Open Dialogue Presented by Kristof Mikes-Liu Niels Buus The University of Sydney
Outline of presentation: Introduction Network meetings Previous research Danish Outcomes Discussion • A brief introduction to the central elements of an Open Dialogue approach, including the seven principles • A live role play of network meeting • Previous research of Open Dialogue • A recent Danish study of outcomes in Open Dialogue • A discussion of the ‘Open’ in Open Dialogue The University of Sydney � 2
Introduction: The origins in Western Lapland Introduction Network meetings Previous research Danish Outcomes Discussion • Grew out of the Finnish (optimistic and ressource-oriented) ‘needs- adapted’ approach to treatment of schizophrenia • They adopted early treatment meetings based on a systemic family therapy approach • The Finns felt that the systemic approach was not well suited the more collaborative network meetings • The approach was later used specifically in crises management • Reorganisation of health care services including psychotherapeutic education of all staff The University of Sydney � 3
The seven key principles Introduction Network meetings Previous research Danish Outcomes Discussion 1. Immediate help 2. A social network perspective 3. Flexibility and mobility Integrated care 4. Responsibility 5. Psychological continuity 6. Tolerance of uncertainty Psychotherapeutic stance 7. Dialogism The University of Sydney � 4
The seven key principles Introduction Network meetings Previous research Danish Outcomes Discussion 1. Immediate help 2. A social network perspective 3. Flexibility and mobility 4. Responsibility We suggest these as the ‘generic’ principles 5. Psychological continuity 6. Tolerance of uncertainty 7. Dialogism The University of Sydney � 5
Care organised round a series of network meetings Introduction Network meetings Previous research Danish Outcomes Discussion Network Network Network Network meeting meeting meeting meeting Time Open ended (non-totalising) language use, need adapted and collaborative approach Two therapists - transparent decision making Inclusion of relevant parts of a person’s private and professional network Outreach when possible All other types of care and treatment continue as usual The University of Sydney � 6
Structure of a network meeting - role play Introduction Network meetings Previous research Danish Outcomes Discussion Opening: What is important for all participants to talk about? Dialogue: Effort to hear all the voices in the room Reflection among the clinicians in front of the family Family’s reflections on clinicians’ reflections This sequence can be repeated several times Close: Planning collaborative actions and eventual next meeting The University of Sydney � 7
Structure of a network meeting Introduction Network meetings Previous research Danish Outcomes Discussion Liz: K r i s Sister t o f Henry: p : Person of O r a D c t i t i o n e concern r Niels: OD practitioner Rick: Boss The University of Sydney � 8
Previous research on Open Dialogue Introduction Network meetings Previous research Danish Outcomes Discussion The gradual implementation of open dialogue in Western Lapland in was not designed to be rigorously tested in a trial, but Seikkula and colleagues have published a number of descriptive post hoc studies drawing on data from the cohort of people receiving open dialogue throughout the implementation period “The treatment group fared better than the treatment-as-usual comparison group on days spent in the hospital, BPRS scores, number of relapses, and employment status. They also used less neuroleptic and had more family meetings” (Gromer 2012, p. 169-70) The University of Sydney � 9
Previous research on Open Dialogue Introduction Network meetings Previous research Danish Outcomes Discussion The gradual implementation of open dialogue in Western Lapland in was not designed to be rigorously tested in a trial, but Seikkula and colleagues have published a number of descriptive post hoc studies drawing on data But because of the basic before and after designs of these studies, the from the cohort of people receiving open dialogue throughout the reliability of data, and the use of basic statistical methods, including implementation period the omission of adjusting for important confounding variables, it is not possible to draw strong conclusions about the effects of open dialogue “The treatment group fared better than the treatment-as-usual comparison group on days spent in the hospital, BPRS scores, number of relapses, and employment status. They also used less neuroleptic and had more family meetings” (Gromer 2012, p. 169-70) The University of Sydney � 10
A Danish register linkage study (under publication) Introduction Network meetings Previous research Danish Outcomes Discussion Aim: To examine whether a Danish adoption of Open Dialogue for young patients (14-19 years) in acute psychiatric crisis reduced the utilisation of health services and social services, compared to usual psychiatric treatment. Methods: A retrospective cohort (n = 503) of patients from Southern Denmark in 2000-2015 was compared to a matched group (n = 1509) from Central and Northern Denmark by linking clinical data with national social and health care registers. The comparison group was created using propensity score matching. Follow-up was at 1, 2, 5, and 10 years. The University of Sydney � 11
Discussion: The “Open” in Open Dialogue Introduction Network meetings Previous research Danish Outcomes Discussion Less individualistic than conventional mental health care service delivery Different organisations of Open Dialogues in different social and cultural settings Power relationships in Open Dialogue is under-acknowledged, under-theorised and under-researched Peer support workers in Open Dialogue The University of Sydney � 12
The St. Vincent’s Open Dialogue Initiative Introduction Network meetings Previous research Danish Outcomes Discussion The Centre for Family-Based Mental Health Care was established in early 2016 The aim was to develop and implement ‘upstream’ family and community interventions Implementation and research at St.Vincent’s Hospitals in Sydney, Nepean Blue Mountains LHD, and Illawarra Shoalhaven LHD and in Melbourne (Alfred Health) Development of new interdisciplinary ‘family work and open dialogue’ elective units of study at Sydney Nursing School Finnish three-year Open Dialogue psychotherapy and train-the- trainer courses commenced November 2017 in Sydney The University of Sydney � 13
Thank you for you attention Contact: kristof.mikesliu@sydney.edu.au niels.buus@sydney.edu.au Some additional ressources are available at: www.researchgate.net and www.youtube.com (search for Niels Buus) The University of Sydney � 14
Literature • Bellingham, B., Buus, N., McCloughen, A., Dawson, L., Schweizer, R., Mikes- Liu, K., Peetz, A., Boydell, K., River, J., 2018. Peer work in Open Dialogue: A discussion paper. Int J Ment Health Nurs. 27 (5), 1574-1583. • Buus, N., Bikic, A., Jacobsen, E. K., Muller-Nielsen, K., Aagaard, J., & Rossen, C. B., 2017. Adapting and Implementing Open Dialogue in the Scandinavian Countries: A Scoping Review. Issues in mental health nursing, 38 (5), 391-401. • Eiterå, A., Hansen, L., Vind, B., Hansen, A., Castella, J., Sørensen, E., 2014. Open Dialogue - key markers and their context. N/A, N/A. • Gromer, J., 2012. Need-adapted and open-dialogue treatments: empirically supported psychosocial interventions for schizophrenia and other psychotic disorders. Ethical Human Psychology and Psychiatry, 14 (3), 162-177. The University of Sydney � 15
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