Open Dialogue sets out to address some of the most intractable problems in mental healthcare, including long-term dependence on psychoactive drugs, low rates of functional recovery from serious mental illness, over-representation of ethnic minorities in services, and long waiting times. Instead of an expert-led diagnosis-treatment model, OD places clients and members of their social network at the centre of a ‘dialogical’ process aimed at discovering ways out of crisis. At the organisational level, OD ensures rapid response, continuity of care and avoids clinical discussion about clients in their absence (Seikkula & Olson 2003). The OD approach was developed in Finland where studies showed dramatic improvement over treatment as usual for first episode psychosis. Britain’s NHS is now conducting the world’s first randomised controlled trial (RCT) of OD. This large-scale RCT will tell us whether on average people in crisis receiving OD do better across 5 NHS Trust sites; but it will not explain OD, or its wider effects. We are looking at ‘why’ and ‘how’ OD works.
We are conducting a complementary, in-depth ethnographic study to investigate how OD principles are put into practice, the effect of working in this way for families and clinical teams, and the social and contextual factors that shape observed outcomes. The focus is on two NHS Trusts participating in the RCT (in London and Devon) their OD clinical teams, the people who use their services, and their communities. The project will run alongside the RCT for the full 3 years of the trial (2020-2023).
The research carried out by the APOD team will explore three different aspects of OD:
- the dialogical model, studied through immersive fieldwork within Community Mental Health and allied teams (Crisis Resolution, Early Intervention Psychosis) to find out how practitioners translate OD principles into practice within clinical encounters and how this is experienced by clients;
- the social network approach, studied by following the pathway of selected case-study families from the therapeutic OD process into their everyday lives, and by investigating the intersections of professional care networks and community social networks that allow connection and recovery;
- the institutional reorganisation of mental health services instigated by OD, studied through historical research and ethnographic fieldwork. This focuses on how OD teams negotiate new relationships with clients, among themselves, and with the established healthcare system; how OD is adapted to the NHS environment, and maintained as a community of practice. Archival and oral history sources are used to set OD in the context of community psychiatry developed following the closure of large asylums across the UK.
Project findings will enhance the RCT’s policy-relevance and improve the translation of OD into new settings, including, if adopted, across the UK’s NHS. The project also establishes the international OD and Anthropology Network (ODAN), providing a gateway for anthropological insights to shape the development and implementation of OD globally.