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Peer Supported Open Dialogue: a review

April 2017

Open Dialogue UK held it's Peer Supported Open dialogue event on 22 March in London.

The event presentations revolved around the success and challenges of implementing Open Dialogue in the NHS. Originally introduced in Finland, Open Dialogue aims at placing mental health within the context of an individual's social circle, from family to friends and employers. The goal is to encourage the conversation to flow between the parties concerned, without puting any emphasis on diagnoses or medication but without necessarily dismissing them either.

NHS Professionals are encouraged to participate in Open Dialogue, and this means them to having to rethink what their role is about. The North East London NHS Foundation Trust (NELFT) leads on introducing Open Dialogue to the UK. People can ask their doctor to refer them to the Open Dialogue UK project, Dialogue First. According to presenters at the conference,  ODUK differs from the original Finnish approach because of the presence of Peer Supporters. The presence of peer supporters emulates the American take on Open Dialogue, as implemented is projects such as Parachute NYC.

Whilst Crisis centre employees and psychiatrists reminded delegates about the possible clash between a dialogue based method and the administrative rigidity of the NHS, peer supporters insisted on feeling valued and treated as equals. Psychiatrists said that despite having to rethink their role and originally hesitating to relinquish the temptation to diagnose and prescribe as the unique solution, they ended up feeling liberated by the possibility of spending more time with their patient's extended circle.

Open Dialogue is an approach that favours empathy and common sense centric conversation. Whilst this is extremely laudable, the very need to train professionals to focus on empathy and not forgetting about placing individuals within their social context is a concerning indictment of our society and services. This was never mentioned during the event.

It is also regrettable that OD training costs so much ( £3250 per person for the full foundation course) as this excludes people who cannot fund the training, whether independently or through an employer. This cost can also be seen as standing in contradiction with the principle of reguarding peer supporters as equal partners:  peers often start up as patients / service users and this means that they will have to rely on the availability of funding within their services. Cuts will logically make this a rarity. This issue did not receive the attention it deserves at a conference with an emphasis on enthusiasm for the method's dialogic core.

Whilst we appreciated the presence of Open Dialogue leaders from around the world, as well as the professionals's willingness to talk about some of the challenges of implementing OD within an NHS context not originally suited to it, only two peer supporters made presentations in an event which clearly aimed at encouraging the growth of the UK OD pilot led by NELFT. We understand however that strategic take is necessary to the survival of a project which is still relatively new and which chances could be compromised by a climate of cuts.

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