The challenges for the UK – (the views of the author Val Jackson)
The Tornio region in Western Lapland has a relatively stable population of approx. 70,000 and mental health services are organised generically. That means that the service works as one comprehensive unit and staff can be employed across the service. It also means the service can work consistently with someone throughout the life of the problem. No assessment is needed at the first contact, and therefore no diagnosis is necessary initially. Every one with a mental health problem is seen by the Open Dialogue team.
In England, as well as having much larger large towns and cities, services are mostly organised along functional models, i.e. there are several teams that have different functions, e.g. crisis team, home treatment team, early intervention teams etc. This allows for greater expertise to be developed around the specific function but individuals are often referred to many teams during the life of a problem. The UK also has higher levels of migration with individuals crossing boundaries between health service providers. Training the majority of staff as family/dialogical therapists would be a challenge, particularly as the model of choice for many trusts is behavioural rather than systemic family therapy. The Parachute service developed in New York will be an exciting project to learn from.
What we do have in the UK are early intervention services, something many countries do not have but to succeed it seems likely that the Open Dialogue approach will need to be adapted. However, there is enthusiasm and passion for change.
Kent A new Peer-supported Open Dialogue service started taking referrals on February 1st 2017, managed by Yasmin Ishaq and Dr James Osborne. They are already reporting a reduction in hospital admissions and use of medication. For more information please email email@example.com
Leeds – aspire EIS ran a small trial in 2014 called Early Network Response (ENR), an overview of which Val wrote about in Context Click here to view
London – Dr Russell Razzaque, associate medical director for NE London Foundation Trust (NELFT) is running an Open Dialogue randomised controlled trial involving several trusts with Professor Steve Pilling as the lead researcher. NELFT in collaboration with London South Bank University (LSBU) run a one year graduate and post graduate certificate course in Peer-supported Open Dialogue, Social Network and Relational Skills (POD). Mark Hopfenbeck has written about the training Click here to view . The course has been accredited by AFT (Click here for more information) as a foundation level training in family therapy.
A third cohort of 70 students completed the Peer-supported Open Dialogue training in October 2017. The 4th cohort began in January 2018. Here is a short video made by Greenlane Films describing the training. https://youtu.be/v4EtYgJ7W5c.
More information can be found at http://apopendialogue.org/ Watch this space for more news about these exciting developments.
Dr Razzaque has also established Dialogue First, a service for families based on OD principles. Referrals can be taken from around the UK. The lead practitioner is Cathy Thorley, family therapist.
Go to http://apopendialogue.org/ for more details.
Newcastle – Several family therapists are employed in the trust and for many years they have actively involved families in planning and decision making. They are now considering participating in a small trial. Contact Kevin.Hawkes@ntw.nhs.uk for more details or read their article in Context. Click here to view
Nottingham – there is a very keen and active Open Dialogue working party. They work actively to influence MH services and the Notts Healthcare Trust published a discussion and strategy document on Open Dialogue that is well worth a read. Click here to view They also offer workshops and seminars from time to time. All are invited to their monthly meetings.
Somerset – The area has a service comprising of four well established family intervention teams working with psychosis. The teams were developed through an in-house university-accredited training course and are made up of staff from across mental health services. The approach has been developed through the integration of systemic and psychoeducational approaches to working with families and the services have many similarities with the Open Dialogue Approach. More information can be found in Context magazine. Click here to view Frank Burbach’s thesis provides further details of the family services in Somerset. http://hdl.handle.net/10026.1/1599
Elsewhere – Open Dialogue UK: promoting the development of the Open Dialogue approach in the UK. See website for details of upcoming seminars and other events. It also runs training courses in open dialogue, and more details can be found in Context Click here to view Open Dialogue UK now has a base in Dalston, London where families and their networks can request to be seen. Go to http://opendialogueapproach.co.uk for more details.
It is worth mentioning the Carers Trust Mental Health and Triangle of Care best practice guide. This incorporates some of the principles of Open Dialogue and some trusts are implementing the guide with many more signed up to it. https://www.rethink.org/carers-family-friends/brothers-and-sisters-siblings-network/information-for-professionals/the-triangle-of-care-families-and-carers-included