Open Dialogue
What is Open Dialogue?
Open Dialogue or Peer support Open Dialogue (POD)
Derived from Western Finland in the 1980s, informed by systemic practice, Open Dialogue (OD) is a different approach to mental health crisis and organising care provision.
The approach has seven core principles;
- Immediate help
- Social network perspective
- Flexibility and mobility
- Responsibility
- Psychological continuity
- Tolerating uncertainty
- Dialogue and polyphony
OD promotes a network perspective, bringing together one’s professional and social networks to provide continuity of care for service users.
It can differ from other treatment as it holds some unique features; consistency of staff, the belief that all voices are equal and the avoidance of quick treatment decisions or labels.
There are no age or diagnostic / difficulties exclusions. Its hope is to create space for new understandings of difficulties in the context of the individual’s own life.
With influence from the Parachute program in New York (Wusinich, at al 2020) whom pioneered the mix of Peer support and Open Dialogue into an urban area, POD developed to aid recovery by means of mutual support, to re-adjust imbalances in autonomy and power that can often be present in health care systems.
This is the POD model we follow at KMPT.
POD is seen as not only a therapeutic approach but also organisational intervention, having a profound impact on the organisation’s culture, and drives significant improvement in staff morale and retention.
OD is recommended by WHO and compliments other interventions including psycho-pharmacology and psychology.
The initial research by the Finnish team showed significant reduction in the use of hospital beds and medication, it demonstrated improved social functioning, and rates of returning to work or study up a third to that of treatment as usual- these findings where reported at 5, 10 and 20 yrs. (Bergström T, Alakare B, Aaltonen J, et al. 2017 ) follow ups. This echoed our own raw data.
Our research paper published 2022 concludes that service users reported significant improvement in wellbeing and functioning as well as a marked increase in perceived support by carers. (Kinane et al 2022- BMC Psychiatry 22:138)
Left to right: (back), Annie Jeffrey, Alex Streater, Paul Roberts, Emma Hogwood, Fleur Whitfield, Anna Garrett, Amy Edwards, Elaine Lee.
Front row: Karly Stead, Jo Fiakkas, Sonja Munday – Missing from picture Dr Vicki Clark, and Amanda Francis.
If you are a KMPT member of staff and would like to sign up for the training, please contact kamnascpt.opendialogue@nhs.net
Key principles
set up and principles
Service set up and principles
Family
Supervision
Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness (ODDESSI)
Principal Investigators Dr James Osborne and Dr Victoria Clark
The ODDESI trial is the largest randomised controlled trial of Open Dialogue. The study is looking at the Open Dialogue treatment model for patients with severe mental health problems, who experience a crisis and receive ongoing community mental health care. The trial aims to evaluate whether Open Dialogue is more clinically-effective and cost-effective than usual NHS community mental health care, in terms of reducing relapse and improving social networks.
ODDESSI Trial Contacts:
Sarah Noordally
Lead ODDESSI Researcher in KMPT
sarah.noordally@nhs.net
Research
The ODDESSI trial | UCL Psychology and Language Sciences - UCL – University College London
Peer Supported Open Dialogue in the National Health Service: Implementing and evaluating a new approach to Mental Health Care
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-03731-7
Open Dialogue compared to treatment as usual for adults experiencing a mental health crisis: Protocol for the ODDESSI multi-site cluster randomised control trial
Peer practitioners within the team have said:
“The Open Dialogue model is a great match for peer support. I’ve found that network meetings create an environment where lived experience can be shared in a helpful way that builds trust with clients. Open Dialogue allows for everyone’s voice to be heard and respected, leading to a better understanding between members of a network, which makes it easier to work alongside people as a peer.”
“Being a Peer in the Open dialogue team, has been a unique and humbling experience, after been in mental health services myself on and off for thirty years, I have never encountered such a authentic way of being and working, open dialogue holds a safe place to help you understand your feelings ,emotions and behaviours whilst being kindly transparent, respectful, and honest within the process. Open dialogue has given me a great opportunity as a Peer to use difficult and painful life experiences into helping others by standing alongside on the road in their recovery.”
POD Ambassador/Carer’s lead Annie Jeffrey:
“I’ve been part of the Peer Supported Open Dialogue Team (based in Canterbury) since the start and believe this trauma informed approach is a therapeutic and holistic way of helping people with mental health problems.
As a past carer I feel I understand some of the challenges carers face and try to support people going through difficult times. I attend Carer and Service User Groups.
Part of my role is to raise awareness of the KMPT POD team which also is part of the ODDESSI research trial.”
The clinicians in the team say:
What I like about working for POD:
- I feel very supported
- I feel more like myself.
- Better relationships with colleagues and clients
- Mindfulness
- Supervision
- The feeling of all being equally important in the room, it makes me feel as thought we are all acknowledged as whole humans, not just ‘roles’.
- The flexibility in the way we work allows for ‘real life’ unanticipated situations without feeling punitive towards service users.
- It feels person centred and needs based as opposed to formulaic.
- Shared, team ‘ownership’ of clients makes the job less stressful.
- Involving and developing client’s networks makes total sense to understand clients’ stories. People don’t experience distress in isolation and don’t want to be dependent on services.
- What I love about Open dialogue is works collaborative with our clients, and their networks. Which, I have not previously experience working as a care coordinator. I would say that I witness more ‘a ha’ moments for people, where they can see change from a place where that didn’t seem possible. As a team, we regularly work together with our clients, so there is less sole working, which shares the load of what we do, let’s face it is heavy duty at times, it just feels safer for us and for our clients.
- That most of my time is spent with people rather than on paperwork.
- Refreshing being able to recognise that we are all humans with emotions which can a share with the people we work with (clients and colleagues).
“Open Dialogue has been a great asset for my son Charlie - he has been able to open up and find much needed support and reassurance regarding his mental health. The sessions have built up his confidence and he feels comfortable with all staff that has been with him on this journey.”
“Open dialogue has been very helpful for me because I felt really listened to, and understood in the discussion between the two therapists. Listening to them discussing, gave me time to reflect on what I was feeling and also open my mind to other possibilities.
The therapy is very person based and I felt able to be open & honest for the first time in my life. At last I seemed to have some agency over my care and it allowed me to get the best from my time in the care of KMPT.”
“I came to Open Dialogue with a history of extensive trauma, which made me feel very afraid to talk about my feelings. Within Open Dialogue I have felt very heard. I have appreciated the time for headspace enabled by practitioners reflecting on what I have said, and I have valued the collaborative way of working. When practitioners have shared their relevant personal experiences during sessions it has made me feel very validated, and added to the sense of trust and safety that I felt within the service. I appreciated that the ownness was not all on me to talk, unlike my precious experiences of therapy. Overall I would describe my experiences of working with Open Dialogue as extremely positive and beneficial to my journey of recovery from trauma.”
“Open dialogue has changed my life for the better. From the consistency of seeing the same people every time, being able to text/call during working hours, being referred easily to additional services, and the involvement of family and friends, it’s a completely different level of support from anything I’ve experienced before. This service saved my life and continues to support my ongoing recovery and well-being.”
