The open dialogue approach to mental health care
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Date
2019
Authors
Hartnett, Dan
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Publisher
University College Cork
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Abstract
Study 1 Abstract - Aim: Open Dialogue (OD) is a family- and social network-based approach to the treatment of psychosis and other serious mental health difficulties. Previous reviews were conducted some time ago and included discussion papers and case composites. A criticism of the literature base with regard to the model has been its lack of focus on primary research. The aim of the present study was to thus provide a current and comprehensive review of OD studies which involved primary data collection. Methods: Studies were identified through electronic searches using Psycinfo, Science Direct, and PubMed, as well as reference harvesting. Following initial screening of irrelevant studies, potentially eligible papers were independently identified by the first and second authors. Study quality assessment tools were also applied to papers selected for inclusion in the review. Results: 15 papers involving 16 studies were identified; 8 studies described OD outcomes, while 8 described qualitative therapeutic process or implementation studies. Reported outcomes were generally positive on a number of key variables such as psychotic symptomatology and service utilisation. Qualitative studies pointed toward a high degree of staff and service user acceptability, and highlighted a number of important process issues, and implementation challenges. Study quality for qualitative studies was generally good, but the quality of outcome studies was assessed as poor. Conclusions: Emerging evidence exists with regard to the effectiveness and acceptability of OD. Therapeutic processes and implementation issues appear well-elucidated. However, it is difficult to make strong conclusions with regard to outcome data due to poor study quality.
Study 2 Abstract - Background: In a perspective which has come to be termed Trauma Informed Care (TIC), there is growing recognition that services in which traumatised individuals may be involved should be organised and delivered in a manner which is sensitive to what is known about trauma. Despite tentative conceptual links between the Open Dialogue (OD) approach to mental health care and TIC as well as moves toward implementing TIC awareness in clinician training, little is known about how OD practitioners understand the concept of TIC, or how this understanding, if at all, impacts their work. The aim of the present study was thus to explore OD practitioner perspectives on TIC and OD. Methods: Fourteen OD practitioners across seven countries and six mental health disciplines completed online demographic and service profile questionnaires and participated in semi-structured interviews. Data were analysed using Thematic Analysis. Results: Six key themes were evident in the data; understanding trauma informed care, on the client’s terms, stories not symptoms, using reflections, continuity and consistency, and barriers to dialogism. These represented participants’ understanding of TIC, as well as a number of perceived trauma-sensitive OD elements. Challenges to implementing these trauma sensitive aspects were also highlighted and these appeared most relevant with regard to the interface between network meetings and the wider health and social services system. Conclusions: OD may exhibit some TIC congruent elements, and the fact that clients are free to construe their experiences as trauma related or not, may represent an avenue for client empowerment which is less present in traditional more ‘trauma assumptive’ TIC models. As in other TIC implementations, a whole-systems approach may be needed to fully implement these TIC aligned OD aspects. The associated shift in organisational structures, particularly the non-hierarchical approach advocated in OD may pose a particular barrier to implementation outside of the Finnish context.
Study 2 Abstract - Background: In a perspective which has come to be termed Trauma Informed Care (TIC), there is growing recognition that services in which traumatised individuals may be involved should be organised and delivered in a manner which is sensitive to what is known about trauma. Despite tentative conceptual links between the Open Dialogue (OD) approach to mental health care and TIC as well as moves toward implementing TIC awareness in clinician training, little is known about how OD practitioners understand the concept of TIC, or how this understanding, if at all, impacts their work. The aim of the present study was thus to explore OD practitioner perspectives on TIC and OD. Methods: Fourteen OD practitioners across seven countries and six mental health disciplines completed online demographic and service profile questionnaires and participated in semi-structured interviews. Data were analysed using Thematic Analysis. Results: Six key themes were evident in the data; understanding trauma informed care, on the client’s terms, stories not symptoms, using reflections, continuity and consistency, and barriers to dialogism. These represented participants’ understanding of TIC, as well as a number of perceived trauma-sensitive OD elements. Challenges to implementing these trauma sensitive aspects were also highlighted and these appeared most relevant with regard to the interface between network meetings and the wider health and social services system. Conclusions: OD may exhibit some TIC congruent elements, and the fact that clients are free to construe their experiences as trauma related or not, may represent an avenue for client empowerment which is less present in traditional more ‘trauma assumptive’ TIC models. As in other TIC implementations, a whole-systems approach may be needed to fully implement these TIC aligned OD aspects. The associated shift in organisational structures, particularly the non-hierarchical approach advocated in OD may pose a particular barrier to implementation outside of the Finnish context.
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Keywords
Trauma , Open dialogue , Trauma informed care , Early intervention psychosis
Citation
Hartnett, D. 2019. The open dialogue approach to mental health care. DClinPsych Thesis, University College Cork.