Friday, 13 March 2015

Open Dialogue Approach

The first national conference on Peer Open Dialogue unfolded with great enthusiasm this week in central London. Attended by a diverse audience of mental health professionals and clients, hosted by Dr Russell Razzaque, together with a large number of contribuitors, trainees and supporters, to share the progress of the first pilot Dr Razzaque (Consultant Psychiatrist, North East London Foundation Trust) started one year ago with the NELFT and three other trusts around the country.

Dr Razzaque appeared to be a kind and gentle man while conducting the conference and when I have had the chance to approach him for a few words during the lunch break. He is probably the ideal consultant a person in distress would like to be seen by, when receiving care.

Some of the mentioned core values of the Open Dialogue (OD) were unconditional warmth, openness and authenticity. It was mentioned the importance of being fully "present", for both patients and professionals, and mindfulness has been quoted several times. Being humane and compassionate seem to be the core of delivering an effective service, working toward constructive communication and connect families and networks around the people in distress to heal together efficiently.

The question here is to see how many consultants are actually prepared to drop their domineering roles and masks, in order to stand at the same ground as their clients. Often the conflict between doctor and patient, considered part of an illness, is not even merely a personality clash, but rather a matter of  traumatised professionals attempting to help traumatised patients, when themselves need to heal and change first.
Relationship skills and the promotion of dialogue seem to be the key points for this healing process to work, rather than the knowledge of prescribing cocktails of often severely damaging drugs. Althought elimination of drugs should always be a discretion of communal decision between patients and doctors and in accordance to individual cases, the reduction of them seems a positively considered option by many OD promoters.

According to some of the speakers at the conference, with the introduction of this approach the Psychiatric system is now sorted. Brilliant, everyone would say. However for some "getting people out of benefits" seemed to be the priority of this approach, while I have not heard about examples of working with people with complex disabilities and severe chronic health conditions that might require constant ongoing support.

"The Open Dialogue approach is both a philosophical/theoretical approach to people experiencing a mental health crisis and their families/networks, and a system of care, developed in Western Lapland, Finland, over the last 25-30 years. Remarkably, Open Dialogue is not an alternative to standard psychiatric services; it is the psychiatric service in Western Lapland."

Lapland is the home of about 3.4% of Finland's population, it extends on about one third of the total national territory and is by far the least densely populated area in the country, according to Wikipedia. Finland also seems to have one of the world's most extensive welfare systems,  that guarantees decent living conditions for all residents, also according to Wikipedia. 
Wondering how the system will adapt in different situations and realities where housing and services for specific needs are the issues affecting the mental health of the entire population, not just some individuals. But we are aware that nothing fixes ALL and we hold the hope that surely this is a gentle way forward much needed for many people using and offering the services.

We are now pleased to announce that both Dr Russell Razzaque and Nick Putman (Consultant Psychotherapist, Open Dialogue UK, Soteria) have accepted our invite: both will give a presentation and answer questions around the Open Dialogue approach, together with a few other members of the UK training team, at our next FEEL event on Friday the 24th of April, 7-9pm, at the historic Kingsley Hall, Bow. More details will follow soon.

In Solidarity

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