justice: the views of victims and offenders. The Third Report from the Evaluation of Three Schemes. Ministry of Justice Research Series 3/07.

Strang, H. (2002). Repair or Revenge. Victims and Restorative Justice. Oxford: Oxford University Press.

Strang, H., Sherman, L.W., Angel, C.M., Woods, D.J., Bennett, S., Newbury-Birch, D., and Inkpen, N. (2006). Victim evaluations of face-to-face restorative justice conferences: A quasi-experimental analysis. Journal of Social Issues, 62(2), 281–306. http://doi.org/10.1111/j.1540-4560.2006.00451.x

Van Camp, T., and Wemmers, J.A. (2013). Victim Satisfaction with Restorative Justice: More than Simply Procedural Justice. International Review of Victimology, 19(2), 117–143. http://doi.org/10.1177/0269758012472764

Walters, M. A. (2015). ’I Thought “He’s a Monster”... [But] He Was Just... Normal’: Examining the Therapeutic Benefits of Restorative Justice for Homicide. British Journal of Criminology, 55(6), 1207–1225. http://doi.org/10.1093/bjc/azv026

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