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Peer Supported Open Dialogue Conference and West Midlands Listening event: a comparative review

28 April 2016

Emma Perry offers a comparative review the Peer Supported Open Dialogue Conference as well as a listening event in the West Midlands. Both occasions provoked reflections on whether things are shifting (or not) in the mental health world.

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Review of the Peer-supported Open Dialogue Conference and a Listening Event for the West Midlands Mental Health Commission

“It’s not the despair. I can stand the despair. It’s the hope!” sighs John Cleese in Clockwise. Cynics are said to be bad tempered romantics and that probably sums me up to a tee. But by the end of the Peer-supported Open Dialogue (POD) Conference in London on 25th April, I was beginning to feel a few glimmers of idealistic hopefulness.

Open Dialogue is a model of mental health care pioneered in Finland. It involves working with the whole family or network rather than just the individual in a holistic, collaborative and non-hierarchical way. Peer-support is now becoming integral to the Open Dialogue approach and North East London Foundation Trust is developing this work with the aim of reducing medication and hospitalisation.

The proponents of POD have an almost evangelical energy in their mission for this approach to transform mental health services. Professor Mark Hopfenbeck explained that POD was about getting alongside each other, one human being to another. Val Jackson emphasised the importance of thinking about the relational nature of identity drawing on the term ‘ubuntu’ – ‘I am who I am because of who we all are’. But the most powerful and moving parts of the day were from people with lived experience who had participated in POD. Speakers gave personal accounts of their experiences and praised the continuity of support, the time that had been given to them (sessions sometimes lasted several hours) and the importance of being really listened to. By lunchtime I had shed a few tears and was grateful I had brought tissues with me.

NSUN and Making a Difference Alliance members (Felix Pring, Vittoria de Meo and Michael Whitaker) also presented their experiences of working with commissioners in North West London and spoke of their hopes for the future. As Vittoria said, “Everything begins with dialogue… Dialogue is about demonstrating respect for another’s life. Through dialogue, we can impart hope, and shape the future”.

I still have a number of questions and some concerns about the POD approach - how is the term ‘peer’ being defined? How will it work in different cultural contexts? How will it work with families where abuse is taking place? Will it be co-opted by the system like so many initiatives before it? Will it challenge the medical model? Why is the evaluation of POD using measures like ‘relapse’?

Nevertheless, by the end of the conference I felt a little hopeful that something somewhere might be shifting.

How disappointing then to attend one of the Listening Events for the West Midlands Mental Health Commission the very next day. A member of the commission gave a presentation which set the tone for the event. The assembled audience of practitioners and people with lived experience were told that the aim of the commission was to produce recommendations to see “how we can best spend the money we have with reduced resources” in order to “reduce impact on services, economy and communities”. The emphasis (unlike that of the previous day) was on £££ rather than people. When people were mentioned it was part of a very clear agenda about “returning to work”. To illustrate this the commissioner said “they could be productive members of society if we just do the right thing for them”.

Although we were told that the event was an important opportunity to hear people’s opinions, this was immediately qualified with a warning that the commission had set their priorities and would make decisions based on what was ‘doable’ and would make an impact, so we should think carefully about what we suggested.

In addition to recommendations from several listening events, a Citizen’s Jury has also been meeting to inform the commission. Although the jury have done plenty of meaningful work, I fear that these voices (and the voices of people at the events) will be lost and ignored due to the priorities of the commission within the wider context of reduced resources.

The listening event felt (to me) as though it was yet another example of consultation rather than co-production. Of commissioners ticking their involvement box before making decisions based on their own cost-cutting priorities within the narrow framework of a ‘back to work’ agenda.

I would like to see the report of the Citizen’s Jury and the listening events clearly informing the work of the commission. Maybe they will actually listen to the recommendations. I hope I will be pleasantly surprised. It’s the hope I can’t stand.

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