‘Open dialogue is an opportunity for post-psychiatry evolution not anti-psychiatry revolution’

By Ash Holderness, a mental health social worker on a crisis and home treatment team in Lincolnshire

In a conference room in East Croydon, London, I start to discuss my own sensitivities, weaknesses and family history. The aim is to find connectedness with others, including those whose life stories seem so different to my own.

I struggle to understand the purpose of sharing in such a way and feel overwhelmed by fear, loneliness and a need to protect myself from sharing too much. It is in this moment I find myself asking: ‘Is this how mental health service users feel in the current system?’

I’ve just started the UK’s first three-year course on open dialogue, a social approach to supporting people experiencing mental health crisis. Guided by a team of Finnish therapists, I realised in that split second that it’s the process that’s important, not the aim.

The open dialogue learning style is very different from the more structured approach here in the UK, where our path and outcomes are laid out before us. As we discussed pieces of art we’d created, which reflect what is important in our life, I found myself increasingly able to open up, barriers were broken down and connections were made.

These elements are key to the open dialogue approach – the ‘skilled worker and patient’ relationship is broken down. It made me think about exposing myself as ‘more human’ with service users, allowing for weaknesses to be revealed.

‘Struggling identity’

As a social worker in a health-led team, I have struggled to find my identity and maintain the values that brought me into social work in the first place.

I enjoy the opportunity to be creative and flexible with the support I offer alongside my nursing colleagues. But, the dominance of the medical model and over-reliance on medicating social problems has posed numerous professional conflicts for me.

It has always been my opinion that social work is considered an afterthought in mental health care – an available ‘treatment’ option to health professionals that comes secondary to health-led interventions.

However, there does seem to be a real ‘sea change’ in the air as services continue to crumble under the pressure of ongoing austerity measures and increasing caseloads. During the training, there was a real feeling around the room that open dialogue presents an opportunity for ‘post-psychiatry’ evolution not ‘anti-psychiatry’ revolution.

Open dialogue aligns itself well to our social work values of diminishing power dynamics, viewing the problem in a systemic way and placing as much emphasis on the family as the individual.

‘Humanistic level’

At every moment on the course we are reminded to reflect as we listen and to share those reflections with each other. In my day-to-day social work practice, those reflections and personal conflicts are often left for supervision, rather than being an opportunity for dialogue with a service user.

The success of the open dialogue approach is partly due to the practitioner’s ability to connect with a person on a humanistic level. It is a skill that I felt I was beginning to learn as we practised again and again throughout the week.

‘Great position’

I do struggle to imagine some professionals being willing to open up in such a way though. It requires a complete culture change to transfer their power to the service user and their family, allow uncertainty and leave behind the current mechanised treatment options.

But as a social worker, I feel we’re in a great position to challenge the power dynamics that exist in mental health and champion an open dialogue approach. We cannot ignore the evidence from Finland and I hope this momentum continues.

Most importantly, we have to remember that service users are at the heart of this movement. The importance of peers with lived experience to drive this change is what separates it from just another therapeutic fashion.

Ash will be blogging about each residential week of his open dialogue training. If you’re interested in the approach visit www.opendialogueapproach.co.uk for more information.