Last week I attended a conference. Nothing particularly unusual in that. This conference had soundbites like “Dialogue is the embodiment of love” or “The three key principles of dialogue are openness, authenticity and unconditional warmth”. Again, regular readers know that I’m quite comfortable with a bit of cosmic wisdom so nothing scary there.
Except that this was a NHS conference, one talking about care for patients with symptoms of psychosis or diagnoses such as schizophrenia. Somewhere you’d expect the talk to be about the tension between psychiatry versus therapy, medication versus talking.
On stage were a broad mix of healthcare professionals ranging from consultant psychiatrists and psychologists through therapists and social workers to peer support workers and carers. They were there to talk about a trial going on in 4 trusts in “Open Dialogue”. This is an approach which has generated a lot of headlines about being “anti-psychiatry” or “pill-shaming” those on medication but the reality turned out to be rather different.
Without going too deep in to the science I want to reflect on a few key points. In the Open Dialogue model the patient is at the centre of the care and members of their family and / or social network are involved in “network meetings” with healthcare professionals (and again I include peer support workers and advocates in that definition, they are being trained alongside clinicians). The emphasis is on patient independence and recovery from day one (they try to see referrals in 24 hours). There is also an expectation that everyone’s views are valid – at one point peer workers were described as co-therapists and whilst for some people that will feel uncomfortable, to me it indicated the inclusive nature of the approach
Many of the speakers reflected on how different it was meeting patients in their own environment, amongst family and friends rather than isolated in a care setting. One of the key things they all seemed to feel was that this approach took more time at first but led to better conversations and decisions which saved time in the long run. There was an admittance that many clinicians are uncomfortable with patients in distress. So a large part of the training in dialogic processes focusses on trainees working on their own issues separately so that they could truly be present when it came to care giving. (One person even spoke of the need to “untraumatise” the NHS workforce). Additionally there was a strand which talked about clinicians being able to let go of having an answer or treatment ready but instead seeing their role as setting up a space where solutions can arise.
At this point I should declare a couple of conflicts of interest. Much of the work around this develops studies by Gregory Bateson, someone I greatly admire. Additionally I have gained a lot from many conversations with Julie Drybrough and from her introducing me to the work of William Isaacs who describes dialogue as “the art of thinking together”. An approach that I think is fundamentally important in this age of social media and digital thinking.
The other interest is that I am a patient under secondary care for my mental health. Someone who dreams of getting several professionals in a room at once to discuss my case. Someone who dreams of being able to co-design / co-create the care that I get. Someone who dreams of having a clinical response which acknowledges my own expertise in my condition. I just want someone to talk to me, not at me.
Obviously there is much much more to the debate than I am presenting here. The trial is still very new and I wouldn’t qualify for the care anyway but across the many people I spoke to in the room there was a genuine sense that this approach could benefit many people. I for one will be watching the trial with interest.