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Third edition
Edited by
Tom Stockmann

Winter 2015/16
 
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The UK Peer-Supported

Open Dialogue

Bulletin

We look forward to seeing you at the 2016 POD conference - see below for details!
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Jointly organised by North East London NHS Foundation Trust and the Academy of Peer-supported Open Dialogue.
 

Monday, April 25, 2016
10:00 AM to 6:00 PM

Logan Hall, 20 Bedford Way, 
London, WC1H 0AL  


Since our last conference, nearly 60 clinicians from around the country have completed the first training in Peer-supported Open Dialogue in the UK and dozens of families in four NHS Trusts have now received care in this way. We are well on our way to making Peer-supported Open Dialogue a reality in the NHS.


At this year's conference hear from:

  • The first UK staff trained in Peer-supported Open Dialogue
  • Peers working in Peer-supported Open Dialogue teams across the UK
  • The first service users and families receiving Peer-supported Open Dialogue in the UK
And learn about:
  • The first national multi-centre trial in Peer-supported Open Dialogue being planned in the UK
  • The UK’s first NHS service based on some key Open Dialogue principles, open to referrals from across the country

Tickets

Tickets for the day conference are donation based - pay as much or as little as you choose, starting at £1.

We are also offering a limited number of tickets for a "Friends of APOD" evening fundraising dinner and post-conference party. 

Click here to buy tickets

All proceeds from tickets will go to further our work in Peer-supported Open Dialogue; research, training, and its development in the UK.

POD Project Update

 
Russell Razzaque
Associate Medical Director and Consultant Psychiatrist, Havering CRT, NELFT
 
Two things have happened within the last few weeks that only a year ago would have seemed impossible.

We have just completed the first official training in Open Dialogue in the NHS. Over 50 students - clinicians with hundreds of years of experience working in front line mental health services between them - came together for four residential modules over the year to learn a new way of working. Some arrived brimming with enthusiasm and expectation, while others arrived uncertain, sceptical, even a little cynical in their disposition towards the subject matter. But by the end, every one has left a passionate and devoted POD practitioner.

We learnt how to create safe spaces in network meetings, for people to find their own meaning in their own experiences and, not only that, we experienced it for ourselves, as dozens of service users and their families were supported dialogically in this way. And the response was phenomenal. Videoed feedback from people we have worked with was truly moving. Some spoke, for example, of how they believe this form of treatment had saved their life, after decades in services, while others spoke of how their whole family had seen positive change as a result. Some even contacted national newspapers to tell their story. 
 
But this is, of course, only the start, as we now need to work together to bring about the full model within our organisations, and this brings me to the other significant development in recent days.

About a year ago - around the time we were starting the course - I met with Professor Steve Pilling. As one of the lead mental health professors in the National Institute for Health and Care Excellence (NICE), my intention was merely to inform him of our project and plan to develop a robust study that demonstrates, once and for all, the evidence for Open Dialogue on a large scale. By the end of the meeting, however, he was committed to being involved himself. With decades of experience in such studies (a lot of our current mental health landscape - e.g. home treatment teams - is down to his own research), he was perfectly placed to lead an academic panel that designed the study and applied for grants. He quickly dedicated staff to the project and started to recruit other similarly high profile academics.

Together we have worked hard on drafting a proposal, and on October 6th, a panel of six professors, plus Jaakko Seikkula and Mary Olsen - also centrally involved as international collaborators - together with myself, Mark Hopfenbeck, Corrine Hendy, Jerry Tew and Sarah Carr from NSUN, submitted a grant proposal for £2.1 million to the National Institute for Health Research (NIHR) for a national multi-centre randomised controlled trial on Open Dialogue. In all, this is the first time Open Dialogue will have been tested on such a large scale, and it is the first time it will have been implemented in any form in the NHS. 

This application was considered alongside research proposal from the whole field of healthcare - from cancer to diabetes, we had to compete against them all; doubtless each tremendously worthy in their own right. At Stage One of the process, they draw a shortlist of the select few trials they will allow to go through to the next stage of the application and in the first week of December, Steve and I received a letter from the NIHR confirming that we had succeeded in passing through Stage One. It was a true moment of celebration for each one of us on the panel.

Now, it is time for us to get down to business again and submit the detailed information required for Stage 2. There's still a way to go before we finally win a grant, but this has been a crucial landmark along the way.
 
At the same time as all this, preparations for the next wave of training has begun. We have two more Trusts joining the trial, who are each sending a team for the 2016 course, and three of the existing Trusts are sending additional staff - some even additional teams - to the next course. All in all we are expecting something like 70 students for the next course, approximately 10% of whom will be peer workers, something we have insisted on from each Trust this time, to really be true to the POD model. 
 
We have learned a great deal from this year's diploma course, and will make adjustments for next time. Crucially, we will also be joined by mentors in training from among the students from the first wave, who will be able to help colleagues understand the model based on their own experience of not only learning, but doing it in their own teams. We will also, as mentioned, have peer workers joining us for the whole course from the start. 
 
So amazing as it is to see how much we've done in the space of a year, there is still so much for us to do. The journey is just beginning, but it's a promising, exciting and hugely rewarding one for the ever increasing numbers of us who are on it. 

POD trainers' reflections

 
Val Jackson

developingopendialogue.com

As I sit here looking at the autumnal picture outside of my window, with the driveway covered in golden leaves, it seems a long way away already from Birmingham.

That week, in fact all of those weeks, were surreal almost. Coming home took some adjustment to ‘life as usual’. The venue was so special I felt bad that we didn’t thank the staff on our last afternoon, and when I went looking for someone later they were already busy with the next group. It was amazing to be part of the journey the trainees are on, and for me it’s relatively easy to be the trainer, rather than the trainee who now has to find a way forward through the quagmire of mental health services.

My learning has been profound throughout the year, and I am really looking forward to starting with a new cohort in January. What is particularly exciting is that rather than this being the vision of Russell, Mark and myself, we are creating something that will grow and develop as the mentors join us next year, and the Academy of Peer-supported Open Dialogue (APOD) comes to life. My hope was always that we could create something sustainable and it really feels that we are doing that, with everyone’s help and support.
 
And now back down to earth as I look at the pile of portfolios I have on my desk. Yes, some of them are long, some of them not so long, but reading them is a privilege. I had forgotten how marking the work of trainees is so rewarding. To see your words written down is very moving, to understand how difficult some of your journeys have been and to read about your learning during this very first cohort.  I can hear your voices as I read each one of them.
 
There is no going back, I continue to learn from all of you.

Thank you,
Val

P.S. That doesn’t mean you can write lots more though!!

POD in vivo


suzanne-chapman-teri-pengilley2.jpg
Image: Teri Pengilley

Suzanne Chapman, a POD service user, has bravely and generously spoken to Celia Dodd of the Independent about her experience of Open Dialogue. Click on the title to read the article:

Open Dialogue: The radical new treatment having life-changing effects on people's mental health

Events and networking


Previous 


KMPT conference on ‘Peer-Supported Open Dialogue – Creative conversations in the mobilising of social networks’. 
Review by Val Jackson

On Friday 11th September I attended the conference in Ashford organised by the Kent and Medway trust, entitled ‘Peer-Supported Open Dialogue – Creative conversations in the mobilising of social networks’. As I was not speaking I paid for my own expenses which involved travel from Yorkshire and an overnight stay at an AirBnB (my first time!). I have to admit the day before I was thinking ‘What a long way to go, perhaps I won’t bother turning up’.

However, as soon as I walked through the door of the hotel I knew I was in the right place. There were 300+ delegates and the place was buzzing. Already I was feeling quite emotional about the progress that has been made, that I have been a part of, and has led to this event. Jaakko came to England just to deliver this presentation.  
 
As always it was great to listen to Jaakko, Mark , Annie and others, all inspirational speakers but the highlight for me was the interview with the Kent family conducted by Jaakko. Present were mum, dad, son and Paul Roberts, the care coordinator and POD trainee.

I heard how through the network meetings the family had felt listened to, acknowledged and in control of their own lives, how their son is now working and living independently. For a brief moment I did wonder if Paul had scripted their responses but I knew this wasn’t so. I felt overwhelmed, especially as the training has been challenging for many trainees, and I knew that Paul had found it difficult at times. Listening to their stories, I just felt so proud of what the trainees have been able to achieve after such a short time, even before the end of the training.
 
Another highlight of the day was to be able to enjoy a glass of wine at the end of the day with Jaakko, Mark, Yasmin, James, Eddy, Catherine and others. Having an on- site bar was a real treat after the Woodbrooke Quaker centre in Birmingham!!
 
Well done Kent and Medway, the day was inspirational.
 



Open Dialogue in Massachusetts
(a presentation in Australia)

"Consumers, carers and clinicians had the opportunity to hear how one US organisation has implemented the ‘Open Dialogue’ model of psychiatric care at an information session hosted by the Mental Health Commission of NSW on 5 November 2015"

Presentation by 
Christopher Gordon, MD (Medical Director, Advocates, Associate Professor Psychiatry, Harvard Medical School) and Brenda Miele Soares (MSW, LICSW, Vice President, Behavioral Health, Advocates) 

Watch the presentation on YouTube here 
 

Third International Conference on Dialogical Practices: “Listen to me!” - Humanizing Human Practices (Kristiansand, Norway, September 2015)
Brief notes from the conference on dehumanising practices, by Tom Stockmann
 
Unfortunately, dehumanising practices in healthcare exist, from Mid Staffs to subtler examples, which are perhaps more stark in the light of POD training. The causes tend to be systemic – people do, of course, enter caring professions to care for others, but we are faced by dehumanising challenges. Sheila McNamee, in her talk ‘Practitioners as people: Dialogic encounters for transformation’, identified a number of such challenges.

Firstly, evidence-based medicine - a good idea in theory, but one which, she argued, appears to have developed to perpetuate the modernist idea of a single truth, to the exclusion of other human understandings. Secondly, diagnosis, which risks reducing an ever expanding chunk of human experience to value-free pathology. Next, burn out, a growing problem in these times of under-resourcing; and finally, the medical model, with its faith in eventually reaching the answer pursuing technical means.

John Shotter, in his talk ‘The (almost) irresistible tendency to dehumanise human practices – and how to humanise them again’ also put forward the view that dehumanising occurs when attempts are made to make things technical. He evoked the idea of a societal machine, composed of citizens acting as cogs with small, highly specific tasks, whose experience is secondary to the functioning of the whole. If even a small number of people don’t keep to their task, the system may collapse, therefore the society develops reward and punishment strategies to keep individuals from deviating. If an individual attempts to act as a human, they are humiliatingly accused of ‘not following the protocol’.

Another overarching theme from the two speakers was that of the problems of striving for certainty. McNamee highlighted the potential dehumanising effects of individuals or groups claiming to hold the Truth, if it denies others their own equally valid truth. The splitting of the world into dichotomies (such as right and wrong) was, she argued, natural, recalling Bateson to demonstrate how it was an inherent effect of our use of language – ‘If I say “up”, I don’t say “down”'. In this divisive way, we make our own meanings of the world – although not necessarily individually, but in ‘multiple discursive communities’ formed of individuals and groups who, in cycles throughout life, develop rituals and patterns, standards and expectations, values, and beliefs. Although the realities so formed can shift, and what is right in one moment may not be right in the next, what is set up is an inevitable conflict between individuals and groups.  

Rather than striving towards agreement and consensus in addressing this problem, in doing so risking the dehumanisation of those with least power, McNamee suggested an alternative approach - a move away from the expert-amateur dichotomy, and a search for new joint understandings between those with different realities.  

Shotter also advocated such negative capability rather than a constant drive towards certainty, and highlighted the importance of harnessing, rather than fearing, the ‘disquiet’ that may result. He reinforced his case for hope by referencing Tom Andersen (with whom Jaakko Seikkula worked closely), who spoke of how a “restlessness in my body which will not leave me alone”, experienced at times of difficulty, helped to drive him onward towards new possibilities, and to positive change. 
 


Future 


Open Dialogue and the Royal College of Psychiatrists

In February 2016, the General Adult Faculty of the Royal College of Psychiatrists will be considering a proposal to establish an Open Dialogue network within the Faculty.

Psychiatrists who wish to support this can contact podbulletin@gmail.com 
 

Open Dialogue UK 2016 Conference"Towards openness and democracy in mental health services - Open Dialogue and related approaches in the UK and internationally"

2nd February. Friends House, Euston, London. 

"This conference brings together many of the leading developers of Open Dialogue internationally.

Keynote speakers will be Jaakko Seikkula, one of the founders of the approach, and Volkmar Aderhold and Petra Hohn, who have been leading the development of the approach in Germany and also in the Parachute Project in NYC.

We are delighted to also welcome three key members of the Parachute Project team from New York, as well as members of the Peer supported Open Dialogue project in the UK. As well as addressing the key themes of openness and democracy, the conference will provide a unique opportunity to get an overview of the current state of development relating to Open Dialogue nationally and internationally.

There will also be a panel of leading clinicians/experts from a variety of backgrounds in the UK who will be reflecting on the presentations, including Peter Kinderman, Anne Cooke, James Davies, Sarah Carr, Sami Timimi, Jacqui Dillon, Julie Repper and Rachel Waddingham.

We have a range of price points for the conference, in the hope that everyone who wishes to attend will be able to, including group discounts and early bird rates. 
Some free places are also available for those who would like to help us with promoting the event and on the day of the conference. Further details of this can be found on our website."

For further details of the conference and to book places please click here: http://opendialogueapproach.co.uk/2016-conference/
 

ISPS UK Residential conference - Therapeutic relationships: Challenges for mental health services and those who use them. Exeter, September 7th-8th, 2016.
 

Group Lives: Tales of Attachment - A Commemorative Conference on John Bowlby’s 25th Anniversary. Institute of Group Analysis, London. December 5th, 2015. 
 

The Dragon Café: "Mental Fight Club’s latest creative project: a relaxing café and imaginative space, open to all, located opposite Borough tube station. (Map). Open every Monday, midday to 8.30 pm."

Publications

therapytoday.com article
Jane Hetherington on Peer-supported Open Dialogue 

Developing Open Dialogue
Val Jackson's website has a host of useful information about Open Dialogue in the UK and beyond

Commentary


Yasmin Ishaq
County Manager – Mental Health Primary Care Social Work Service, Professional Assurance Team, Kent County Council, Social Care, Health & 
Well-being 

UNDERSTANDING THE OPEN DIALOGUE FROM A SOCIAL WORK PERSPECTIVE

During the training for Peer Supported Open Dialogue, the value of understanding what motivates us as individuals was central to understanding what we contribute to others, including colleagues, service users, families and organisations. As a social worker and manager I have recently considered why the Open Dialogue has appealed to me as a social worker. Thus this piece considers what social work and the Open Dialogue approach have in common and how all perspectives can offer a richness to future practice.
​ 
I qualified in social work over 26 years ago and have worked within statutory mental health services for the last 20 years. In that time, I have seen the impact of social determinants and how this informs ways of understanding mental distress. The term recovery is often used within current mental health practice in the UK, but can this terminology be used when the biomedical disease model still dominates much of practice in statutory mental health services?

There is a different feel to understanding recovery from a disease model as opposed to a period of mental distress understood from a relational perspective. Thus recovery is not necessarily just about a remission of symptoms, but, from a social perspective, it is viewed as regaining positive roles and relationships that may have been damaged by the ruptures caused by the mental health crisis. Tew et al. (2011) suggest that recovery may involve a journey of both personal change and social (re)engagement, which highlights the importance of creating, accepting and enabling social environments, within which recovery may be supported.

When I entered social work, it was with strong values that emphasised supporting individuals who for various reasons had found it difficult to manage what is happening in their lives and were looking for support to find resolutions. In all the time I have worked in social work, the majority of these difficult times have not been in isolation but within a family, social, cultural and community context. Yet when stepping into the world of mental health services I found a very individualistic way of understanding mental distress that was led by the bio-medical disease model. This way of understanding mental distress, challenged my understanding of mental distress which I saw through a lens of relational crisis, often significantly affected by social determinants.

Increasingly over the last 10 years or so, I have become disillusioned with the model of care being dominated by a bio-medical understanding  of mental distress, particularly in relation to psychosis (I have recently ended a 10 year post managing an early intervention in psychosis (EIP) service). The EIP model has given greater emphasis to social and psychological factors in the overall treatment of psychosis but I have still found within the wider context of treatment the emphasis has remained focused on adherence to a medication regime that ultimately conveys a message of deficits that need to be corrected.

It was approximately 5 years ago that I was first acquainted with the Open Dialogue approach at an ISPS conference. I heard Jaakko Seikkula speak about the work in Western Lapland and immediately I felt something resonate within me that started a journey of discovery and dedication to supporting change in the UK that could embrace the approach and bring it eventually into mainstream mental health services. I saw a key role for social work practice in this approach with its strong psycho-social emphasis that embraced choice, empowerment and inclusiveness.

When considering the role of social work in mental health services and how this attunes with the principles of Open Dialogue, I will draw on recent social work discussion documents including Ruth Allen’s 2014 paper on ‘The Role of the Social Worker in Adult Mental Health Services’. This paper proposes five areas of practice that should frame the deployment and development of social workers. They are;

A. ‘Enabling citizens to access the statutory social care and social work services and advice to which they are entitled, discharging the legal duties and promoting the personalised social care ethos of the local authority. Choice of how to manage.'

The approach of personalisation is used to promote self-management and a focus to on the ability of people to protect themselves and promote their own well-being. Promotion of agency within the individual and the family allows for new understanding to be created within social network meetings and thus expanding the opportunities for change.

B. 'Promoting recovery and social inclusion with individuals and families.'

Promoting the internal agency of the individual and the family is core to social work practice, and using systemic, co-productive and other relational models promotes working alongside and in partnership with others. The importance of hearing all voices is important as part of the social network and is central to the Open Dialogue approach. Core to change is the inclusion of all who are important to the individual in distress thus gaining understanding from many perspectives rather than relying on expert views of difficulties. It also means that assets within the network can be utilised and promote the recovery that is meaningful to the individual and their family/network.

C. 'Intervening and showing professional leadership and skill in situations characterised by high levels of social, family and interpersonal complexity, risk and ambiguity.'

Understanding complex relationships and gaining a balance that is enabling for all concerned can help ensure protection of the most vulnerable without losing the important voices of all concerned. Again working with the uncertainty of what may be happening enables curiosity to remain present and prevent early formulation or judgments that may close down prematurely important dialogue that can otherwise create new understanding. Honest and transparent conversations about risk is openly discussed in network meeting that again can promote individuals and families to take control of decisions about how they manage difficult situations within their family. How relationships operate on an interpersonal/intersubjective level are not always explicit but being able to stay in the moment of the feelings generated can affect implicit understanding of what is happening.

D. 'Working co-productively and innovatively with local communities to support community capacity, personal and family resilience, earlier intervention and active citizenship'.

This area is perhaps the key area for future development and attunes to the principles of Open Dialogue and social work practice with early intervention and self-support in communities and families central to positive change. Social work training and practice aim to strengthen social and family networks and support sustainable change. Changes brought about by the Care Act 2014The Five Year Forward View and the NHSE Mental Health Task Force promote hope and qualities based on good communication and relationship skills. Thus as Tew (2011) identified, social work has a constellation of approaches that promote empowerment, is systemically informed, reflective in practice and focused on helping people meet their own goals.

E. 'Leading the Approved Mental Health Professional workforce.'

Whilst the statutory powers within the Mental Health Act can at times lead to the deprivation of someone’s liberty, the Open Dialogue approach can still inform how these assessments are undertaken, particularly listening to and involving families in the process of the assessment rather than the more formal consultation that meets the legal requirement. Involvement of families may enable more opportunity for less restrictive options to be considered and drawing on the assets available at a family/community level.

Core to social work practice is enabling the mobilisation of individual, family and community capability and the principles of Open Dialogue provide a practice framework that promotes this inclusive approach. In the UK the approach will necessarily be adapted to work within legal and practice guidance but social work may find it has an important voice that can inform and support the systemic change needed for the paradigm shift from an essentially disease centred model to a social relational model. The Five Year Forward View talks of the ‘slow burn, high impact’ which gives value to relationships and recognising that sustainable change requires time and dedication to the value of relationships within places and communities.
 
References:
Allen, R. (2014). The Role of the Social Worker in Adult Mental Health Services. TCSW.
Tew, J., Ramon, S., Slade, M., Bird, V., Melton, J., & Le Boutillier, C. (2011). Social Factors and Recovery from Mental Health Difficulties: A Review of the Evidence. British Journal of Social Work, 1-18.

POD in the media


Guardian article on the NYC Parachute Project
New York ‘Parachute’ Programme for people with acute mental distress lands in the UK

Guardian letter
Mental health needs urgent extra funding to avert crisis, say trust chief executives 
Includes a mention of the Peer-supported Open Dialogue project

Campaigns


'Wear Your NHS'

Support Junior Doctors T-shirt - designed by Dame Vivienne Westwood



Led by Dr Lauren Gavaghan (POD clinician - pictured above with Ben and Vivienne Westwood):

"This is a campaign to raise awareness of the issues facing Junior Doctors and the NHS more widely, and an opportunity to demonstrate support for both them and for OUR NHS. We have all been, are, or shall be, patients one day."

To find out more, and to buy your t-shirt, visit 
wearyournhs.com
 
 
'Only Us'

Also created by a POD clinician. 


"There is no 'them and us' - there's #OnlyUs. Whatever our mental health label, 4/4 of us are human beings."

The Only Us campaign on Twitter: 
https://twitter.com/OnlyUsCampaign

Badges can be ordered here: 
http://www.buttonbadges.co.uk/smiley_teary_badges.html

Social Media Bite

Peer Supported Open Dialogue Conference 3
Further highlights from the 2015 Peer-supported Open Dialogue conference 
Follow @pod_bulletin on Twitter
If you have any thoughts about, or feedback on, the content of this bulletin, please email us at podbulletin@gmail.com. We want to stimulate discussion and really value your views. 
 
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