Every time I read about Open Dialogue, I see the ethos of restorative justice in its principles. Open Dialogue is a ‘social network approach’ in which clinicians work as a team (minimally as a pair) with patients (clients) along with members of their family, friends, colleagues, support workers, neighbours or any other persons they wish to involve. The focus of treatment represents a shift from individual psychopathology to empowering social networks for a relational approach to recovery, involvement of the same team in the care pathways of people wherever they go and adapting the care processes according to the clients’ needs (Mosse, 2019). This approach, pioneered in Finland, is different to much of mental health care in the UK, but it has been discussed for many years with interest by several NHS Trusts around the country and is now being implemented in the UK. It is unique and innovative and has recorded striking results in Finland, Germany and parts of the USA. For example, in international non-randomised trials, 72 percent of those with first episode psychosis treated via an Open Dialogue approach returned to work or study within two years, despite significantly lower rates of medication and hospitalisation compared to treatment as usual (Stockman, 2016).
Open dialogue and restorative justice share foundational principles of healing, rehabilitative goals and dialogic relationships to allow for diverse individuals to find meaning and the space to recover. While there are many definitions of restorative justice, the overarching understanding of restorative justice is that it is an ethos. As an ethos, it is not only a methodological tool for the restoration of harm and rebuilding relationships, but also encompasses a sensitivity to and an orientation towards the values, principles and ethics of respect, equality and community collaboration. There are 4 foundational principles that Open Dialogue shares with restorative justice:
The “individual” as more than labels
One of the key foundations of the ethos is the acknowledgement that individuals are complex beings who are shaped by socio-political, cultural and economic factors. To slot people into arbitrary categories of “good” and “evil” limits the possibility of justice and a journey towards healing because it forecloses the possibility of conceiving of a solution and the capacity to build a relationship with the “other.” While this does not mean that there is no harmed party and a harming party in a crime, practising restorative justice enables both parties to interact and converse and see each other beyond the boundedness of the crime. It allows the offended person
to ask unanswered questions and explain the impact that the crime had on their life. It also gives a chance for the offender to reflect on their actions, make amends and work towards refraining from causing future harm.
Open Dialogue involves a radical shift from the traditional psychiatric treatment model of labelling and giving meaning to people’s experiences such as diagnosing them with schizophrenia or psychosis. These diagnoses are based on narrow definitions that lead to a predetermined pattern of treatments or interventions to ease the symptoms (Waddingham, 2017). What the Open Dialogue approach offers is the time and space to engage with someone’s own meanings and the many different meanings that already exist in a family/social network. It would be easy for practitioners to talk ‘about’ the person, to take an expert position and puzzle over what would be best for them. ‘Witness thinking’ in Open Dialogue orients practitioners to a more ethical way of being with people. It demands that they do their best to be alongside someone, to figure things out together. It’s about nurturing a relationship and calls for a recognition of the autonomy, wisdom and personhood of those they are trying to support (ibid.). Dialogic and relational space
In restorative justice, there is a shift from a punitive stance to a dialogic intervention. The traditional approaches in criminal justice are like monologues framed within bureaucratic systems which are often experienced negatively by people who feel that they are misunderstood, not heard or treated with dignity. Restorative justice instead focuses on a relational approach, where the conversations, interventions and nature of relationships between different parties is co-designed and co-produced by everyone (Gavrielides, 2022). Restorative justice assumes the existence of “social liaison” that bonds individuals in a relationship of respect for others’ rights and freedoms and recognises people as agential beings who can take responsibility for their own actions.
Open Dialogue is based on these values of reframing the therapeutic space and the involvement of the client. It aims to shift from an expert-led diagnostic language to discovering ways out of crisis, new openings and agency through a dialogue involving social networks and the therapeutic team. Clients are seen as agents who have the capacity to generate new emotions and construct narratives with others in their lives that can help in healing. The underlying principle is that rather than focusing on expert-led treatment and intervention, clients are given the space to speak, reflect and co-create interventions with a group involving family members, friends, caregivers and medical experts.
Power sharing
Crucial to the idea of creating a dialogic space is the ability to relinquish power and the desire to have one’s social will and authority prevail in a relationship. Applying restorative justice principles requires the practitioners to reflect on their own impulses, thoughts and actions and change the way they use power to dominate or influence other individuals (Gavrielides, 2022). This requires a continuous conversation with oneself and a more active integration and learning of how to respect and respond to diverse people’s opinions and thoughts in a way that is rehabilitative and healing for everyone.
Similarly in Open Dialogue, the idea is to re-shape patient and professional hierarchies, where the therapist’s job is not to offer authoritative expertise, but to respond and say what it feels like to hear the things being said. In this therapeutic space, the therapist is a ‘conversational artist’ having ‘an expertise in asking questions from a position of “not knowing”’ to allow ‘locally’ constructed understandings and vocabularies (Anderson, 1992 as cited by Moss, 2019, p. 12). This not knowing involves a shedding of unequal power dynamics in healthcare and embracing new modes of relating, knowing and being-with clients that gives everyone an equal space to co-construct the healing process.
Always moving
There are core principles underlying restorative justice, but the beauty in this approach is that it is flexible and always open to new values and interpretations. While this aspect may be criticised for being un-scientific and lacking clarity, the notion of justice and collaborative approaches in the interest of all parties cannot be bound by rigid rules and meanings (Gavrielides, 2022). The idea of an intersubjective and dialogic space requires a constant shift, fluidity and reconfiguration of actions, interventions and communicative strategies to allow for an impactful and meaningful process of healing and recovery that suits the needs of the parties involved. Since it is based on lived experiences and is a way of being and doing in everyday life, defining restorative justice to a narrow understanding will itself be an injustice to the dynamic and diverse realities and experiences of people.
Open Dialogue is an approach that is also acknowledged as constantly evolving. It has no fixed frames of reference or meta-language and does not claim to hold answers to the complexity of emotions and experiences involved in the process of recovery or treatment. Rather, it derives its strength from the idea of recovery as arising between the productive, emotional and reflective interactions among diverse groups of people (Mosse, 2019, p. 6). Every immersive period with different stakeholders in the therapy has its own trajectory and conceptualisation of what counts as healing. It involves a practice of “being with” others and an “aliveness” that exceeds our existing categories and styles of thinking (Stevenson, 2012, as cited by Mosse, 2019).
In adopting its foundational principles and values, I believe the Open Dialogue approach embraces the ethos of restorative justice. Embracing this ethos allows for a kind of psychiatry and mental health treatment that fosters interactive meaning-making, a responsiveness to each other’s experience, the ability to reflect on an awareness of our emotional selves and co-creating healing and restorative interventions. While an understanding of restorative justice and its application in models like Open Dialogue is an ongoing process, these approaches are remarkable and heartening developments that have the potential to contribute towards gentler, more respectful and impactful models of care and restorative change.
Bibliography
Anderson H., Goolishian H. (1992) The Client is the expert: A not knowing approach to therapy. In Therapy as Social construction, McNamee S., Gergen K. New York:Sage Publications.
Gavrielides. T. (2022). Introduction to Restorative Justice Art: Four steps to restoring mental health, London: RJ4All Publications.
Mosse, D. (2019). Reflections on Open Dialogue in mental health clinical and ethnographic practice. In Emma Gilberthorpe, (ed.) Anthropological Perspectives on Global Challenges. (ASA Monograph Series). New York & London: Routledge.
Razzaque, R., Stockmann T. (2016)An Introduction to peer-supported Open Dialogue in mental healthcare. BJPsych Advances, 22. 348–356.
Waddingham, R. (2017). Some of the things that excite me about Open Dialogue. Behind the label. https://www.behindthelabel.co.uk/open-dialogue-excites-me/
The Frightening Statistics
For the academic year 2020/2021, the UK government website has reported 352,454 cases of suspensions and 3,928 permanent exclusions in England. The most frequent cause of exclusion reported is continual disruptive behaviour, accounting for 42% of suspensions and 39% of permanent exclusions. [1] The Challenging School Exclusions report by JUSTICE (2019) highlights that since 2012 the number of permanent and fixed school exclusions in England has increased year on year. These statistics far outpace those in Scotland, Northern Ireland and Wales, and significantly affect students from ethnic minority backgrounds and those with special educational needs and disabilities (SEND). [2] For example, research involving the University of York indicates that there were 7,900 permanent exclusions in England compared with only 3 cases in Scotland between 2017/2018. On an international level, we fared even worse as a country with the school exclusion rate in the UK being 10 times higher than any other European country. [3]
These alarming statistics do not end here. An article by The Guardian refers to the data as only “the tip of the iceberg”, with research suggesting that 5 times more young children are being schooled in alternative provisions for excluded students than the actual statistics dare to admit. [4]
The Timpson Review of School Exclusion in 2019, commissioned by the government, has acknowledged and established that not all school exclusions may have been legal, justified and completely rational. [5] In addition, the aforementioned JUSTICE report has raised some critical concerns in regard to school leaders’ poor decision-making, their inconsistent understanding of legal duties, high occurrence of informal exclusions and potentially unlawful “off-rolling”, and calls for a systematic reform for school exclusions that demands an approach that is robust, consistent, fair and also considerate to a child’s individual needs. [2]
What is “Off-rolling”?
“Off-rolling” is described by Ofsted as “the practice of removing a pupil from the school roll without using a permanent exclusion, when the removal is primarily in the best interests of the school, rather than in the best interests of the pupil. This includes pressuring a parent to remove their child from the school roll”. [6] “Off-rolling” has also often been perceived as a tactical move by school leaders to remove poor-performing pupils that are likely to lower the school’s national test performances (such as GCSEs) to manipulate their academic standing, or the so-called “gaming” the league tables. [7] SEND and disadvantaged students are strikingly the most affected. [8] In a 2017 briefing to MPs, the Children’s Commissioner claimed that 89% of mainstream schools in England would have lower GCSE pass rates if the results of those students who had been off-rolled or moved to alternative provisions between Year 7-11 were included in their yearly results. [9] Furthermore, an interesting study conducted by Done and Knowler (2021) involving 21 senior school leaders suggests that schools potentially are aware of loopholes of how allegations of “off-rolling” can be evaded. More importantly, the study demonstrates school leaders’ reluctance and defiance to openly discuss the topic as evident by their low number of participants, with only one head teacher willing to be interviewed face-to-face despite widespread advertising. [10]
But is it entirely the fault of the school? Findings by Machin and Sandi (2020) contested the idea that “off-rolling” is mere “gaming” [11], and their research suggests a greater systematic failure that is due to conflicting interests between a political obsession to maintain academic standards and a goal to allow for inclusive education. [12][13] Underfunding, limited resources, overworked staff, low pay, burn-out teachers forever leaving the profession– schools are at their wit’s end, forced to find ways to work around harsh restrictions. School exclusion becomes a tool used by those in power to mask an inability to effectively carry out inclusive education, and to exert dominance over those who are marginalised.
An Infinite Loop of Social Reproduction
School exclusions can have serious, long-term impacts on young people, but they can also incur serious economic costs with an estimate that each unit of permanently excluded children will go on to cost an astonishing £2.1 billion in education, criminal justice, health and benefits over their life. [4] Many global studies including The Edinburgh Study of Youth Transitions and Crime, performed by the University of Edinburgh, pointed to a “school-to-prison” pipeline. [14] This includes Natalia’s uncle who was excluded in Year 7 and since never returned to school and was in the end imprisoned. [15]
The Edinburgh Study found that pupils that are excluded from school at the age of 12 are 5 times more likely to be imprisoned by the age of 24. In addition, boys and children from single-parent and low-income families are found significantly more likely to be excluded. Conversely, it is discovered that students with equally poor behaviour from two-parent families and more affluent backgrounds are more tolerated by schools and less likely to be excluded as a result. Professor Lesley McAra, Head of the University of Edinburgh’s School of Law, argues that their study ultimately shows that the criminal justice system is being used as a way to admonish socially marginalised groups and members of society who are living in deprived communities and are vulnerable. [14] This creates a cycle of social reproduction where marginalised groups continue to be oppressed in favour of those in power and exacerbates the hierarchical culture in society.
With Sean Harford, Ofsted’s national director, going as far as to admit in 2019 that schools in areas with greater poverty continue to be less likely to be rated as ‘good’ [16], it seems that a great educational reform is in need to have any hope of removing such a deeply rooted and troubling characteristic in British education.
References:
[1] DfE (2022) https://explore-education-statistics.service.gov.uk/find-statistics/permanent-and-fixed-period-exclusions-in-england (Accessed: 16 September 2022).
[2] JUSTICE (2019) Challenging School Exclusions. London: Sidley Austin LLP. Available online at https://files.justice.org.uk/wp-content/uploads/2020/08/06165917/Challenging-Report.pdf (Accessed: 16 September 2022).
[3] The University of York (2020) https://www.york.ac.uk/news-and-events/news/2020/research/exclusions-english-schools-last-resort/ (Accessed: 30 September 2022).
[4] Weale, S, (2017) ‘School exclusions data in England only “the tip of the iceberg”’, The Guardian, 10 Oct. Available online at https://www.theguardian.com/education/2017/oct/10/school-exclusion-figures-date-england-only-tip-iceberg (Accessed: 30 September 2022).
[5] DfE (2019) Timpson Review of School Exclusion. Available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/799979/Timpson_review_of_school_exclusion.pdf (Accessed: 16 September 2022).
[6] Owen, D. (2019) ‘What is off-rolling, and how does Ofsted look at it on inspection?’. Ofsted: schools and further education & skills (FES), 10 May 2019 [Blog]. Available online at: https://educationinspection.blog.gov.uk/2019/05/10/what-is-off-rolling-and-how-does-ofsted-look-at-it-on-inspection/ (Accessed: 17 September 2022).
[7] Ofsted (2019) The annual report of Her Majesty’s Chief Inspector of Education, Children’s Services and Skills 2017/2018. Available online at: www.gov.uk/government/publications/ofsted-annual-report-201718-education-childrens-services-and-skills
[8] Graham, B., White, C., Edwards, A., Potter, S. and Street, C. (2019) School exclusion: A literature review on the continued disproportionate exclusion of certain children. London: DfE.
[9] Children’s Commissioner (2017) Briefing: Falling through the gaps in education. London: Children’s Commissioner for England. Available online at: https://www.childrenscommissioner.gov.uk/wpcontent/uploads/2017/11/BRIEFING-Falling-through-the-gaps-in-education-CCO.pdf (Accessed: 6 October 2022).
[10] Done, E. J. and Knowler, H. (2021) ‘Off‐rolling’ and Foucault’s art of visibility/invisibility: An exploratory study of senior leaders’ views of ‘strategic’ school exclusion in southwest England. British Educational Research Journal, 47(4), pp. 1039-1055.
[11] Machin, S. and Sandi, M. (2020) Autonomous schools and strategic pupil exclusion. The Economic Journal, 130(625), pp. 125–159.
[12] Done, E. J. (2019) ‘Education governance and the responsibility to include: Teachers as a site of dis-cursive tension’, in: J. Allan, V. Harwood and C. Jørgensen (eds) World yearbook of education 2020. London: Routledge.
[13] Slee, R. (2014) Discourses of Inclusion and Exclusion: Drawing Wider Margins. Power and Education, 6(1), pp. 7–17.
[14] The University of Edinburgh (2016) https://www.ed.ac.uk/news/2013/exclusionprison-280213 (Accessed: 16 September 2022).
[15] BBC Bitesize (2019) https://www.bbc.co.uk/bitesize/articles/zd9wkmn (Accessed: 30 September 2022).
[16] Harford, S. (2019) ‘Our latest statistics: a first look at the EIF’. Ofsted: schools and further education & skills (FES), 16 December 2019 [Blog]. Available online at: https://educationinspection.blog.gov.uk/2019/12/16/our-latest-statistics-a-first-look-at-the-eif/ (Accessed: 17 September 2022).
Issues of poverty are intersectional; they impact communities in different ways and for different reasons. Research shows that over one third of LGBTIQ+ people living in London face significant financial hardship and lack sufficient financial resources to maintain a suitable standard of living. A report published in 2017 by the London Assembly Health Committee suggests that financial hardship is exacerbated by experiences of discrimination which make it harder for LGBTIQ+ people living in London to earn money, stay financially secure and pursue their goals.
Those who identify as LGBTIQ+ are also more likely to suffer from depression, anxiety, paranoia, schizophrenia, and post-traumatic stress disorder. Being LGBTIQ+ doesn’t cause this, but the experiences that many LGBTIQ+ persons face such as homophobia and transphobia make the issues of mental health and poverty more prevalent.
Research also suggests that discrimination against the LGBTIQ+ community increases the chances of homelessness and extreme poverty. Young LGBTIQ+ people currently comprise up to one quarter of the youth homeless population in Britain. The Albert Kennedy Trust organisation that supports young LGBTIQ+ people, estimated that 150,000 were homeless or at risk of homelessness as a result of intolerance . Stonewall Housing, a London-based organisation which offers specialist advice and support to LGBTIQ+ people, says that two thirds of young people who access their services state their housing problems are directly linked to their sexual orientation or gender identity.
For this reason, solutions to poverty and mental illness need to intersectional; they need to take into account the sexual orientations and gender identities of those who are in need of help. The government seems to be taking this position more seriously, with the Equalities Office conducting research to help better understand LGBTIQ+ people’s experiences of homelessness, the challenges they face, and to enable tailored support to be provided. But who knows how long this may take.
Right now, LGBTIQ+ people are facing a mental health crisis with limited resources and with minimal financial support. Organisations are calling on the government to enact immediate change; with better referral pathways between housing services to ensure the safeguarding of vulnerable LGBTIQ+ persons, homelessness data to include gender diverse, trans and non-binary identities and for protections against LGBTIQ+ discrimination to be strengthened and more accessible. These are only small steps necessary for tackling a pandemic of economic and social violence experienced by the LGBTIQ+ community.
Words by Didier Muller
