Open Dialogue in Nottingham

“The name Open Dialogue was first used in 1995 to describe two key features of the approach: the use of open family/network meetings and a set of principles for organising the whole psychiatric system that made dialogue possible.” Nottingham Open Dialogue group, September 2013

Back in early September I wrote about the conference I went to in Nottingham – Psychiatry beyond the current paradigm. One of the workshops at the event focussed on an innovative approach to mental distress and crisis work called Open Dialogue, and I promised to write more about it in a future post – so here goes.

Before going to Nottingham I had read briefly about the approach in Robert Whitaker’s book – Anatomy of an Epidemic. “Western Lapland in Finland has adopted a form of care for its psychotic patients that has produced astonishingly good long-term outcomes.” You can read more on Robert’s website here. Robert has subsequently referred to the Open Dialogue approach again in blogs and other writings, quoting it as a clear mandate for change. 

So, what happened at Nottingham? Well, first of all, hour one of the session was absolutely Powerpoint free. That was refreshing in itself. A group of people have been meeting informally in the city to look at what is happening in Finland, and several of them had agreed to lead this workshop. They introduced themselves, and explained that they were considering how Open Dialogue could be put into practice locally. They educate themselves at meetings, having a mailing list of about a hundred, and a core 16 – 18 people attend the meetings regularly. Originally they began as people with “lived experience”, but the group has now expanded to include some professionals “which has changed the dynamics”. 

What followed for the first half of the workshop was a dramatisation and replaying of an actual Open Dialogue meeting which had taken place in Finland some years ago. This was extremely powerful, as for those of us attending it really felt as if we were watching and listening to an actual meeting. The professionals involved listened for a long time without saying anything at all to both the person in distress and the close family members. Eventually, when they did speak, they shared their views amongst themselves and allowed the person and his family to listen in. Further dialogue between the whole group then followed, and throughout the session the sense of absolute crisis seemed to gradually ebb away through use of this continued dialogue. There is no video of the workshop, but if you want a feel read “The Story of Pekka and Maija” on pages 411- 414 of Jaakko Seikkula and Mary E. Olson’s article about the approach.

The second half of the Nottingham workshop was used to explore the Open Dialogue approach in more detail and for this a presentation was used, but again group members took turns to explore the different areas. Some of the key points for me were:

• Psychosis is a temporary, radical disengagement from shared communication practices.
• The need to create safety/trust to allow people to express deep fears.
• Stay with the situation as it is, and allow it to develop (without using specific “tools”).
• The reflection that the team does is in the family meeting.
• Results have been better for those who took no neuroleptic medication or had it at a later point.
• Is the medication for the sake of the individual or for those around them, including the team?

The group reported an 85% recovery rate for psychosis using this approach. So that, rather than a growing number of people going on from psychosis to be labelled as “schizophrenic”, there are actually very few people with this diagnosis in this area of Finland. It is actually disappearing.

A film-maker called Daniel Mackler has produced a number of videos on Open Dialogue, some of which are available on the web. I particularly enjoyed his interview of Jaakko Seikkula, Professor of Psychotherapy in Finland (author of the article quoted above), in which Jaakko states: “All of us could have psychotic problems! Psychosis is an answer to a very difficult life situation.” 

I was truly impressed by what the Nottingham group had found out so far, and how they conveyed their learning at the workshop. You can find further links to documents about Open Dialogue on our new website page here – and thank you to Nottingham Open Dialogue for sending us some of these. What can we do in Powys to bring this innovative approach a little closer to us…? Do you have ideas about this? Let us know by commenting below.

Meanwhile, to finish….  Monica Cassani, “a social worker and … a person whose life was severely ruptured by psychiatric drugs”, created the BeyondMeds blog and posts about the mental health system in the United States, and alternative approaches such as Open Dialogue. This week in the UK the BBC reported on the need for more psychiatric beds – in England…. I’m inclined to agree with Monica’s view that maybe, if the Open Dialogue approach was widely adopted just as has happened in Western Finland, then the psychiatric hospital beds (wherever they are in the world) would lie empty…

Top mental health books: Part 1

I've been on holiday this week - the plan was to sow all my veg for the coming season. But it's been so cold that not a single seed has gone in!

So, plan B. Reading. I asked my colleague Laura (she is much more well-read than me!) to recommend some of her favourite mental health books - which she has. And then I thought - it would be good to share them with a wider audience. So, here it is, the first of an occasional series of top reads on mental health:

Living with Voices: 50 Stories of Recovery 
Published by PCCS books in association with Birmingham City University. There is a range of contributors, including Professor Marius Romme, Dr Sandra Escher, Jacqui Dillon and Professor Merwyn Morris. 
Laura says: I think this is a great book, I couldn’t put it down. It gives so much insight into people's experiences and in my opinion shows how questionable the level of medicalisation that we do around these behaviours, thoughts and emotions is (i.e. the view of voice hearing as a sypmtom of mental illness). A bit like your grief post - the people’s stories in this book tell us about personal trauma and stress and in my opinion their very human responses (e.g. hearing voices) to these adversities rather than a symptom of an illness.

Thinking About Suicide: Contemplating and comprehending the urge to die 
By David Webb, published by PCCS books. 
The author completed the world’s first PhD on suicide by someone who has attempted it. 
Laura says: I found this book really interesting and it really made me question just how dangerous some of our knee jerk responses to people talking about wanting to die might be. It also made me think more deeply about responsibility and confidentiality. Could our reactions (i.e. individuals and services) and actions (e.g. sectioning, treatments) stop people from being able to openly and honestly talk about their feelings of wanting to die? How valuable is it for people considering suicide to be able to talk about these feelings without fear of what others might do in response? 

The Myth of Mental Illness by Thomas Szasz and Szasz under Fire edited by Jeffery A Schaler
Published by Harper Collins and Open Court Publishing respectively. 
Thomas Szasz was a psychiatrist and academic who criticised the medical approach to treating mental distress. 
Laura says: I can honestly say that Thomas Szasz changed my life by changing my ideas. When I first read The Myth of Mental Illness I found it hard going, his views were so alien to everything I had ever understood about mental illness since my first experiences of psychiatry in my early teens. Szasz’s ideas challenged everything. My issues with the book are not though a reflection on his writing, he is one of the most clear and logical authors I have every come across.  As I read other books about these ideas my understanding became clearer and I particularly found the book Szasz Under Fire useful.

Anatomy of an Epidemic
By Robert Whitaker, published by Broadway Books. 
This award-winning journalist explores why with every passing year so many more Americans are labelled as "mentally ill", and considers whether the increasing use of psychiatric medicines could be contributing to this rise. 
Laura says: Robert Whitaker would be a must for me. I cannot recommend this highly enough.

Trauma - From Lockerbie to 7/7: How trauma affects our minds and how we fight back
By Gordon Turnbull and published by Bantam Press.
Laura says: This book was my introduction to the subject of post traumatic stress disorder in any detail and I became interested in the similarities between this diagnosis and other "mental illness" diagnosis. I also found it fascinating to read the journey of PTSD as a "mental illness" diagnosis in and out (and in again) of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Gordon’s use of people’s live experiences alongside his own clinical knowledge journey are really thought provoking. His insight into why two people might experience the same external trauma and yet respond and cope very differently is also in my opinion very relevant to our wider understanding of mental health.

So, this should get us started! We'll post again in future with more recommended reads, and also include some fiction works.  In the mean time we will be ordering copies of these books at our local Powys libraries, so if you want to get hold of a copy why not get in touch with your library, details of which you can find here.

If you have any reading recommendations that you think we should share then please do get in touch.
Happy reading from all at Powys Mental Health!

PS: for those still troubled about the gardening... you could always try Cold Climate Gardening by Lewis Hill....