THE Dorothy and Brian Wilson CHURCHILL FELLOWSHIP to research innovations for improving the lives of victims of serious violence committed by people

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2 THE Dorothy and Brian Wilson CHURCHILL FELLOWSHIP to research innovations for improving the lives of victims of serious violence committed by people with a mental illness Canada, the USA, UK, and The Netherlands Michael Power Churchill Fellow 2016

3 INDEX 1 3 EXECUTIVE SUMMARY INTRODUCTION 4 Dorothy and Brian Wilson Churchill Fellowship Program 6 PART ONE Utilising Restorative Justice Practice in Mental Health Options for Australia to Consider Recommendations 22 PART TWO Enhanced support for families of homicide victims Advocacy / support for families interaction with health services Therapeutic groupwork and residentials Other ideas RECOMMENDATIONS IMPLEMENTATION BIBLIOGRAPHY

4 KEYWORDS Victims of violence Mental health Forensic mental health Restorative justice practice Support for families of homicide victims ACRONYMS CCI (Center for Court Innovation) ICJIA (Illinois Criminal Justice Information Authority) NACRJ (National Association of Community and Restorative Justice Conference) NHS (National Health Service) RJP (Restorative Justice Practice) QHVSS (Queensland Health Victim Support Service) SMI (Serious Mental Illness)

5 CHURCHILL FELLOWSHIP 2016 Michael Power, Churchill Fellow 2016, presenting at the Restorative Justice and Victim Awareness Network event on 19 July 2017 at the Institute of Psychiatry, Psychology and Neuroscience, London.

6 EXECUTIVE SUMMARY Victims of serious violence committed by people with a mental illness are often left with significant needs. When Courts decide that the person who committed the violence was of `unsound mind at the time, or are now unfit for trial, or have diminished responsibility, victims are often left feeling distressed and traumatised. They struggle with feelings of anger and frustration that no one is held fully accountable for the violence. This can happen when Courts decide that the person who committed the violence is to receive a mental health defence and the alleged offender shifts to being a forensic patient. Confidentiality provisions prohibit victims from understanding why the violence happened and knowing what treatment is being provided by mental health services to prevent future violence. Victims and their families often fear for their own and the communities safety. Family members of a person with a serious mental illness, or people known to them, are often the victims of violence in these cases, rather than the general public. Family members may have lost faith in mental health services if they have tried unsuccessfully to obtain effective treatment for their relative with a mental illness. Opportunities to rebuild relationships can be lost and victims are unable to have their questions answered due to patient confidentiality. Violence against mental health staff committed by people with a mental illness, is also an ongoing concern for health services. The focus for the Dorothy and Brian Wilson Churchill Fellowship was seeking innovative responses to improve the lives of victims of serious violence, their families and people with a mental illness. This included investigating beyond what is already provided to families of homicide victims in Australia to improve their longer-term well-being. Australian supports currently comprise immediate practical support, financial assistance, counselling, court support, peer support and an opportunity to provide a victim impact statement. Restorative Justice (also known as restorative justice practice, restorative approaches, community conferencing, victim/offender mediation, victim/offender dialogue, restorative dialogue, circles, peacemaking circles) has emerged in recent years in Canada, England, and The Netherlands to respond to the needs of victims of people with a serious mental illness, their families and forensic patients. These practices provide a structured and facilitated opportunity for communication between the victim (or their family) and the forensic patient. This occurs directly in a face to face meeting, or through a third party or letter, where the patient acknowledges the harm and takes responsibility for repair of the harm and reducing the potential for further harm to others. This process can be undertaken separately to the Court system, prior to Court, or as an alternative approach. Recent use of restorative practice in mental health has adapted the extensive knowledge and research available from youth justice, schools, adult criminal justice, Indigenous models of peacemaking circles, group conferencing as well as models of conflict resolution in the wider community. It is acknowledged this process may not be suitable for all victims, or all people with a mental illness, but when used effectively it has multiple benefits for victims (including mental health staff), families and patients. A secure forensic mental health service in Calgary (Canada) takes a unique approach to working with forensic patients, their families and stranger victims to respond to the needs of all those harmed. Extensive psychoeducation is provided as soon as possible with the patient s family after the offence when it is likely that a court will make a finding of `not criminally responsible. The service reaches out to family members and victims who were strangers to the patient to provide treatment for trauma and grief. They seek consent from forensic patients to share information with victims on how the mental illness contributed to the violence and their current progress in treatment. Victims who were strangers to the patient often benefit from being able to tell their story, to the treating team. The team is able to provide information about the forensic mental health system. The victim s information helps the treating team to balance the victim s concerns and protect them better. This can enable victims to move beyond the impact of the offence with a greater understanding of why the crime occurred and the patient s current treatment and risk management. Four forensic mental health services in England, together with restorative justice practitioners, have been developing restorative practices responding to patient to patient violence, patient to staff violence and patient to stranger victim violence. Four private and two state-operated secure forensic mental health services in The Michael Power 2016 Churchill Fellowship 1

7 Netherlands are implementing restorative approaches to facilitate communication between victims in the community and forensic patients. An evaluation has commenced in the four private forensic mental health services of a guideline providing direction for staff facilitating this work. Important lessons are available from the United States including: developing effective localised services using restorative approaches in community justice courts and services responding to violence; providing the media with a role in supporting the implementation of restorative justice practice in new contexts; and funding bodies to use research and consultation to develop a holistic victim services sector that includes restorative justice. For families of homicide victims, including cases committed by a person with a mental illness, innovative services are underway in England, the United States, Canada, and The Netherlands to respond to their unique needs. This includes systems advocacy, resources for mental health staff and employers and the Duty of Candour framework in England in health services. Structured groupwork programs based in a Calgary hospital focused on grief and loss and residential programs in England have had a positive impact for families of homicide victims The services covered in this Churchill Fellowship program provide new and innovative ways to respond to the complexity of issues and suffering of people impacted by serious violence and those with a serious mental illness who commit that violence. The next step is harnessing support to adapt and implement these ideas in Australia. A range of recommendations are provided in this report, including establishing trials for Australia s context. Michael Power 2016 Churchill Fellowship 2

8 INTRODUCTION Michael Power, Director, Queensland Health Victim Support Service P.O. 710 Ashgrove, Queensland, Australia 4060 Personal contact details: Victims of serious violence suffer significant negative impacts on their physical health, psychological and emotional wellbeing and social role. When violence is committed by a person with serious mental illness (SMI) significant tensions exist between the needs of victims, responses from justice and forensic mental health systems and the needs of forensic patients. In homicide cases, these tensions can further compound the trauma and grief experienced by family members. As Director of Queensland Health s Victim Support Service, which specialises in helping victims and their families in cases diverted to the forensic mental health system, I am interested in what is available to improve the lives of victims, their families and forensic patients beyond what is currently provided in Australia. Finding better ways of responding to these complex issues formed the basis of my Churchill Fellowship application. Investigating these issues is not intended, in any way, to perpetuate or reinforce any stereotype of people with a mental illness as violent. The aim is to find better ways of responding to the occasions when serious violence does occur. I am deeply grateful to Dr Brian Wilson for his sponsorship of the Dorothy and Brian Wilson Churchill Fellowship that enabled me to travel to Canada, USA, England and The Netherlands. I greatly appreciate the help of all of the people I met and spoke with, who generously gave of their time and resources. A number of people assisted in facilitating meetings with other agencies and professionals which was of great help. This included Dr Sergio Santana in Calgary, Susan Johnson from Surviving Victimhood in Chicago, Brett Taylor at the Center for Court Innovation in New York, Dr Gerard Drennan in England and Nienke Feenstra in The Netherlands. Many of the people I had contact with went out of their way to share information, resources, their knowledge and experience. Some returned early from leave and others helped with transport or travelled long distances to meet. Most importantly all of the professionals I had contact with were a wonderful reminder of the great humanity and strength of people who commit their lives to helping others. I would like to thank A/Professor John Allan, former Chief Psychiatrist for Queensland Health and now Executive Director, Mental Health, Alcohol and Other Drugs Branch and Nicola Doumany, Executive Director, Community Justice Services, Department of Justice and Attorney General (Queensland) for supporting my Churchill Fellowship application. Finally and most importantly I would like to thank my wife (Chris) and my two daughters (Kate and Georgette) for all of their encouragement and support in undertaking the Churchill Fellowship travel and supporting my aim to translate what I have learnt into tangible benefits for members of the Australian community and to share that information more widely with professionals in other countries. Michael Power 2016 Churchill Fellowship 3

9 Dorothy & Brian Wilson Churchill Fellowship Program June Oakland, California, USA National Community and Restorative Justice Conference (NACRJ) a 3 day event with over 1300 delegates Professor Marilyn Armour, Professor of Social Work and Director, Institute for Restorative Justice and Restorative Dialogue, University of Texas June Calgary, Alberta, Canada Dr Sergio Santana (psychiatrist) Medical Director, Forensic Assessment and Outpatient Services, Calgary, Alberta, Canada (3 days with Dr Santana, observing case reviews, family meetings, visiting services and meetings with staff, forensic patients and their families) Tracy Sutton, Manager, Advance Care Planning / Goals of Care and Grief Support Program, Alberta Health Services, Calgary June 2017 Chicago, Illinois, USA Susan Johnson, Executive Director, Chicago Survivors and Citizens for Change Bob Koehler, peace journalist, syndicated columnist with the Chicago Tribune Reshma Desai, Manager, Strategic Policy Advisor, and Dr Jaclyn Kolnik, Manager, Center for Victims Studies, Criminal Justice Information Authority, Illinois 5 14 July 2017 New York City, New York State, USA Bob Koehler, journalist and RJ facilitator, syndicated journalist with the Chicago Tribune Greg Berman, Director, Center for Court Innovation Carol Fisler, Director of Mental Health Court Programs, Center for Court Innovation Brett Taylor, JD, Senior Advisor, Problem Solving Justice, Center for Court Innovation Kenton Kirby, Director of Trauma Support Services, Crown Heights Community Mediation Center & Save Our Streets, Crown Heights, Brooklyn Viviana Gordon, Deputy Director and Jackie Renaud-Rivera, Peacemaking Program and Judge Alex M Calabrese, Red Hook Community Justice Center (meetings and Court observation) Ruth O Sullivan, Clinical Director, and Judge Honourable Matthew J. D emic, Brooklyn Mental Health Court, Kings County (meetings and Court observations) Jennifer Petersen, Deputy Project Director, Willie Bernardez, Coordinator of Intake and Scheduling Operations, Shlomit Levy, Clinical Coordinator, Bronx Community Solutions Professor Thomas Hafemeister, (Professor of Law and Psychology retired) Suzanne Brown-McBride, Deputy Director Policy and Programs and Sarah Wurzburg, MA, Grantee Technical Assistance Manager, Council of State Governments Michael Power 2016 Churchill Fellowship 4

10 17 28 July 2017 England Professor Margie Callanan, Program Director for Clinical Psychology, Director of Salomons Centre for Applied Psychology, Canterbury Christ Church University Fin Wood, Restorative Justice and Sycamore Tree facilitator, Restorying Lives Dr Gerard Drennan, Head of Psychology and Psychotherapy, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust Henry Kiernan, Kiernan Consultancy (restorative justice trainer and facilitator) Sarah Cooper, Psychology Lead, Sussex Forensic Mental Health, Brookfield Centre Forensic and Specialist Services, Kent and Medway NHS and Social Care Partnership Dr Andy Cook, Clinical Psychologist, Forensic Healthcare Services, Dr Anne Sheeran, Lead for Psychology in Forensic Healthcare Services, Carly Partridge, Clinical Nurse Specialist, Clare Maidment, mental health nurse, (Chichester), Dr Mike Lawson, Doctor of Clinical Psychology, and Julie Payne, social worker, Sussex Partnership NHS Dr Estelle Moore, Head of Psychology Services, Broadmoor Hospital, Strategic and Professional Lead for Psychology and Psychological Therapies, West London Mental Health Trust, Broadmoor Hospital, Crowthorne, Berkshire Julian Hendy, Hundred Families, Leeds Catherine Owen, National Homicide Service Operations Manager, Victim Support, United Kingdom Nicola Bancroft, Assistant Director, Remedi (Restorative Services) United Kingdom Amy Johnson, Family Liaison and Investigation Facilitator, Derbyshire Healthcare NHS Foundation Trust 19 July 2017 Restorative Justice & Victim Awareness Network Event, Institute of Psychiatry, Psychology & Neurosciences, Camberwell, London (included - Mariette van Denderen, Criminologist, Researcher, van Mesdag Clinic, The Netherlands) Debra Clothier, Chief Executive Officer, Escaping Victimhood, Winchester 1 4 August The Netherlands Dr Kim van Zijp-Lens, Assistant Professor and Alice Bosma, Victimology PhD Student, Tilburg Law School, Intervict, Tilburg University, Tilburg Dr Vivienne de Vogel, Head of Research Department and Dr Inge Breukel, van der Hoeven Kliniek, Utrecht Nienke Feenstra, Restorative Justice Netherlands Piet de Jong, Advisor Forensic Psychiatry, Veldzicht, Balkbrug Hans van Splunter, Forensic Social Worker, Oostvaarders Kliniek, Almere Victor Jammers, Member of the Board of Directors, Dr Sonja Leferink, Researcher and Senior Policy Advisor and Nannie Putters, Head of Case Management, Victim Support Netherlands, Utrecht Michael Power 2016 Churchill Fellowship 5

11 INFORMATION GATHERED & ANALYSIS This report brings together information gathered from meetings, conversations, observations and ongoing contact with professionals and services during the Churchill Fellowship program in Ideas for service innovation for victims, their families, mental health and forensic mental health services are proposed for Australian states and territories to consider. Part One of this report focuses on the provision of restorative justice practice in mental health and forensic mental health. Part Two focuses on what else is available to assist families of homicide victims in Australia. A detailed report summarising information gathered from each contact during the Churchill Fellowship program is available on request from: mpower1@vtown.com.au Michael Power 2016 Churchill Fellowship 6

12 PART ONE What are the issues? Victims of serious violence suffer a range of impacts usually categorised under physical, psychological, emotional, financial and social role. Many victims experience trauma and grief and their potential for recovery is influenced by their personal history, family support, access to specialist services, community and workplace support and justice system responses. For families of homicide victims, trauma and grief are profound from the unexpected and violent loss of a loved one. These impacts can have a debilitating impact on future wellbeing. A further complicating factor for victims arises when the person who committed the violence has a SMI. It is important to note here that most people with a mental illness are no more violent than others from the general community. Rather they are more likely to be victims of violence themselves (Peterson and Heinz 2016). Research also indicates however, that some people with a serious mental illness can be more violent (Choe, Teplin & Abram 2008) particularly those with co-occurring substance misuse (Markowitz 2011). When courts find people with a serious mental illness to be of unsound mind (known in other jurisdictions as not guilty by reason of insanity, or not criminally responsible) they shift from being an offender to a forensic patient. Victims in these cases can feel the person charged has not been held accountable for the violence. This raises concerns about professionals assessments, the quality of court decision making and whether potential risks for harm to others will be adequately managed. The sense of injustice for some victims is heightened when in some jurisdictions, such as Queensland, no conviction is recorded and charges do not proceed if a person is found to be of unsound mind. Forensic mental health services are focused on treatment, rehabilitation and risk management for patients who have committed serious violence. Some clinicians may view any communication from a stranger victim, or their family, as potentially destabilising. 2016), people with a serious mental illness are more likely to harm family members, or people known to them, rather than strangers (Soloman, Cavanaugh and Gelles 2005). Family members of patients where the harm has been to another family member may have divided loyalties and be ambivalent about their future support for the patient. They may have questions of the patient, but do not have an avenue to have those questions answered, or may struggle with rebuilding a relationship with the patient until those questions are answered. It is in this context that opportunities are lost for victims to have their questions answered; to reduce their ongoing concerns about their safety; to improve confidence in the mental health system and re-establish family or other relationships. For patients there can be a lack of understanding of the real impact of harm caused by their actions and the opportunity to incorporate that understanding into motivation for reducing potential future harm. Current culture, interventions and structures in forensic mental health do not facilitate opportunities for patients with a mental illness to hear and understand the impact of the violence with the aim of improving the lives of both patient and victim. For mental health staff harmed by patients, there can be a loss of opportunity to deal with the impact of the harm and repair caring relationships where possible. Brett Taylor, JD, Senior Advisor, Problem Solving Justice, Center for Court Innovation, New York Victims, particularly stranger victims, often have questions such as: why did the violence occur? What was the role of mental health services if the person was already receiving treatment? What is the patient doing now to get well? Do they recognise the impact of the violence? Are they committed to reducing their risk for further violence? Contrary to media portrayals of unpredictable and irrational acts of violence by people with a mental illness that reinforce public fear (Peterson and Heinz Kenton Kirby, Director of Trauma Support Services, Crown Heights Community Mediation Center & Save Our Streets, Crown Heights, Brooklyn Michael Power 2016 Churchill Fellowship 7

13 Motivated by seeking a better response to these issues the Churchill Fellowship program focused on gathering information on the recent innovative use of restorative justice practices utilised in other jurisdictions with victims of violence and people who commit that violence with a mental illness. This included the use of restorative justice practice in forensic mental health services between mental health staff and patients who harm them. An additional focus was on what else could assist family members of homicide victims, beyond what is provided already in Australia and particularly in cases where the homicide is committed by a person with a serious mental illness. Viviana Gordon, Deputy Director, Red Hook Community Justice Center, New York Successful examples of achieving community acceptance in using innovative approaches to violence by the CCI was highlighted by information provided by New York based services, including the Crown Heights Community Mediation Center (Kenton Kirby), the Red Hook Community Justice Center (Viviana Gordon, Jackie Renaud-Rivera and Judge Alex Calabrese), the Bronx Community Solutions (Jennifer Petersen, Willie Bernardez, Shlomit Levy) and Brooklyn Mental Health Court (Ruth O Sullivan and Judge D Emic). In establishing each of these service models extensive consultation was undertaken within their local community and service system so upon commencement they were identified as part of the community. All of these services use the crisis created for people when they are charged as part of the criminal justice system as an opportunity to quickly facilitate and encourage their engagement with services that address underlying issues contributing to their offending (Petersen, Bernardez, Levy and Taylor). A critical factor highlighted by CCI when considering the use of restorative justice is that it is labour intensive to do it well and therefore it is important to consider how to scale up its use and promote its value to funding agencies and the wider community (Berman). Essential to this is an evaluation framework where it will take three to five years to determine the effectiveness of new programs responding to violence (Taylor). A number of critical factors need to be considered for the successful implementation of new services responding to violence. The first, highlighted by the Center for Court Innovation in New York, is the importance of undertaking extensive local community and service system consultation to develop a model tailored to the local context (Brett Taylor). Judge Alex M Calabrese, Red Hook Community Justice Center, New York Jennifer Petersen, Deputy Project Director, Willie Bernardez, Coordinator of Intake and Scheduling Operations, Shlomit Levy, Clinical Coordinator, Bronx Community Solutions Michael Power 2016 Churchill Fellowship 8

14 Restorative Justice Practice Restorative justice practice is not currently used in Australia between victims of violence and people who commit that violence in forensic mental health systems. The Australian Mental Health Commission, when considering mental illness and justice, identifies that `good practice can also include restorative justice approaches which focus upon the whole of person needs of the offender as well as the victim. This can help minimise the negative impacts upon mental health, support community re integration and reduce re-offending (Australian Mental Health Commission 2013). Australian states and territories have, to varying degrees, implemented restorative justice in the criminal justice system where it is increasingly seen as suitable for use in cases of serious violence (Larson 2014). It was clear in attending the National Association of Community and Restorative Justice Conference in Oakland that restorative justice (in all its forms) has progressed through youth justice, adult criminal justice, schools, community and organisational conflicts toward becoming a social movement providing principles and processes for how communities respond to harm and create opportunities for healing. England has also had a widespread rollout, with restorative justice services offered to all victims of violence. For example, the Sussex Restorative Justice Partnership has the objective of `Ensuring victims have equal access to Restorative Justice at all stages of the criminal justice system irrespective of the age of the offender or the offence, and incorporating multi agency case management, assessment and decision making (Sussex Restorative Justice Partnership 2016). Information from Dutch Victim Support (Jammers, Leferink and Putters) is that The Netherlands has also been gradually implementing a European Union Directive 2012/19 EU that encourages European Union countries to establish National Restorative Justice Services (DG Justice Guidance Document 2013) and that victims have a right to be informed about restorative justice (Leferink). What do we mean by restorative justice, or restorative justice practice? Howard Zehr in 2002 defined restorative justice as `a process to involve, to the extent possible, those who have a stake in a specific offence and to collectively identify and address harms, needs, and obligations, in order to heal and put things as right as possible (Zehr in Umbreit and Armour page ). Core to the process is that whilst it is victim centred, it is not victim controlled and offenders need to be treated with respect, to reintegrate them into the larger community without reoffending (Umbreit and Armour 2011). Michael Power 2016 Churchill Fellowship 9

15 This is an alternative to the justice system which focuses on what laws have been broken, guilt, punishment and retribution. Restorative theory relies on acknowledging harm and needs, where offenders take responsibility to make right the wrongs that have been committed, as much as possible (Umbreit and Armour 2011). Different types of restorative justice practice are identified, although their processes have become blurred over time (Umbreit and Armour 2011). These include victim/offender mediation (or conferencing), family group conferencing, circles and other types of interventions (Umbreit and Armour 2011). Research over 30 years is that restorative justice makes a significant contribution to an increased sense of involvement for victims and healing, offender responsibility, learning and reduced recidivism (Umbreit and Armour 2011). The main process for all of these types of approaches is working through: what has happened? What has been the harm caused? What has been the impact of the harm? What needs to happen to repair the harm? In the Australian context restorative justice (victim/ offender mediation) in youth justice and adult criminal justice has been connected to the court process or offered as an alternative to Court, or after the Court process is completed (Larson 2014). Australia has developed expertise in practice and research in restorative justice practice and community conferencing across different contexts. Restorative Justice Practice is a term used in England to refer to a broader approach to repairing harm that is not necessarily linked to the justice system. The term Restorative Conversations is also used in the context of discussions with the person who committed the harm without the involvement of the victim. Issues discussed are: What has happened? What has been the harm caused and its impact? What can the person do to repair the harm? Organising Committee, National Community and Restorative Justice Conference (NACRJ) a 3 day event with over 1300 delegates Restorative Justice Practice inclusion of people with a serious mental illness Historically one of the groups not referred to restorative justice in the adult criminal justice system has been people with a serious mental illness and those involved in the forensic mental health system. This is regardless of whether the situation is part of the Court process, or operating separately to the justice system. One of the arguments has been that restorative justice approaches are not suitable to use with people with a serious mental illness because they do not have the capacity to effectively participate. Further, to be confronted by the impact of their violence can be destabilising. However new information gathered from the United States and forensic mental health services in Calgary, England and The Netherlands makes it clear that restorative justice is a process suitable for use with people with a serious mental illness because mental illness is not a fixed state. It fluctuates and people become well for long periods of time. Participation can often still occur even when some symptoms of the mental illness continue. An individual assessment is required to determine capacity to participate in the process. Within forensic mental health services, this assessment can be a combined process between a restorative justice facilitator and a clinician within the service. Whereas for restorative justice services in the community it is an option to seek advice from a clinician, who is working with the person who committed the harm, on whether they have a capacity to participate (Bancroft). If a person is found not legally responsible for violence due to their mental illness, then a question arises: why should they take responsibility for the harm they have caused? Information gathered during the Churchill Fellowship is that there are important benefits for the recovery of people with a mental illness when they take responsibility for the harm they have caused when well enough to do so. This is part of integrating what they have done into their recovery process (Drennan, Cook, Santana, Breukel and de Vogel). Discussion at the Restorative Justice and Victim Awareness event in England highlighted that whilst patients cannot take responsibility for the past, when they have the capacity to recognise the harm they have caused, they can take ownership of the actions and take responsibility for the harm going forward. Further, it can limit a patient s progress if they do not work through taking responsibility for their actions (Restorative Justice and Victim Awareness event 2017). A third issue to consider is that people with a serious mental illness may not recall committing the violence, Michael Power 2016 Churchill Fellowship 10

16 so how could they be expected to participate in a restorative justice process? Information gathered reveals this is similar to the situation in the criminal justice system where people may not recall the details of committing the violence, particularly if they are affected by drugs or alcohol. This does not preclude them from participating in a restorative justice process (Armour). The focus of the process is on the harm caused to others and not a detailed recollection of the person who caused the harm on what exactly they have done. Professor Margie Callanan at the Salomans School of Psychology in England raised the issue that restorative justice aims for a constructive process called re-integrative shaming. But for some people with a serious mental illness, careful assessment is needed on whether they are able to incorporate that process. She highlights that people with a mental illness are often already suspicious about the motives of others and live with a heightened sense of shame about what they may have done. A practical issue identified by Professor Hafemeister is that using restorative justice practice may not be suitable for victims and people with a serious mental illness post court as it can be a number of years until a patient is well enough to participate. This could be too long for victims to wait, potentially delaying them getting on with their lives. Professor Armour suggests an alternate view, that participation in a restorative process with the person who committed the harm may be one of the few ways the victim has of freeing themselves from the impact of the harm. Michael Power 2016 Churchill Fellowship 11

17 What we know from the use of restorative approaches in other contexts, is that focusing on the harm caused and what needs to happen to repair the harm, moves away from notions of punishment to restoration of relationships, self-worth and an integration of the offence into people s lives to enable both victim and patient to move on. The consistent message from forensic mental health services in Canada, the United States, England and The Netherlands was that there are significant benefits for victims and people with a mental illness in participating in restorative justice practice. A summary of the specific benefits highlighted in the information gathered is: it meets the needs of victims and people with a mental illness in cases of lower level violence. This can be a useful alternative intervention to Court whereby police or courts could refer to a restorative justice process in the community which has better outcomes than proceeding through the justice system (Hafemeister) for low level violence cases that are already proceeding to court, an alternative is to provide access from the court to a restorative justice process, such as the process used by the Red Hook Community Justice Center (Gordon, Calabrese and Renaud-Rivera) in cases of serious violence post court restorative justice practice provides an opportunity for communicating between the victim and the person with a mental illness about what happened and for the victim to hear the patient take responsibility for hurting their life (Armour) the pain shifts from the victim to the patient who takes ownership for the impact of their actions (Armour) in cases of serious violence it enables a better understanding through communication via a 3rd party (treating team) of the mental illness and how risks are managed. Information is shared by the treating team with the consent of the patient (Santana) communication with the patient through the treating team can build confidence for the victim to incorporate the offence into their life and move forward (Santana) enables victims and patients to deal with negative fantasies about each other to reconstruct through dialogue a new meaning and reality for each other that is more constructive (Santana) for families of patients (who are also often victims) it provides another opportunity alongside family therapy to rebuild relationships. For stranger victims, it provides some release as they have a better understanding and experience being heard by the patient and treating team (Santana) provides a useful process for victims, particularly when they have been `stuck in relation to the impact of the crime (Desai and Kolnik) provides a process for conversations with patients about their feelings of guilt and shame (Restorative Justice and Victim Awareness Network Event - England) participation in a face to face meeting with a victim of violence by the patient brings something extra to assist them in addressing their behaviour (Cook) patients feeling and facing up to what they have done provides an opportunity to be accepted, and not rejected including the worst part of themselves (Cook) contributes to addressing offending behaviour which is part of core business for forensic mental health services, and not as an `add on (Drennan) investment in a culture for mental health services that reduces violence to mental health staff (Cooper) reduces the number of patients identified as `incompatible with other patients so they can attend the same activities (Moore) Restorative Conversations are also part of the process with forensic patients where they are encouraged to restore relationships with their environment and take responsibility for the harm to others. Forensic patients need to do this otherwise their treatment will stall as they are not taking responsibility for their actions (De Vogel, Van Denderen and Breukel) the process can build on the role of forensic mental health staff (social workers who already work with families of patients) to extend to include contact with stranger victims of the forensic patient (De Vogel, Van Denderen, Breukel and van Splunter) restorative justice process strengthens the victim perspective for the treating team as the social worker is able to bring the wider impact for the victim and their family into the consideration of the forensic patient and treating team (van Splunter) RJP fits in relation to being more collaborative with patients, both in terms of vulnerabilities and risks (Sheeran) Michael Power 2016 Churchill Fellowship 12

18 Lessons learnt from implementing RJP with people with a mental illness Implementation of restorative justice practice in mental health needs to be considered from a broad perspective of how it integrates with the wider service system for victims (Desai and Kolnik). A useful starting point is to map existing support services available for victims (Brown-McBride and Wurzburg). Acknowledging the tension between victims wanting to feel informed versus the health information of the patient Brown-McBride and Wurzburg at the Council of State Governments in New York suggest an alternative. This is to focus on better reporting at a systems level by health services. For example, in Pennsylvania there is a trend to start to report at a systems level on outcomes for completion of forensic treatment programs. Whilst there may be a lingering suspicion for victims about whether the person who harmed them had completed a program, how systems talk about treatment and report on programs at a system level is an area that would be useful to consider for further development (Brown-Mc-Bride and Wurzburg). The work of the ICJIA provides an excellent example of how commissioned research on the needs of victims of crime was combined with a consultation process with the victims services sector to help map out and plan for longer term investment in victim services (Illinois Criminal Justice Information Authority). This included the type and place of restorative justice practice within the wider range of services for victims of violence (Desai and Kolnik). Finally, an important factor to take into account is the role of the media to help educate the community on the value of restorative justice in new contexts. This can be achieved through utilising personal stories of how restorative justice practice has improved the lives of victims and the person who committed the harm (Koehler). Different models of restorative justice practice are underway in Canada, the United States, England and The Netherlands between victims of violence and people who commit that violence with a mental illness. Models of restorative justice approaches specifically within mental health or forensic mental health were not identified in the United States. Given there are over 400 different mental health courts in the United States where localised differences occur in each state (Fisler) an analysis of whether restorative justice practice was used in these courts was not undertaken as part of the Fellowship Program. People with a mental illness in the community responsible for lower level violence can in some arrangements access restorative justice, such as circles which are offered as part of the Red Hook Community Justice Center in New York. The service is based within the Court building and people are diverted from the court to engage in restorative circles facilitated by the Red Hook Community Justice Center staff. Uniquely a range of services for both offenders and victims are located within the Court building, or through a partnership with the Red Hook Community Justice Center. The outcome of the victim and offender participating in a circle is reported by the Center staff back to the Court to assist the Judge in finalising the matter. Carol Fisler, Director of Mental Health Court Programs, Center for Court Innovation, New York Reshma Desai, Strategic Policy Advisor, and Dr Jaclyn Kolnik, Manager, Center for Victims Studies, Criminal Justice Information Authority, Illinois An alternative model suggested by Professor Thomas Hafemeister in the United States is to provide access to restorative justice for people with a serious mental illness in cases of lower level violence either prior to arrest, or as an alternative to being dealt with by the Court. This approach aims for the greatest benefit from the investment in restorative justice practice for both victims and people with a mental illness (Hafemeister). The restorative justice approach used by the secure forensic mental health service in Calgary includes active outreach by the treating team to families of the patient and stranger victims to respond to their needs. Where possible the treating team, led by Dr Sergio Santana, facilitates communication about the patient (with their consent) with their family. A staged process is used to rebuild relationships. As part of working systemically, the treating team reaches out to engage stranger victims. It is discussed with stranger victims that the treating team wishes to better understand what has happened. Staff of the treating team discuss with stranger victims that whilst they know the patient, they do not know the victim and their concerns. Understanding these concerns will help the treating team to be Michael Power 2016 Churchill Fellowship 13

19 balanced in their work to protect them. They also provide the victim with information about the forensic mental health system, including how risks are managed. Communication is also facilitated with stranger victims and the patient via the treating team. This can occur over a number of years at the pace of the victim and may be delayed for periods when a patient becomes unwell. Experience has shown this process is helpful for stranger victims and can be sufficient for them to be able to move forward. For patient families, including those estranged from the patient, it helps to facilitate the rebuilding of relationships as soon as possible with the patient (Santana). Restorative justice practice has been implemented in England in four forensic mental health services, with three making significant progress using a combination of trained mental health staff and external restorative justice facilitators to provide a restorative process for victims and patients (Restorative Justice and Victim Awareness Network event 2017). The four services are: Forensic and Specialist Services, Kent and Medway NHS; Forensic Healthcare Services, Sussex NHS Partnership; John Howard Centre, East London NHS Trust; and Broadmoor Hospital, West London Mental Health Trust. Implementation of restorative justice practice in England in forensic mental health commenced at the Firs, Hellingly Centre, Sussex originally by Dr Gerard Drennan. It was viewed as a paradigm shift contributing to reducing the potential for future offending. This work is continued by Dr Andy Cook who completed her PhD on restorative justice in forensic mental health (Cook, Drennan and Callanan 2015). All four services have implemented restorative justice practice as part of their work with patients to assist them in acknowledging the harm from their actions, to incorporate this into their longer-term recovery and as a motivator for reducing the potential for future harm to others. Dr Sergio Santana (psychiatrist) Medical Director, Forensic Assessment and Outpatient Services, Calgary, Alberta, Canada (3 days with Dr Santana, observing case reviews, family meetings, visiting services and meetings with staff, forensic patients and their families) Dr Andy Cook, Clinical Psychologist, Forensic Healthcare Services, Sussex Partnership NHS Dr Gerard Drennan, Head of Psychology and Psychotherapy, Behavioural and Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust Fin Wood, Restorative Justice and Sycamore Tree facilitator, Restorying Lives Whilst all four forensic mental health services in England are at different stages of implementation, they initially started with a focus on patient to staff violence which has been a concern for health services and patient to patient violence. More recently the services have included the process as part of their work with families of patients. This is being extended to stranger victims in the community. A significant advantage for developing restorative justice practice in England has been the use of one key restorative justice trainer and facilitator, Henry Kiernan, to support three of the four services. This has enabled the effective sharing of information, ideas and practice across the three services. In 2017 the use of RJP in the forensic and specialist service of Kent and Medway NHS was commended by the Care Quality Commission as part of its accreditation (Care Quality Commission 2017). Dr Vivienne de Vogel, Head of Research Department, Van Der Hoeven Clinic and Dr Inge Breukel, Van Der Hoeven Clinic The restorative justice process is provided by mental health staff trained in restorative justice, or in combination with an external independent restorative justice facilitator (Cooper, Moore, Drennan, Cook, Kiernan and Patel). The South London and Michael Power 2016 Churchill Fellowship 14

20 Maudsley NHS has also implemented the Sycamore Tree program to raise victim awareness and to prepare participants for potential involvement in restorative justice. Traditionally the Sycamore Tree program is used in prisons and was adapted and implemented in a forensic mental health service on three occasions (Drennan and Wood). A consistent message from the implementation of restorative justice practice in England in forensic mental health services was the importance of embedding its use in the operation and culture of the service and to identify resources to sustain it as an ongoing part of the service (Restorative Justice and Victim Awareness Network event 2017). Nienke Feenstra, Restorative Justice Netherlands and Piet de Jong, Advisor Forensic Psychiatry, Veldzicht, Balkbrug Similar to England, forensic mental health services in The Netherlands identified that implementation of RJP requires a culture shift for mental health staff in promoting the use of a restorative approach to communication between victims and forensic mental health patients (Van Denderen). In The Netherlands the terminology used instead of restorative justice practice was victim/offender mediation. Four privately operated secure forensic mental health services are in the process of implementing a guideline, developed in collaboration with victim services and restorative justice services, which supports facilitation of communication between victims and mentally ill offenders (Breukel and de Vogel). The guideline was developed in 2016 and commenced implementation in May 2017 (de Vogel). An evaluation will occur over an eighteen month period. The social work role within the forensic mental health service is recognised as a key position to supporting the implementation of the guideline (van Denderen). Whilst there had previously been communication by social workers with victims as part of treatment for the patient, the guideline introduces a restorative framework whereby the communication is intended to benefit both victim and patient (Leferink). Eight scenarios are provided in the guideline with questions to be considered for each, depending on whether the communication is initiated by the victim, the patient or another person (van Denderen). The four private forensic mental health services implementing the guideline are: the van der Hoeven Clinic (Utrecht); Mesdag Clinic (Groningen); Pompe Clinic (Nijmegen); and De Woenelse Poort Clinic (Eindhoven) (van Denderen). Another two secure forensic mental health services operated by the state (Oostvaarder Clinic (Almere) and Veldicht (Balkbrug) are also implementing a restorative justice practice approach to communication between victims and forensic patients, but they are not included as part of the evaluation (Splunter & de Jong). Hans van Splunter, Forensic Social Worker, Oostvaarder Clinic, Almere Michael Power 2016 Churchill Fellowship 15

21 A summary of the critical issues identified by mental health staff to consider in implementing restorative justice practice in mental health are: an assessment of suitability for forensic patients needs to include their capacity to manage the re-integrative shaming element of the process (Callanan) and capacity for empathy (Moore) time is needed for traumatised people to participate in the process (Callanan) restorative justice facilitators will need to have training in mental health, criminal justice, forensic mental health (Hafemeister) with well-developed relationship skills and a trust in the process (Armour) documentation supporting the process needs to include what happens if something goes wrong (Hafemeister) the role of a skilled facilitator is critical to ensuring victims and patients are not harmed in the process (Callanan) and that they are viewed as independent to all involved (Hafemeister and Callanan) the treating team needs to talk about their own ambivalence and ethical issues before reaching out to stranger victims (Santana) mental health staff who are victims of violence need to be able to identify a benefit for themselves, and not solely participate for the benefit of the patient (Kiernan) the use of RJP in mental health services responding to harm caused by patients to mental health staff is not a `quick fix for shifting patients back to wards where the staff member works (Kiernan) for people with an intellectual disability and history of mental illness, the process needs to be adapted e.g. shorter questions and assistance with problem solving (Cooper) an organisational change strategy is needed to embed restorative justice practice in a forensic mental health service. A starting point can be restorative conversations and education about restorative justice (Cooper, Moore and Kiernan) when responding to issues of harm from patients to mental health staff it is more suitable where staff and patients interact over a longer term period where there has been an investment in the relationship, rather than in an acute setting (Drennan) recognising that the involvement of mental health staff as victims within a restorative justice practice process can be challenging as it asks them to talk about the impact of violence on themselves where they need to step out of their professional role (Moore, Cook and Kiernan) it requires a change in culture for mental health staff to see the possibility of the usefulness of victim and offender communication (van Denderen, Cook, Moore, Cooper, Kiernan, Drennan) it is important for victims to have the choice about participation, and for the victim to be given information on the patient so they have realistic expectations of their interaction in a joint meeting (van Splunter) work with families by forensic mental health services often focused on building family support for the patient, whereas introducing restorative justice practice has added a structured opportunity to repair the harm to victims (Cook and Lawson) Based on the information gathered throughout the Churchill Fellowship a number of options are suggested for consideration and further investigation for use in Australia. Michael Power 2016 Churchill Fellowship 16

22 OPTIONS FOR AUSTRALIA TO CONSIDER Pre Court, or as an alternative to a Court decision In cases of lower level violence committed by people with a mental illness, an approach to consider is for police pre charge, or prior to a matter being dealt with at Court, is to offer a restorative justice process. This potentially can occur now in some jurisdictions, but following up on people with a mental illness to determine if they are able to participate in a restorative justice process requires formal partnerships with mental health clinicians to access advice, or to have restorative justice facilitators with confidence in assessing these issues. This process may also be suitable for cases where police are called to incidents of lower level violence from patients to family members, where victims do not wish to proceed with formal charges. In addition to accessing mental health services, this option includes offering the person with the mental illness and their family a restorative process. This approach borrows from the ideas of Professor Hafemeister as a way of diverting people with a serious mental illness out of the criminal justice system and facilitating a path to accessing mental health services. This approach would need the agreement of the victim who, at a time and place suitable for them, could agree to communication (direct or through a third party) as a way of having the harm acknowledged with the person with the mental illness committing to repairing the harm. Seeking agreement from a victim for their case to be dealt with on an alternate path to the standard criminal justice system has had good success in the Brooklyn Mental Health Court. Victims whose cases are being considered for referral to the MHC regularly agree for the person who harmed them to be dealt with in that court so they can access treatment and ongoing monitoring (O Sullivan and D Emic). This approach requires documented referral pathways and sufficient capacity in restorative justice services funded by the state and working in partnership with victim support services, police and mental health services. Whilst this is a larger reform where the potential investment opportunity requires detailed analysis, its benefits have the potential to reduce longer term criminal justice, victim support and mental health costs, together with a more effective response to the harm caused to victims and reduced potential for further offending. Restorative Justice Practice as an option from Court for people with a mental illness The Red Hook Community Justice Centre provides an impressive example of how a Court can incorporate a range of services to assist victims and people involved in committing lower levels of violence from the one court building, including restorative justice circles. This can include people with a mental illness in the community who are receiving treatment and support (Renaud-Rivera). The use of circles may not be a suitable option for some people with a serious mental illness who may find it difficult to keep track of conversations by multiple people in the room (Hafemeister). Within Australia, Melbourne has its own version of a community court known as the Neighbourhood Justice Centre which provides a community conferencing program using restorative justice practice. Building on the expertise this service has already is a good starting point for considering how people who commit lower level violence with a SMI are included in the process. Queensland recently reviewed and implemented a new Mental Health Act 2016 that commenced in March One of the new inclusions in the Act was that Magistrates can now decide that a person can be granted a mental health defence for a low level violence offence on the basis that the person charged was likely to have been of unsound mind at the time of the offence. Previously this decision could only have been made by a Judge in the Mental Health Court. The Magistrates Court decision is informed by reports from mental health staff. Implementation of the Act did not provide a pathway, or process, for victims to understand the basis of this Court decision. This opens the way for an option of offering a restorative justice process for victims and the person who receives a mental health defence with the aim of contributing to recovery for both. Implementation would require the participation of police prosecutors, Magistrates, mental health services, victims services and restorative justice providers. Michael Power 2016 Churchill Fellowship 17

23 Restorative Justice Practice in forensic mental health services Building on the innovative work in Canada, England and The Netherlands providing restorative justice practice in forensic mental health in Australia would benefit from adapting these approaches to state and territory service systems. There are two main approaches to consider. (A) Restorative justice practice in FMH where communication is facilitated by the treating team The approach used in Calgary requires a senior clinician involved in treating the forensic patient to have a systemic approach and commitment to facilitating the repair of harm to all those involved. They are instrumental in facilitating communication and rebuilding relationships as soon as possible by forensic patients who are responding to treatment. Patients with longer term rehabilitative needs may not be suitable in the early period post-offence for involvement in this process. The treating team, under the guidance of the senior clinician, reaches out to stranger victims who are offered support and assistance with trauma and grief. Additional grief and loss support are provided from a partner service for family members of homicide victims. The senior clinician seeks the patient s consent to share information about them with the victims over a period of time. They also engage the victim to understand their story and provide information on how the person who harmed them will be managed as part of the forensic mental health system. Within the Australian context reaching out to stranger victims to facilitate communication with forensic patients would be a significant practice change for forensic mental health services. Consideration of victim needs beyond risk issues is seen by the treating team as the responsibility of other services. Implementing this approach would require senior clinical leadership support. The approach would need to be incorporated into the framework of the provision of forensic mental health care both at a clinician and service level. Establishing links between senior forensic clinicians in Australia and Dr Sergio Santana in Calgary would potentially build interest in this approach. (B) Restorative justice practice in FMH where the process is facilitated by internal and/ or external restorative justice facilitators A broad approach to facilitating restorative justice practice between victims and forensic mental health patients was found in England and The Netherlands. It responds to a range of scenarios including: patient to patient violence; violence from patients to mental health staff (where police may or may not be involved); and post court between forensic patients and victims in the community. Based on the information gathered my analysis of the key elements for successfully providing restorative justice practice to respond to multiple scenarios in forensic mental health is outlined in Table 1. This information incorporates lessons learnt from professionals in the United States. Sarah Cooper, Grace Rew (forensic psychologists in training), Dr Andy Inett, lead for secure forensic psychology services (Forensic and Specialist Services, Kent and Medway NHS and Social Care Partnership) and RJ facilitator and Henry Kiernan, RJ trainer and facilitator. Michael Power 2016 Churchill Fellowship 18

24 Table 1. Key Elements for Restorative Justice Practice in forensic mental health Aim of restorative justice practice in the context of victims and people who commit violence with a mental illness Intended benefits To provide an opportunity for communication to repair harm. It requires acknowledgement of harm, opportunity to talk about the impact of the harm, building an understanding of the role of mental illness in the commission of the violence and committing to repair harm where possible. In some cases, such as family or friends of the patient, it can facilitate the rebuilding of longer term relationships. For mental health staff who have been harmed, it is an opportunity to rebuild the caring relationship and to reduce the potential for further violence. Victims participation in the process contributes to longer term recovery and wellbeing as much as possible Patients taking responsibility for actions and hearing the impact of harm can benefit recovery and potentially reduce future offending Process Integration with the wider service system Localised model development Family members opportunity to discuss the impact of the harm and rebuild relationships Provided by trained RJP facilitators from within the service, or an external facilitator, or both depending on the case. It includes initial assessments of suitability, clarification of expectations and voluntary participation for both victim and patient. It may include a number of individual meetings prior to a joint meeting, or facilitated communication by a 3rd party, such as a clinician, or through a letter. An agreement between victims and patients is not a goal of the RJP process in the context of FMH, but it can be an outcome if agreed as useful for both people For cases involving harm to staff by patients it is most suitable when there has been a longer term relationship between the patient and the staff member, such as in medium or high secure services, rather than acute mental health services where there is shorter term interaction and turnover of staff and patients in the services The provision of RJP for victims of violence and people who commit violence with a mental illness needs to be integrated with the wider service system for victims and other supports for patients Critical to the long term sustainability of RJP in the context of victims and people who commit violence with a SMI is the need to undertake extensive consultation on how it will be delivered and agreement on governance arrangements This includes establishment of partnerships with victim support services to approach victims to offer them involvement in the RJP and to support them through the process Organisational change and culture Training Partnerships are also required with local restorative justice services, or practitioners, to maintain networks with key practitioners who can facilitate the process and provide guidance on key issues Implementation includes multiple strategies intended to embed restorative justice practice in the service, including senior executive and clinical leadership support, information awareness days for staff, patients and families, Restorative Justice Champions in the service, consideration of restorative justice practice as part of ward meetings and documenting alignment of restorative justice practice with service values Mental health staff are trained in restorative justice practice with the process adapted for the services patients Michael Power 2016 Churchill Fellowship 19

25 Governance Policies, protocols and referral pathway Peer group supervision Promotion Media Resources Using a Restorative Justice Practice group with a professional lead within the service to oversee the provision of RJP. This includes oversight of training, management of referrals, assessments, tracking of RJP outcomes and coordination of reporting. The group can include the function of peer supervision. The services approach to providing RJP is documented and covers: types of referrals accepted; assessment of suitability; process for approaching victims and patients to participate; seeking consent for voluntary participation; identifying what is recorded in patient files; role of treating team in supporting / approving participation for the patient; identifying what happens if something goes wrong; process for managing referrals and alternatives to restorative justice practice if not suitable; identifying what data is to be recorded. Developing a guideline with victim support services, RJP providers and mental health staff that outlines how to effectively manage different scenarios for RJP, including different considerations depending on who initiates the process Established a peer support group for mental health staff involved in implementing RJP in the service. This includes support from an external restorative justice facilitator with expertise in ethical, practice and process issues Active and regular opportunities for promotion of the use of RJP is needed internally in the service, for example through posters, short videos including people who have participated, information packs, information sessions, RJ Champions on the wards, and feedback to senior managers on progress and outcomes. Co-production of resources to promote the use of RJP will enhance its acceptance by patients and victims. An important success factor is engagement with the media to educate the community on the benefits of implementing restorative justice practice within the context of victims of violence and people who commit that violence with a mental illness. Given the often negative portrayal of people with a mental illness related to violence, the promotion of positive stories about the outcome of using restorative justice practice for individuals is important. Resources for implementation of restorative justice practice include: training of mental health staff; funding for external restorative justice practitioners for expert advice, support of peer group supervision and joint provision of restorative justice sessions Administrative support for recording of required information Evaluation and Reporting Dedicated time for FMH staff to undertake RJP sessions and embed the process in the service Ongoing evaluation of the use of restorative justice practice is required with the aim of continuous improvement. Longer term research to build an evidence base in this area is important for understanding what are the most effective and sustainable models for particular forensic mental health contexts Ongoing reporting to the senior managers of the impact of the provision of RJP in the service is also important Michael Power 2016 Churchill Fellowship 20

26 RECOMMENDATIONS Restorative Justice Practice in mental health The Australian Mental Health Commission stated there is an urgent need for `a clearer view of the extent to which promising practice exists, and is able to be scaled up across Australia; we need piloting and evaluation of diversion and restorative justice approaches. (Australian Mental Health Commission. Justice System and Mental Health Report Card 2013). In pursuing this further the following recommendations are provided for Australian states and territories to consider: 1. Dedicated resources are needed to examine the opportunities for utilising restorative justice practice in Australia either pre-charge, pre-court, or post-court in mental health and forensic mental health services between victims of violence and people with a mental illness who commit that violence 2. Senior leadership in mental health and forensic mental health services consider the benefits of implementing restorative justice practice in their service to respond to patient to patient violence; patient to staff violence; violence from patients to their families and violence from patients to stranger victims. Development of restorative justice practice should build on existing expertise and skills in restorative justice practice in other contexts (e.g. youth justice, criminal justice, and community conferencing) 3. In the context of diversion of people with a serious mental illness who commit lower level violence from court, pre-charge or pre-court, Departments of Justice and Attorney s General consider how their current provision of restorative justice services (victim/ offender mediation) can be more inclusive of people with a serious mental illness 5. Development of approved models for implementation in mental health and forensic mental health are based on extensive consultation with local services including mental health clinicians, victim support services, restorative justice practitioners, families, carers, patients, police and mental health advocates 6. Engagement of the media to support longer term community education about the benefits of implementing restorative justice practice in cases where violence is committed by people with a serious mental illness 7. Implementation includes evaluation and research to continuously improve implementation, effectiveness and sustainability 8. Maintenance of a network of interested professionals within Australia, Canada, England and The Netherlands using restorative justice practice in mental health to share ideas, resources, evaluation and research in this area. This includes formalising links with established restorative justice services and leading practitioners in Australia. 4. Collaborate with mental health staff and services, restorative justice experts, victim support services on the establishment of a trial of restorative justice practice responding to issues of violence committed by people with a serious mental illness Michael Power 2016 Churchill Fellowship 21

27 ENHANCED SUPPORT FOR FAMILIES OF HOMICIDE VICTIMS Services provided by community based homicide support services in Australia for families include crisis and practical support, counselling, court support, peer support, and support to develop a victim impact statement. Peer support can include acknowledgement and memorial services for victim s families as well as social activities. Queensland also funds Victim Assist Queensland, which provides financial assistance and the Queensland Health Victim Support Service to assist victims of violence committed by a person with a mental illness, or intellectual disability, where the case is referred to the forensic mental health system. This includes supporting families of homicide victims through the forensic mental health system. This section of the report covers information on innovative services to assist families of homicide victims that could be adapted for Australia s context. Michael Power 2016 Churchill Fellowship 22

28 PART TWO Advocacy and support for families interaction with health services Hundred Families In cases where a homicide is committed by a current, or former patient of a mental health service, crucial questions are raised for families of the victim as well as the wider community. Questions include: What was the role of the mental health service? Could the service have done something more, or different to potentially prevent the homicide? How are families views incorporated into any review or investigation? How are they kept informed of these processes? Who has responsibility for implementing review recommendations? What are the lessons learnt from these cases? Do they effectively inform practices across the mental health system? Are recommendations from reviews and investigations implemented effectively and sustained over time? Whilst the media may pursue some of these questions and seek to allocate blame, what is often of importance for families is to have honest and open communication with mental health services about what occurred. A clear pathway is needed for families views to be incorporated into reviews, investigations and to be kept informed of their progress, including implementation of recommendations. It is in response to a need for families to help with these issues and questions that the Hundred Families organisation was commenced by Julian Hendy as a charity in the United Kingdom ( Julian Hendy s father was killed by a person with a mental illness who was receiving treatment by a mental health service. Hundred Families focuses on helping families of homicide victims committed by a person with a mental illness. Experience has shown families feel they are treated as outsiders by mental health services that are unclear about what they can say to families, or whether they can even speak with them. This was a gap in services where no one was available to help families understand and interact with mental health services. Hundred Families estimates that of the approximate 500 homicides that occur each year in the United Kingdom, about one hundred of these are committed by a person with a mental illness. Julian Hendy, Hundred Families, Leeds The service provides direct support and resources for families to help them understand the roles and processes within the criminal justice and mental health systems. This includes information about internal reviews and external investigations by mental health services. The service also works with mental health service staff so they are aware of the impact of homicide and understand their policy and legislative obligations in communicating with families. Resources have been developed by the service, including `A practical guide for families after a mental health homicide and `How to engage better with families after patient homicides. Julian Hendy is a documentary film maker and has produced a documentary `Why did you kill my dad? which was played on the BBC. It is available on Hundred Families website and provides a useful training resource for mental health clinicians and policy makers (Hendy). Hundred Families provides systems advocacy in the United Kingdom through participation in policy development, consultation groups and training for members of parliament and other service providers and policy makers. An ongoing focus of the work of the service is to highlight that a significant number of review recommendations are similar across multiple reviews and investigations. For example, an independent thematic review of investigations of ten homicides by mental health patients between 2007 to 2015 by the Sussex Partnership identified a similar range of recurring themes in each of the investigations (Fowles 2016). The strategic benefit of Hundred Families is its capacity to undertake systems advocacy to influence government policy and responses from mental health services. It also builds and shares knowledge on these issues across the United Kingdom. Michael Power 2016 Churchill Fellowship 23

29 Family Liaison and Investigation Facilitator (Derbyshire Healthcare NHS Foundation Trust) One National Health Service in England, the Derbyshire Healthcare NHS Foundation Trust, has implemented an innovative role that complements the work of Hundred Families. This is the Family Liaison and Investigation Facilitator role that commenced in March When a serious incident or death occurs to a patient of the Derbyshire Healthcare NHS Foundation Trust the Family Liaison and Investigation Facilitator role contacts family of the patient to offer condolences and to inform them about any review and checks with them about the type of communication they want from the Trust. This role supports the implementation of the Duty of Candour framework by providing assistance to families of people where a patient suffers moderate or above harm. Families of homicide victims where the person responsible for the crime was receiving a mental health service from the Trust is also provided assistance from this role. Generally, families of homicide victims in these cases struggle to identify who in mental health services they can talk to and what questions they can ask. Mental health staff can also be unsure about what they can discuss with families of homicide victims. The Family Liaison and Investigation Facilitator role provides a single point of contact for families. The role is positioned within a corporate patient safety unit of the Derbyshire NHS. Importantly it provides an educative and support role to NHS staff on their obligations under the Duty of Candour framework and Being Open policy so they are clear about what they can discuss with families. The role also supports families to be involved in investigations as well as supports investigators to include families. The role has evolved over the last two years and includes assisting families to make a formal complaint. One of the aims of the role is to assist families to access as much information as is able to be shared by the NHS Trust. This can include asking the patient to provide consent to share information with a family. The family can be provided with redacted versions of investigation reports. The role reports to a higher level committee within the Derbyshire NHS. Further details about these policies are at: Care Quality Commission Duty of Candour: Serious Incident Framework: National Guidance on Learning from Deaths: CQC Report on Learning Candour and Accountability Michael Power 2016 Churchill Fellowship 24

30 Therapeutic support groupwork, residentials and facilitated peer support The role of groupwork in assisting family members to deal with the impact of a homicide is an area where clinicians have mixed views. Groupwork has well-researched and documented benefits, including normalising experiences of the impact of trauma and reducing isolation. Therapeutic groupwork has an extensive history with adults who have been sexually assaulted, child sexual abuse, historical institutional child sexual abuse and domestic and family violence. One view is that to bring together individuals from families of homicide victims in a groupwork setting could potentially re-traumatise participants as they hear stories of others impacted by homicide. Peer support is more commonly used in Australia instead of therapeutic groupwork. Peer support provides social support, community awareness raising about the impact of homicide and engagement in meaningful activities such as community education to reduce violence. Groupwork holds the potential to help family members deal with the traumatic and complicated grief from the violent loss of a family member. The groupwork is not about `getting over or `moving on from the homicide, but rather how to `live with the loss. Professor Armour advised significant contributors in this area in the United States are Dr Ted Rynearson (a psychiatrist who established the Violent Death Bereavement Society) who has been a clinician working and researching for many years in the area of violent death and bereavement. He has developed a six to eight week group program. Margaret Mackabie from Survivor Resources Inc, in Minnesota, has also developed a groupwork program and training. Two services visited during the Churchill Fellowship program provide innovative ways in utilising short term groupwork and residentials to assist family members of homicide victims. The Grief Support Program, Calgary, Alberta is based in the Calgary Hospital and provides a structured group program to assist people coping with grief and loss related to the death of a partner or other family member. This includes family members of homicide victims who are included as part of the groups, rather than a dedicated homicide support group. The service includes 50 volunteers who assist in facilitating groups as well as other program activities. The Grief Support Program works in collaboration with Dr Sergio Santana and his team at the Alberta Forensic Mental Health Service to complement the support provided by that service to family members of homicide victims (who may also be family members of the forensic patient). Information from Tracy Sutton, Manager of the Grief Support Program outlined that the groupwork involves a structured six week program of two hours per week with a psycho-educational focus. The program includes a mix of individuals who have suffered loss from health, motor vehicle and other causes of death, including homicide. The groups are facilitated by an experienced clinician and a volunteer who has been through the program and wishes to support others. Groups use the Dual Process Model based on the idea of moving between processing the loss and avoiding the loss (Stroebe and Schut 1999). Groups can be large (up to 18 participants) with 2 co-facilitators and volunteer facilitators, or small (12 participants) with one counsellor and volunteer/s. The groups comprise one hour of psycho-education, a short break and then one hour of small group activities. The benefit of including volunteers who have experienced loss is that they help with instilling hope for participants in showing how they have been able to continue with their life and incorporate the loss of their family member. Grief Support Centre, Calgary, Alberta Health Services (established by Bob Glasgow) Michael Power 2016 Churchill Fellowship 25

31 Experience has shown over time that family members of homicide victims benefit from participating in the mixed groups. They often perceive they will be stigmatised when compared to other participants, but this does not occur. Each person participating in a group first participates in individual counselling. It sometimes can take longer for family members of homicide victims to prepare to participate in a group. This includes an assessment and preparation for the group as well as understanding what may trigger symptoms of trauma. Once in the group there is a coming together of participants, recognising that there are also unique features of loss associated with homicide. The service operates under a trauma-informed model and aims to normalise the experience of grief. For very traumatic loss then it is important to normalise and bolster skills, strengths and resilience. This can include more time needed for `meaning making as part of the working through grief. Escaping Victimhood Escaping Victimhood is a charity in the United Kingdom that has been using residential workshops with success in assisting family members of homicide victims as well as victims of serious assault and sexual assault. The program focuses on assisting people post court sometimes years later, after a homicide to establish a `new normal. The program involves a three night, four-day residential program (plus a one day, non-residential follow up) at a welcoming and comfortable venue near a transport hub where people will feel safe. Up to twelve participants attend each residential and predominantly more women than men. The residentials are primarily designed for family members and direct victims 18 years and older. The residential is not promoted as `doing therapy but rather it does have an overall therapeutic benefit. Many family members of homicide victims and victims of other serious crimes, do not feel safe and staff actively contact confirmed participants prior to a residential to encourage and assist them to attend. Staff will pick up confirmed participants if they are struggling to attend. Participants are provided with a lot of written material about the residential prior to it commencing. Experience has shown that some people start panicking the day before the residential and staff contact them to address any concerns. Practical issues are arranged, such as the venue not asking for credit card details when participants arrive which may prompt them to feel unsafe or embarrassed due to their financial situation. Costs are covered by different funding sources, usually funding allocated from other agencies, such as the National Homicide Service, Victim Support UK, for a person s attendance. Debra Clothier, Chief Executive of Escaping Victimhood outlined the program structure covers content on two themes, education on trauma and its impact on the brain and body. The second area of content is on change and uses the idea of a hero s journey. This content is covered in morning sessions. Overall the program aims to help participants recover a` new normal. The program uses film segments to highlight the ideas of journey and responding to challenges. In the afternoons the program provides opportunities to participate in trauma massage which can help participants sleep at night. Photography and art are used as activities to encourage the creative part of the brain to be used again as it can be negatively impacted by significant trauma and grief. During the residential, participants can have time one to one with the facilitators to apply what they have learned to their own situations, as they are not expected or encouraged to share their stories when part of the group. The program is led by two facilitators, one with expertise in trauma (usually a psychologist) and another on change. The program also focuses on reinforcing change for people through predicting that once they finish the program that they may have a dip but will pick up again. As part of planning for the return home, it is discussed that friends or other family members may wish them to return to old ways of behaviour. Six weeks after the residential participants are invited to a one day workshop to reinforce the changes they had made and check progress on achieving their goals. At the end of the program, participants are provided information on other services that could assist them, including restorative justice. For family members bereaved by homicide, they may feel if they look to the future they are leaving their loved one behind. Issues discussed include permission to dream about the future and describing what that dream would look like. Michael Power 2016 Churchill Fellowship 26

32 Other ideas to assist families of homicide victims Chicago Survivors ( org) is a homicide support group that responds to a high number of homicides each year in Chicago. The service responds 24/7 with up to 2 to 3 homicides per night, which far exceeds the rate of homicides in Australia each year. The service has been using, or is investigating, a number of innovative practices to support families of homicide victims, including: Victor Jammers, Member of the Board of Directors, Dr Sonja Leferink, Researcher and Senior Policy Advisor and Nannie Putters, Head of Case Management, Victim Support Netherlands, Utrecht The residential program offered to families of homicide victims has been part of a research project for a PhD candidate which is due to report positive findings at the end of Some lessons learnt have been that while initially it was considered an option to use volunteers (often those who have been victims) to assist with delivering some of the program, the material was too challenging and they couldn t be objective. The role of the facilitators is crucial, they must have a capacity to work together and debrief after each day. They must be familiar with each other s material so they can support the other. It is crucial to recognise that providing the residential is a 24 hour per day process with attention to the needs of participants throughout the four days. The service has kept the same model for three years, because of the research, and only recently has more flexibility been introduced based on feedback from participants. Utilising a 24/7 model to quickly support family members after a homicide, either at the hospital or another location. This includes liaising with employers of family members if required. Speakers Bureau provides family members media skills to undertake community education activities on the impact of homicide as well as to create a video (or another creative process) to document a positive narrative of their family member who has been killed Providing education for Judges on the needs of homicide victims Coordinating meetings with families and police to seek updates on unsolved homicide investigations Investigating the application of the Child and Family Traumatic intervention program from Yale University to support parents to more effectively help their children (7 18 years) with the impact of losing a family member from homicide. More information is at: cvtc/programs/cftsi/index.aspx Dutch Victim Support has implemented four types of peer support with families of homicide victims that have varying degress of staff participation. This includes: (a) facilitated peer support groups with six to ten family members where staff provide some content and facilitation with encouraged self management; (b) peer support progams for family members over four weekends with a therapeutic focus delivered by a trauma support service; (c) an online peer support forum where families can exchange information anonymously; and (d) peer support that included a pilgrimage to another country (this has occurred once) (Leferink). Dutch Victim Support has also facilitated peer support groups with young people who were siblings of a homicide victim. They have also used different times for the delivery of the groups, including over four weekends. The service is supporting research by a PhD student who is investigating the use of facilitated peer support groups (Jammers, Leferink and Jammers). Michael Power 2016 Churchill Fellowship 27

33 Victim Impact Statements Current opportunities to participate in the justice system for victims of violence are the provision of victim impact statements to Court. Whilst not only applicable to families of homicide victims, they are often promoted as a way of victims having a voice in the justice system. Research indicates our understanding of the use of Victim Impact Statements may need a more refined approach. Provision of a victim impact statement may not have a mediating effect on the long term wellbeing for victims. Dr Kim van Zijp-Lens, Assistant Professor and Alice Bosma, Victimology PhD Student, Tilburg Law School, Intervict, Tilburg University, Tilburg the state and whilst they are not a party to criminal justice proceedings, they can help with compensation claims, assist in preparing a victim impact statement and submitting other documents to the court on behalf of the victim (Jammers, Leferink and Putters). Partnerships between homicide support and restorative justice services The National Homicide Service, Victim Support UK, provides a national support service in England and Wales. It utilises professional staff (case workers) and volunteers that aim to get families `back on their feet to cope and recover to a point where they can live their life. Caseworkers provide a single point of contact for families which is complemented by a trained volunteer. They assist with practical and psycho-social issues. Support is usually provided over a two year period where it is expected families will hit `rock bottom after the trial (Owen). Therapeutic support for families can be accessed through counsellors and also attending residential workshops held by Escaping Victimhood. Support for families of homicide victims committed by people with a mental illness is complimented by the work of Hundred Families. Research by A/Professor Kim Lens in The Netherlands indicates that victims of more complex and serious cases are more likely to provide a victim impact statement (Lens, Pemberton & Bogaerts 2014). Further, the provision of a Victim Impact Statement will not necessarily result in a therapeutic benefit. Instead what is needed is a focus on who will benefit from utilising a victim impact statement and under what conditions (Lens, Pemberton, Brans, Braeken, Bogaerts and Lahla 2015) rather than using a standardised approach. Legal and case management support Dutch Victim Support in The Netherlands is a national victim support service that employs case managers and has volunteers to assist victims of crime. Victims of lower level violence are supported by volunteers. Victims of serious violence, including families of homicide victims, are supported by case managers (social workers) who coordinate responses to social, psychological and financial needs. The service provides specialised case managers for families of homicide victims where support starts from as early as possible through to the conclusion of any appeal process. Uniquely Dutch Victim Support facilitates access to legal services for victims of serious violence to assist them with their rights. A victim s lawyer is funded by Nicola Bancroft, Assistant Director, Remedi (Restorative Services) and Catherine Owen, National Homicide Service Operations Manager, Victim Support, United Kingdom Whilst the National Homicide Service has a model of support consistent with other homicide support services in Australia, the service also has a partnership with a restorative justice service provider (Owen). Remedi is a restorative justice service provider that is a charity in the United Kingdom providing RJP services in adult and youth justice areas. The service receives referrals from multiple sources, including the National Homicide Service. Remedi is promoted with caseworkers in the National Homicide Service to consider discussing the option of restorative justice Michael Power 2016 Churchill Fellowship 28

34 with families of homicide victims. Discussion occurs with the National Homicide Service caseworker at the time of referral to Remedi on what stage the case is at and whether there are any orders prohibiting contact. Even if the person charged has entered a guilty plea, they may not always be suitable for inclusion in a restorative justice process (Bancroft). Staff involved in facilitating restorative justice practice in these cases need training on complex and sensitive practice. Part of the assessment is to consider what is the motivation for the offender to participate in restorative justice. Two staff are always involved in these cases as part of preparation with both the victim s family and the offender. There can be practical challenges in arranging RJP in these cases, depending on which prison the offender is held. The process can be undertaken in a staged way, through indirect communication, such as a letter, then leading to a joint meeting. Partner agencies can be kept informed on the process through consent forms (Bancroft). Experience has shown that cases can be slow when they involve the provision of RJP concerning a homicide (Bancroft). Whilst the process of offering some form of restorative justice communication between families of homicide victims and the offender is not new, the more innovative aspect of this arrangement is the ongoing close working relationship between the National Homicide Service and a community based restorative justice service provider. Michael Power 2016 Churchill Fellowship 29