The way mental healthcare is delivered in the UK is undergoing a quiet revolution – moving away from the current 1:1 based services towards seeing service users together with their whole social network thus potentially lowering substantially the rate of hospitalisation and speeding up the return to work.
The Open Dialogue London Conference on Wednesday 11 March, 2015 will be a major landmark on that trajectory.
The national conference has attracted professionals - doctors, nurses, social workers, occupational therapists and others - and those who use their services (patients and their families) to learn about an ongoing initiative that has the potential to change the whole system of mental health care delivery towards a model known as Open Dialogue.
Open Dialogue is a humanistic approach to mental healthcare that was pioneered in Finland and has since been taken up in a number of countries around the world, including much of the rest of Scandinavia, Germany and some states in America.
Most recently, New York City invested over $50 million in an Open Dialogue service. The model involves seeing service users together with their whole social network; family, friends and anyone else who the patient would like to involve. All staff receive training in family therapy and related psychological skills, and treatment is provided for the whole system/network together, with every crisis seen as an opportunity to rebuild communities and create a sense of agency and meaning within them.
It is a significant departure from the current 1:1 based services used in the UK, yet the results observed so far in other countries are startling. Current data shows that 72 per cent of those with an episode of psychosis treated via an Open Dialogue approach returned to work or study within two yearss, despite significantly lower rates of medication and hospitalisation compared to treatment as usual.
Several NHS Trusts in the UK - including North East London NHS Foundation Trust (NELFT), North Essex, Nottinghamshire and Kent & Medway - are setting up pilot Peer-Supported Open Dialogue services over the next couple of years, where service user volunteers join the teams to help build social networks around patients who may lack much by way of network or family. The initiative, led by NELFT is part of a proposed multi-centre trial to build the evidence base for such services in a UK context, with the ultimate intention of enabling more wide scale take up across NHS services, should the outcome improvement and cost reductions seen in other countries remain consistent.
Training, led by NELFT, started in October 2014 and the enthusiasm that has built up among mental health clinicians learning the model - and service users who are beginning to experience it in their localities - has led to word of it spreading far and wide.
The Open Dialogue London Conference: Wednesday 11 March, 2015
Over 600 people from across the Uk and including the Republic of Ireland, have booked their places for the conference - all without any advertising. The ripples have spread across the system and the Department of Health is now giving the transformation project full support.
Minister of State for Health, Norman Lamb, who was due to attend though is now unable to due to a diary clash, has nevertheless issued the following statement of strong support for the Open Dialogue initiative:
"Good mental healthcare centres around good relationships; relationships between clinicians and service users, and relationships between carers, families and the communities involved and affected. Open Dialogue is a holistic approach to mental health service provision that brings the cultivation of these relationships to the forefront of care. It is a truly person-centred approach with the kind of outcomes that have inspired groups of professionals around the world - from Scandinavia to the United States - to change the way their care is delivered.
“The pioneering NHS Trusts that have joined together to demonstrate its efficacy in a UK context deserve great credit. And if they replicate the kind of outcomes we have seen in other countries, then it will also show that, better care from the outset really does cost less in the long run. I therefore applaud all those involved in this trial and wish them every success in their continued endeavours. This is how change comes about, and I thank all of those who are starting to make it happen."
Luciana Berger MP, Labour Shadow Minister for Health, will be attending and opening the Open Dialogue London conference.
Dr Russell Razzaque, pictured, consultant psychiatrist and associate medical director at North East London NHS Foundation Trust (NELFT), who has been coordinating the national initiative, says that the Open Dialogue model ‘puts relationships back into the heart of mental healthcare’.
Dr Russell Razzaque says the training, in which 12 teachers are being flown in from five different countries, is teaching clinicians: ‘to relearn how to connect on a genuine human level first, before we bring out the templates and tick boxes. This actually requires real effort and skill, due to the high levels of distress often experienced in the people we care for. Butut once we do that, we find that a sense of safety starts to grow around the relationships we cultivate, and that is often the most powerful intervention we can make, especially if we can then assist others to do the same.’
Dr Russell Razzaque observes that the new paradigm that is potentially emerging is ‘about putting long term relationships before quick fixes, and this paradoxically leads to more recovery and less dependence on services in the long run’.
A second wave of NHS Trusts are now being recruited into the trial, with training due to begin in January 2016.
The Open Dialogue London conference will take place at: 275 Oxford St, London W1C 2DJ on Wednesday 11 March from 9am to 5pm.