5th Symposium on Open Dialogue5th Symposium on Open DialogueApproaches to Mental Health Approaches to Mental Health

Services ImprovementsServices Improvements `One Vision Many Voices``One Vision Many Voices`

Open DialogueOpen Dialogue The experience of TrialogueThe experience of Trialogue

Mental Health Trialogue Network IrelandMental Health Trialogue Network Ireland The experience of Open Dialogue The experience of Open Dialogue

Processes for an Irish Mental Health Processes for an Irish Mental Health ServiceService

Trialogue meetingTrialogue meeting

Open DialogueOpen Dialogue

As a form of open communicationAs a form of open communication As a therapeutic approachAs a therapeutic approach Service DeliveryService Delivery As a process to aid organisational As a process to aid organisational

developmentdevelopment As a process for community developmentAs a process for community development

Open Dialogue as communicationOpen Dialogue as communication

““where it is perceived as a joint action that joins where it is perceived as a joint action that joins people together in a temporary mutual world people together in a temporary mutual world experience. Participants have to be willing to experience. Participants have to be willing to engage in this dialogue or a situation needs to engage in this dialogue or a situation needs to be created where it can ensue” (Bakhtin 1981)be created where it can ensue” (Bakhtin 1981)

Subject to subject (with,not to!)Subject to subject (with,not to!) Co-creating and naming their worldCo-creating and naming their world Don’t have to abandon beliefs or valuesDon’t have to abandon beliefs or values

Open Dialogue as therapeuticOpen Dialogue as therapeutic

……..Dialogue with and about the client’s Dialogue with and about the client’s narrative, through listening and clarifying narrative, through listening and clarifying their story. Through generation of a mutual their story. Through generation of a mutual understanding an inevitable change is understanding an inevitable change is instigated by the expert clientinstigated by the expert client………………(Anderson and (Anderson and Goolishian 1992Goolishian 1992 ) )

Underpinning service delivery & Underpinning service delivery & Organisational Development….Organisational Development….

Western Finland Western Finland Open Dialogue Network based practice for people referred to Open Dialogue Network based practice for people referred to

services with ‘psychosis’services with ‘psychosis’ Open Network MeetingsOpen Network Meetings

Birmingham – Acute Inpatient CareBirmingham – Acute Inpatient Care Open Dialogue GroupsOpen Dialogue Groups

Dublin Acute Inpatient CareDublin Acute Inpatient Care Leadership Programme change management model – Leadership Programme change management model –

DCU/HSEDCU/HSE Patients and Clients Council Bamford Monitoring group Patients and Clients Council Bamford Monitoring group

Northern IrelandNorthern Ireland

As a process for community As a process for community developmentdevelopment

Just to be clear……….Just to be clear……….

Characteristics of Open Dialogue Characteristics of Open Dialogue Processes and ParticipationProcesses and Participation

The dialogue is based on give and The dialogue is based on give and take as opposed to one way take as opposed to one way communicationcommunication

All people concerned by the issue All people concerned by the issue under investigation should have the under investigation should have the opportunity to participateopportunity to participate

Participants are obliged to help other Participants are obliged to help other participants be active in the dialogueparticipants be active in the dialogue

All participants have the same status All participants have the same status within the dialogue arenawithin the dialogue arena

Experience is the point of departure Experience is the point of departure for participationfor participation

At least some of the experience the At least some of the experience the participant has when entering the participant has when entering the dialogue is seen as relevantdialogue is seen as relevant

It must be possible for all participants It must be possible for all participants to have an understanding for the to have an understanding for the topics under discussiontopics under discussion

(Gustavsen, 2001)(Gustavsen, 2001)

An argument can be rejected only after An argument can be rejected only after an investigation (and not for instance, on an investigation (and not for instance, on the grounds that it arises from a source the grounds that it arises from a source with limited legitimacy)with limited legitimacy)

All arguments to enter the dialogue must All arguments to enter the dialogue must be represented by the actors be represented by the actors (participants) present(participants) present

All participants are obliged to accept that All participants are obliged to accept that other participants may have better other participants may have better arguments than their ownarguments than their own

Among discussion issues can be the Among discussion issues can be the roles occupied by participants with no roles occupied by participants with no one exempt from such a discussionone exempt from such a discussion

The dialogue should be able to integrate The dialogue should be able to integrate a growing degree of disagreementa growing degree of disagreement

The dialogue should continuously The dialogue should continuously generate decisions that provide a generate decisions that provide a platform for joint actionplatform for joint action

Examples of non open dialogue Examples of non open dialogue approachesapproaches

Some community group practices Some community group practices Associations & voluntary groups Associations & voluntary groups Institutional norms & culturesInstitutional norms & cultures Routine protocol & practiceRoutine protocol & practice Hierarchical decision making Hierarchical decision making Interviewing to fit the boxes (monologue)Interviewing to fit the boxes (monologue) Ward roundsWard rounds Service access protocolsService access protocols Management committeesManagement committees Enforced democracy (majority/loudest rules)Enforced democracy (majority/loudest rules)

The creation of a community forum where The creation of a community forum where everyone with an interest in mental health everyone with an interest in mental health participates in an open dialogueparticipates in an open dialogue

www.trialogue.co

Developing a Mental Health Trialogue Developing a Mental Health Trialogue Network in Participating CommunitiesNetwork in Participating Communities

‘Mental Health Trialogue Network Ireland’ ‘Mental Health Trialogue Network Ireland’ Emerging as a process outcome of the leadership Emerging as a process outcome of the leadership

programmeprogramme 7 areas and then snowballing7 areas and then snowballing Integrating with existing Trialogue groups where they Integrating with existing Trialogue groups where they

existexist Local facilitation & sustainabilityLocal facilitation & sustainability Enabling interested people/groups to step outside their Enabling interested people/groups to step outside their

own bubbles to experience others views perceptions and own bubbles to experience others views perceptions and suggested solutionssuggested solutions

A communication networkA communication network Web, advertisement, local public area noticesWeb, advertisement, local public area notices

Parallel process to leadership teams in local mental Parallel process to leadership teams in local mental health communities with option for the Trialogue health communities with option for the Trialogue participants to become active in informing and participants to become active in informing and further developing community response to further developing community response to mental health issues within…mental health issues within…

Participating SitesParticipating Sites

South TipperarySouth Tipperary Dublin South CentralDublin South Central GalwayGalway DonegalDonegal Dublin South WestDublin South West MayoMayo West CorkWest Cork

Mental Health Trialogue NetworkMental Health Trialogue Network

Funded through GENIO Funded through GENIO Core project teamCore project team Steering groupSteering group Local community facilitationLocal community facilitation ParticipantsParticipants Interested othersInterested others

PROJECT AIMSPROJECT AIMS To facilitate the establishment of community

leaders in the area of mental health To develop a community forum using the

‘Trialogue’ processes To strengthen the voice of people with

mental health problems & families/ carers regarding needs & supports in their communities

To provide a focus for developing awareness and action around mental health within communities

HOW THE AIMS WILL BE HOW THE AIMS WILL BE ACHIEVEDACHIEVED

Establish monthly Trialogue meetings in 7 Establish monthly Trialogue meetings in 7 communities in Ireland during 2011communities in Ireland during 2011

  Create an online Mental Health Trialogue Create an online Mental Health Trialogue collaborative community accessible to collaborative community accessible to public public 

Provide a learning forum for leadership Provide a learning forum for leadership teams to develop community development & teams to develop community development & Trialogue facilitation skillsTrialogue facilitation skills

BENEFITS OF THE BENEFITS OF THE PROJECTPROJECT

Emergence of community leaders in relating to Emergence of community leaders in relating to mental health problems and community responsemental health problems and community response

Increased understanding of mental health problems Increased understanding of mental health problems among community membersamong community members

Increased capacity among people with mental Increased capacity among people with mental health and their families & carers to advocate for health and their families & carers to advocate for and determine supports needed in communitiesand determine supports needed in communities

Provision of a community focus for actions aimed at Provision of a community focus for actions aimed at developing mental health awareness and actiondeveloping mental health awareness and action

Creation of an online resource and Mental Health Creation of an online resource and Mental Health Collaborative NetworkCollaborative Network

As a result of participating in 2 or As a result of participating in 2 or more Trialogue Meetings …….more Trialogue Meetings …….

Peoples understanding of mental health and mental distress increasedPeoples understanding of mental health and mental distress increased SU= 64%, P = 84%, FM = 56%, Com 67%. SU= 64%, P = 84%, FM = 56%, Com 67%.

People are more informed about how people respond to, manage and cope People are more informed about how people respond to, manage and cope with mental health problemswith mental health problems

SU = 72%, P = 63%, FM = 89%, Com = 100%SU = 72%, P = 63%, FM = 89%, Com = 100% People are People are more aware of what is good and not so good about the mentalmore aware of what is good and not so good about the mental

health services in their community health services in their community SU = 64%, P = 73%, FM = 55%, Com = 100%SU = 64%, P = 73%, FM = 55%, Com = 100%

People have increased awareness of where and in what way people with People have increased awareness of where and in what way people with mental health difficulties experience stigma and discrimination in their mental health difficulties experience stigma and discrimination in their communitycommunity

SU = 71%, P = 68%. FM = 67%, Com = 100%SU = 71%, P = 68%. FM = 67%, Com = 100% People are more aware of who has a responsibility for promoting mental People are more aware of who has a responsibility for promoting mental

health and dealing with mental illness in their communityhealth and dealing with mental illness in their community SU = 43%, P = 69%, FM = 44%, Com = 66%SU = 43%, P = 69%, FM = 44%, Com = 66%

SU = service users; FM = family members; P = professional care providers; and Com = other interested community members

www.trialogue.co