Open Dialogue blog

One of our Open Dialogue leads and students, Jane Hetherington, has written some blog posts about the Open Dialogue project. Jane is a Senior Psychological Practitioner.

The  first (KMPT)  Open  Dialogue  Service  in  Canterbury, Kent 

The  new  Kent  and  Medway  Partnership  Trust (KMPT)  Open  Dialogue  Service  became  operational  at  the  beginning  of  February  it  is  based  in  Canterbury , Kent  and  comprises  of  6  practitioners  from  a  variety  of  professional  backgrounds. The  experienced  team  of  clinicians  and  peer  support  workers completed  the  Open  Dialogue  training  last  year  and  are  all  enthused  about  being  involved  in  the  birth  of  a  new  approach  to  mental  health  within  KMPT .

The  Open  Dialogue  Service  has  already  had  the  first  few  referrals  and  the  team  are  situated  in  the  same  area  as  the  Single  Point  of  Access ( SPA) service which  enables  them  to work  in  conjunction  with  SPA.   SPA  is  a  comparatively  new  service  in  KMPT which  fits  well  with  the  ethos  of  Open  Dialogue Services,   in  that  the  first  principle  of  immediate  help is  more  readily  provided,  as  SPA  handles  the  majority  of  new  referrals .  The  team  will  be  the  first  of  the  three  teams  that  will  eventually  be  in  place  in  Kent  and  the  services  users  being  seen  by  this  first  Open  Dialogue  Service  will  be  participating  in  the  largest  Randomised  Control  Trial  (RCT)  in  the  world  on  Open  Dialogue  led  by  Professor  Steven  Pilling of  University  College  London.

The  Open  Dialogue  Service  adheres  to  the  principles  of  the  Open  Dialogue  training  and  the  7  principles of  Open  Dialogue.  The  team  has  met  with  the  social  network  mobilising  support  for  the  service  user and  their  families  and  have  been  flexible  and  mobile  in  the  interaction  with  the  network. The  network  meetings  have  been  held  in  the  family  homes  and  at  times  convenient  to  participants and  have  run  in  excess  of  normal  appointment  times  to  meet  the  needs  of  the  network.  This  Open  Dialogue  Service  will   be  responsible  for  the  ongoing  treatment  of the  family  network  in  their  journey  through services  providing  the  all-important  principle  of  psychological  continuity with  staff  remaining  constant.  The  Open  Dialogue  Service  is  also  prepared to tolerate  uncertainty with  premature  decisions  in  relation  to  treatment  being  avoided  and  the  families  being  encouraged  to  explore  a  variety  of  options.  The  last  principle  of  dialogue  and  polyphony  is  being  practiced  in  the  interactions  at  the  network  meetings  every  voice  in  the  room  is  heard,  respected  and  responded  to.   

A carer's perspective

Carer Annie Jeffrey talks about the 2nd Module of the Peer Supported Open Dialogue Training (POD) with Jane Hetherington, Senior Highly Specialist Psychological Practitioner in Early Intervention.

Annie feels strongly that Peer Supported Open Dialogue would have helped her and her family when her son became unwell and she has taken an interest in this approach over the last few years attending seminars and workshops. She was therefore delighted to join the KMPT POD training which, although she admits is challenging, she finds enjoyable. Annie described to me how she was looking forward to the second week of training and was excited to be meeting again with “the great bunch of people” participating on the course.

“I was excited to learn that Jakkoo Sekulla was travelling from Finland to teach for two days and Mary Olsen was arriving from Boston to present to us. They are two of the foremost figures in Open Dialogue. Jakkoo’s commitment to the work and its continuity has impressed us all. This is an important part of the approach and essential to enable the individual to engage at a meaningful level in the process.”

Annie also found their attitude towards listening to and valuing the individual resonates with her completely. “The practical and experiential component of the course involves the sharing of personal experiences. This part of the POD experience has allowed us to mould as a group while introducing significant trust.”

“The presence of children in the family network meetings taught by Val Jackson and Nick Puttman has been important to me while the mindfulness and yoga has helped me through a challenging week! The focus in our next training session will on peer support and we all look forward to another challenging but worthwhile week.”

Annie Jeffrey participates in a number of Carer’s groups including the South East Regional Committee for Rethink, Vice Chair of Ashford Mental Health Action group (on the Kent board), East Kent Carers Council and is involved in other organisations.

Our journey

May 2015 - London Conference

A year ago I attended the first Peer Supported Open Dialogue (POD) Conference organised by the North East London Foundation Trust (NELFT) in London. There were approximately 150 delegates from different parts of the country and from different professional backgrounds, in addition to service users and carers who had an interest in Open Dialogue and the ethos attached to this model.

A year later we were in Oxford St with a long queue stretching outside the building and a frisson of excitement in the air. It became clear that this conference was going to be attended by over 500 people and professional and political interest was growing. We felt part of an exciting development in mental health with messages conveyed from the current Health Minister and the shadow Labour Minister in attendance. It felt as though we were involved in something pivotal.

The Kent team were there in force to support their colleagues at KMPT and the representatives of the other three trusts involved in the training and subsequent pilot. A number of our team spoke to the audience discussing various aspects of POD, what the training represented to them and their perspective as service users, carers and clinicians.They were well received by the audience many of whom were acquainted with the principles of POD and the philosophy behind it and the presentations by the Trust carers and service users were particularly appreciated.

Discussions and questions followed the various presentations and the response from the audience was enthusiastic and engaged. Many carers and service users expressing how they wished this approach had been available for them in the areas in which they live and how they felt the POD approach would have made a considerable difference to themselves and their families. Their was a sadness and regret about some of these questions and the discussion that followed in that this pilot, exciting though it is, will only be available to a limited number of families and the need is considerable. The hope being that this approach will eventually revoloutionise mental health service provision by evolving into a model of standard care.

March 2015 - What next?

On the 11 March the Kent team attended the first national Peer Supported Open Dialogue conference in London. This conference was a follow on from the NELFT conference the previous year and the audience had quadrupled reflecting the increased interest and growing enthusiasm for this approach.

The Shadow Minister for Health Luciana Berger opened the conference and there was a message from Jeremy Hunt the current Secretary of State for Health both were supportive of the approach and of provision for mental health in general. Tutors on the POD training initially spoke followed by psychiatrists from various trusts who are participating as students in the training. A number of questions arose from service users and carers who had clearly researched Open Dialogue. All four trusts involved in the training were present and involved in the day and we were represented by Yasmin Ishaq, Annie Jeffrey, Amanda Francis, Dr Beth Coleman and Jane Hetherington discussing the implications of POD for carers, service users, clinicians and managers.

The conference covered the theory behind Peer Supported Open Dialogue, the training, research, implementation and the way forward with the structure and funding of the pilots. It was a dialogical experience true to the POD model with the audience interacting and asking questions at the end of each section of presentations. The enthusiastic participation of the audience evidenced the burgeoning interest in POD, service users and carers expressing dismay that the pilot was not more extensive as it represents a possibility of hope.

New York, New York!

Jane Hetherington reports on an open dialogue conference held in New York. Find out how she will bring back lessons learned to help OD to be implemented within the Trust.

The International Society for Psychological and Social Approaches to Psychosis (ISPS) Conference March 18-22
Location - The Cooper Union, New York

I was really pleased to be able to deliver a workshop at this conference. I spoke about the challenges that Peer Supported Open Dialogue (POD) presented for us as clinicians, the training and ultimately delivering this approach in a multi disciplinary team incorporating peer support workers and carers. The workshop promoted some lively discussions especially in relation to implementation in an Australian setting and the difficulties. There were practitioners, service users and carers from a range of countries discussing research, services, innovations and experiences, with so much to absorb, reflect on and enrich practice.

The delegates were spoilt for choice with the multiplicity and variety of workshops, presentations and discussion forums. My colleague Tom, a psychiatrist from the North East London Foundation Trust (NELFT), and I, focused our attendance on Open Dialogue (OD) orientated presentations and some of the most respected names in OD were in attendance. We were particularly interested in workshops led by the New York base ‘Parachute Project’ whose models of OD in the differing New York boroughs are what we will be basing the UK pilot project on, although increasingly I feel that we will acquire our own model.

Tom and I also visited the Department of Health in Queens where we spent an afternoon with the POD train the trainer group, who kindly gave us time to ask questions about the implementation of their model. Our American hosts were generous with their time and experience and it was an informative session which answered some of our questions on a practical and pragmatic level. I felt that the trip and connections we made will prove significant in the future, certainly it made me consider a number of issues in relation to initial referral, assessment and supervision.

It is now over a year since we started our journey on this inaugural NHS peer supported Open Dialogue (OD) training in Birmingham with Russell Razzaque, Val Jackson and Mark Hopfenbeck. We have been fortunate enough to have enjoyed the input of some of the foremost figures in the field of OD - Jaakko Seikkula, Mia Kurtti and Kari Valtanen from the Finnish teams, Mary Olsen from the USA, Nick Putman from the UK and an excellent foundation in systemic thinking provided by Frank Burbach. The majority of us have now completed the four modules and the FRONTER (web based learning site) postings and submissions required. We have been required to examine ourselves, our motivation, thinking and formative experiences and to reflect on our professional practice and personal motivation. I think the course for all of us was more challenging than we anticipated and the Mindfulness/Yoga component was essential for managing our emotional wellbeing.

In KMPT we have set up supervision in accordance with the Finnish model, based on a goldfish bowl type exercise with the practitioners working in the family network meeting surrounded by the rest of the team. The inner group discuss the family and their impressions of what is happening therapeutically, the outer team then contribute their thinking and reflections on model fidelity. This was essential to ensuring our practice was adhering to the ethos of OD. We continue to see families in the four podlets we formed, these podlets consist of practitioners from a diversity of backgrounds and most podlets are having network meetings with two families.

We are going forward with the training. A number of people will be trained as mentors and a further tranche of training has been funded. Several other trusts are involved in the second training wave and there will be over a hundred further trainees. The aim in KMPT is for two teams to be ready to participate in the RCT by autumn 2016 these teams are currently planned to be situated in Canterbury and Medway. We continue to remain enthused as a team and determined to ensure that POD is embedded within our trusts because we feel this is the way forward for mental health provision within the UK.

Open Dialogue in Australia

Jane Hetherington, Principal Psychotherapist and Open Dialogue peer hasn’t let her holiday to Australia stop her spreading the Open Dialogue love!

“Whilst in Australia I took the opportunity to present to a number of Universities and training centres on the subject of Peer Supported Open Dialogue. Phil Benjamin from the Australian Branch of International Society for Psychological and Social Approaches to Psychosis (ISPS) organised these venues and I would like to thank him and other ISPS colleagues for hosting me. I spoke at Swinburne University, Latrobe University, the Bouverie Family Therapy Centre and the Institute of Applied Psychology in Sydney. There is considerable enthusiasm for the concept of POD in Australia and the talks were well attended by groups of professionals and those with lived experience.

“I was asked some extremely pertinent questions which made me consider what we have been doing here in the UK and particularly in KMPT in relation to the implementation of the model and how it can be managed in existing teams. I did not have all the answers, but I do not think the audience expected me too and there was a healthy discussion which allowed me to obtain a greater understanding of the Australian Mental Health System and funding issues. I met some really interesting people whom I intend to maintain contact with.”

www.isps.org.au

 

Jane Hetherington

2016 NELFT POD Conference

Impressions

The Kent POD team were as much in evidence at the second NELFT conference in London as they were at the first one. NELFT and KMPT comprise the two largest teams in the NHS POD training. There were presentations from families and clinicians discussing their experience of working with the Finnish model and the personal testimonies moved everyone, people were perceptibly tearful.

Annie Jefferies discussed how she feels POD with its emphasis on continuity of care and listening would have made a difference to her son's treatment. Dr James Osbourne spoke as a counselling psychologist with a clinical emphasis on the approach and the improvement in outcomes. Heather Jeays who is in the second tranche of students, spoke of her impressions of the training and the differences POD represented to her in comparison with standard treatment.

We talked about bringing power to the patient to encourage them not to be the passive recipients of treatment a departure from the paternalistic, medical model. Peer-supported Open Dialogue creates a new paradigm in treatment for the clinician too, encouraging the professional to return to their core Rogerian person centred values and to a greater satisfaction in their work. We explored how services are currently set up for the convenience of clinicians not for the benefit of the individual and this need to change.

Professor Stephen Pilling was there to explain in greater depth how the RCT would be organised in accordance with NICE guidelines and what would be required in order to receive the appropriate funding. KMPT will be part of the largest worldwide trial of the POD model within an NHS setting this is an exciting time for the Trust and the clinicians involved in the new teams which will be based in Canterbury and Medway.

ISPS Exeter Conference

I looked forward with considerable anticipation to the ISPS Exeter Conference. I always enjoy the annual conference as it is a place to interact with service users, carers and like minded clinicians to discuss psychosis, what it means in terms of a diagnosis and treatment options from a non medical model perspective. The discussions during workshops and over meals, are always stimulating and a learning experience. I come away enriched and more focused in my thinking about therapeutic interventions and the wide range of potentially helpful options.The thinking at this conference originates from an integrative perspective and does not promote CBT as the only approach to working with people that will produce successful outcomes. What I enjoy about this dialogue is the emphasis on the impact of mental health issues on the family and the service user's social network.

The Exeter Conference met expectations with presentations on family work, Open Dialogue, Peer Supported Open Dialogue and compassion based approaches. There was also much discussion on diversity and how the politics of Brexit had impacted on this. What I took away from one presentation was that due to government cuts starting 10 years ago many of the innovative projects that addressed BAME issues lost their funding. The same BAME difficulties remain but are no longer addressed through individual initiatives so there has been regression in this field.

Myself and Yasmin Ishaq had an extremely interactive experience in our own workshop when we presented on Peer Supported Open Dialogue in relation to the supervision model we have developed here in Kent. The audience were engaged with the concept of Peer Supported Open Dialogue and what it could offer to their own families. Carers were determined to take the discussion to the commissioning groups - the source of the all important money and therefore the catalysts for change.

Jane Hetherington.

Reporting on recent developments within Peer Supported Open Dialogue (POD)

It has been a while since I updated the Innovations section on recent developments within KMPT in relation to the training and a lot has happened..........

The  second tranche of trainees have nearly completed their POD training. These trainees come from a more generic background than the original group in that they are not predominantly EIS staff but from a number of services within the Trust. KMPT now has 4 mentors in training Paul Roberts, Dr James Osbourne, Yasmin Ishaq and myself and we have almost completed our course. The NHS POD training will continue to be rolled out on an annual basis to other Trusts and organisations both at home and abroad and KMPT will continue with its involvement.

The Trust has already won several awards for innovative practice in relation to the inception of POD within KMPT and the Board of Governors were presented to by a group from the POD training and are extremely supportive of the POD project.

We are also in the throes of setting up a generic Open Dialogue Service within KMPT these services will be centred initially in Canterbury and later in Medway. Yasmin Ishaq has been appointed service manager for the new team and is ideally placed to do so, as she has completed the POD training and has a long standing interest in Open Dialogue. The service will be based on the Finnish model and adhere to the Open Dialogue principles .This includes meeting with the client within 24 hours of referral and maintaining continuity of care with a group of trained POD practitioners involved in the regular network meetings. Individuals will be referred to this service in accordance with the requirements for a Randomised Control Trial (RCT) and those that do not receive Open Dialogue will receive treatment as usual. The purpose of the RCT will be to obtain NICE guideline approval, subsequently Open Dialogue would then be recognised in the same way as CBT is as a preferred treatment option. In addition to the RCT other quantitative and qualitative studies will be occurring.

Everything is now moving forward, exciting times are ahead.

Jane Hetherinton