Abstract
BackgroundOpen Dialogue, an approach to mental health care which is based on collaboration between an individual and their family and social network, originated in Western Lapland in the 1980’s and has been developing internationally. Our quest for better approaches to Mental Health Care with improved carer and service user experience led us to develop and test a model of Peer Supported Open Dialogue (POD). There is no research currently looking at the impact of a standalone POD model in an NHS community team so this study evaluates its implementation, clinical effectiveness and value to service users, their families and NHS staff. Method50 service users treated by the POD Team were recruited with additional participants from family and wider social network. Questionnaires covering wellbeing, functioning, satisfaction were collected through validated scales completed at baseline, three and six months. Data regarding adherence was collected following each network meeting. Data from electronic medical records was collected looking at functioning, contact rate, those in employment or full-time education and the mean bed days per episode of care between service users receiving POD compared to traditional services. Results Service users treated were young people with a mean age of 35 years, slightly more males than females. The approach was effective on service user reported measures of wellbeing and functioning. Clinician reported measure showed better outcomes than treatment as usual at the six month point. There was a marked increase in perceived support by carers which increased across the study. Over half the meetings were attended by carers. The POD group had greater face to face contact, longer contact times and an important clinical difference in the number of bed days used. Clinician adherence to the model was very high. The Community Mental Health Survey showed high satisfaction rates for service users including carer involvement.Conclusions It was possible to transform to deliver a clinically effective POD service in the NHS. This innovative approach provided continuity of care within the social network, with improved carer support and high satisfaction for service users, carers and clinicians.Trial registration: (isrctn.com/ISRCTN36004039. Retrospectively registered 04 January 2019.
Open Dialogue: a rights-based approach to treatment in mental health care
