Open Dialogue

Open Dialogue is a community-based and integrated way of engaging with a service user’s family or social network, from the very start of them seeking help (within 24 hours of crisis). It is a psychologically consistent approach in which the majority of decision-making is carried out in a network meeting, via the people who are most important to the service user.

Key aspects of the approach include:

• Ensuring an immediate response at the point of crisis
• The same care professionals being involved throughout the care
• Social network inclusive meetings
• All clinical discussions being undertaken in the presence of the service user’s core social network, who they define themselves
• All decisions being co-created by the service user, their support system and the practitioners to strengthen a sense of agency.

To use this approach, staff are specifically trained in utilising these meetings as the focus of the therapeutic process, enabling a strong emphasis on improved agency and long-term recovery from day one.

As a philosophy, Open Dialogue addresses ‘what has happened to a person?’ rather than ‘what is wrong with them?’, ensuring that the people most important to a patient are invited to network meetings.

Anticipated outcomes of Open Dialogue include reduced hospital admissions and lengths of stay, increased wellbeing for clients and families, increased client satisfaction and high staff satisfaction.

The treatment approach originated in Finland in the 1980s and has led to improved outcomes around recovery, return to employment and reduced medication.

There were impressive findings from Finland which indicate a 78% reduction in bed days, a two thirds reduction in use of anti-psychotics and more than a third reduction in relapse rates for a psychosis population.

Additionally, the Ten-Year Plan and the Care Act 2014 promote the following principles which attune to the Open Dialogue Approach:

• Early detection and intervention for mental distress or emerging mental health difficulties
• Prevent development of more serious problems
• Self-determination – the right to decide how you want support and care
• A holistic, whole family, whole community approach
• Asset and placed-based approach that focusses on strengths and recovery
• Equality and parity of esteem
• The right to have support that is timely and effective

CNWL will be gradually moving towards an Open Dialogue philosophy of care, which will eventually be integrated across all mental health teams.

The Trust will be adopting an adaptation of the Finnish model by building a peer support team. However, there is scope for wider involvement as many of our staff have or have been close to lived experience of trauma.

CNWL aims to create a collaborative approach to care where staff work alongside people and their networks, rather than a top-down approach. Open Dialogue is about working “with people”, not “to people”.

Teams will be closely supported with learning and techniques of applying Open Dialogue within the treatment they offer. CNWL is also aware that each Borough or team may need individual adaptations to the method so we will continue to provide updates as this methodology is implemented.

• The Official Open Dialogue Page for Kent and Medway NHS and Social Care Partnership Trust includes a series of videos unpacking the principles and processes behind Open Dialogue
• More information on Open Dialogue Training Opportunities

Dr Gareth Jarvis, Medical Director for Jameson Division, has been releasing a series of blogs over the past year, walking readers gradually through the Open Dialogue model. The entire series, so far, can be found two accordions below

Amanda Bueno de Mesquita, UKCP Registered Systemic Fmaily Psychotherapist & Clinical Supervisor, has hosted a series of conversations with CNWL staff and other medical professionals to discuss their responses to Open Dialogue training, benefits of the model and the ways we can implement Open Dialogue within CNWL.

Click the following links to listen:

Episode 1

Dr Gareth Jarvis, Medical Director for Jameson Division

Episode 2

Dr Ryan Kemp, Director of Therapies

Episode 3

Angela Neblett, Leadership Coach and Organisational Development Consultant

Episode 4

Mel Ball, Head of Lived Experience Workforce 

Episode 5

Professor Nina Barnett, Consultant Pharmacist