Peer supported Open Dialogue in the National Health Service: implementing and evaluating a new approach to Mental Health Care

Catherine Kinane,James Osborne,Marcus Colman,Yasmin Ishaq,Douglas Macinnes

doi:10.1186/s12888-022-03731-7

Catherine Kinane, James Osborne + Show 3 more

Open Access

https://doi.org/10.1186/s12888-022-03731-7

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Abstract

BackgroundOpen Dialogue is an internationally developing approach to mental health care based on collaboration between an individual and their family and social network. Our quest for better approaches to Mental Health Care with improved carer and service user experience led us to develop and test a model of Peer Supported Open Dialogue (POD). There is no research currently looking at the implementation and effectiveness of a standalone POD team in the NHS so we evaluate its implementation, clinical outcomes and value to service users and their families.MethodA before-after design was used. 50 service users treated by the POD Team were recruited and participants from their family and wider social network. Service user self report questionnaires covering wellbeing, functioning, satisfaction were collected and one carer self report measure; at baseline, three and six months. A clinician reported measure was collected at baseline and six months. Clinicians perceptions of practice were collected following network meetings.Results50 service users treated were recruited with a mean age of 35 years with slightly more males than females. Service users reported signficant improvements in wellbeing and functioning. There was a marked increase in perceived support by carers. Over half the meetings were attended by carers. The Community Mental Health Survey showed high satisfaction rates for service users including carer involvement.ConclusionsThe study indicated it was possible to transform to deliver a clinically effective POD service in the NHS. This innovative approach provided continuity of care within the social network, with improved carer support and significant improvements in clinical outcomes and their experiences.Trial registration(isrctn.com/ISRCTN36004039. Retrospectively registered 04/01/2019.

Highlights

Open Dialogue is an internationally developing approach to mental health care based on collaboration between an individual and their family and social network
Clinical outcomes were consistent across mental wellbeing and work/social adjustment, Community Mental Health Survey (CMHS) and Health of the Nation Outcome Scales (HoNOS) scores and showed that this approach is clinically effective with significant improvements across all measures
As Peer Supported Open Dialogue Services emerge in the UK, this study provides the first evidence of clinical, social and satisfaction outcomes in mainstream mental health services

Summary

Introduction

Open Dialogue is an internationally developing approach to mental health care based on collaboration between an individual and their family and social network. Open Dialogue is an approach to working with mental health crises that originated in Western Lapland, Finland [1, 2]. It has gained substantial international interest due to its emphasis on social network support, generating dialogue about the mental health crisis and involving the service user in all decisions regarding treatment [3]. The aim of dialogic practice in Open Dialogue is to actively listen and respond, generating dialogue between all participants This is unlike traditional treatments where methods or interventions are planned for a specific diagnosis to reduce symptoms or change thinking. POD is integrative and inherently democratic with transparent decision making

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