Open Dialogue: Improving the Patient and Family Experience in Mental Health
There is a quiet revolution happening in mental health care, in particular in the response to psychosis and crisis. Many patients and their families feel they are still not being listened to or being invited to be part of the decisions made about their care and treatment. They are no longer content with the traditional system where the professional is the sole expert, and with the lack of recognition for the expertise of the patient and family. A more fundamental way of structuring mental health services that authentically places the patient and family/network at its centre is needed. Open Dialogue, which is a relatively new system, originating in Finland, may provide a significant advance to address these issues and is being piloted in several countries worldwide including the United Kingdom.
In this report I have outlined the development of Open Dialogue, the principles that underpin it, and how these principles permeate the whole Open Dialogue system.
The travel scholarship enabled me to visit Tornio, Finland, the internationally recognised home of Open Dialogue. In Tornio I spent a week looking at all aspects of the Open Dialogue system as well as experiencing the network, treatment meetings, which are the bedrock of Open Dialogue. I then spent one week in England at a residential Open Dialogue training event where four trusts are preparing to be part of the first multi-site Open Dialogue pilot in the UK. Subsequently I visited three states in the United States of America (Massachusetts, Vermont and New York), where the principles of Open Dialogue were being integrated into mental health systems. In particular the Parachute Project in New York City has attracted much international interest and state funding. It is the first time Open Dialogue has been implemented in a major urban environment.
There are a number of recommendations and intended implementation that can be explored nationally and within my place of work to improve patient care.
1.1. There should be more circulation of Open Dialogue throughout the United Kingdom as the approach is still largely unknown, especially among mental health nurses. The dissemination of information should be to all stakeholders, patient and family/carer groups, and professional and community groups.
1.2. Curricula design for pre and post registration nursing throughout the United Kingdom should consider including the important elements of Open Dialogue.
1.3. Regionally the next step would be to identify a team/service interested in piloting Open Dialogue in Northern Ireland; this could be done in conjunction with the university and the international Open Dialogue Network.
1.4. The education and training of the staff in the pilot project would be critical. There would have to be discussions of how the pilot could be brought forward by reviewing some of the models I have learned about in the course of my visits.
1.5. It will be important to have an evaluation system established for the pilot project.
The overall message from my visits is that patients and families are no longer content with the traditional system where there is lack of recognition for their expertise. Open Dialogue attests to the importance of ensuring all voices are heard and responded to. It is also critical that in this transformative time for health care that mental health nursing has a voice, a voice that is heard and responded to. In the full report I have summarised my experiences and impressions from these visits and outlined where I believe there are learning points for mental health nursing and mental health systems throughout the United Kingdom. This was a very enriching experience and has important lessons for mental health nursing and nurse education. This journey seemed to be a natural extension of my experience with THORN and this is what originally attracted me to learning about Open Dialogue.