A recent article published in the journal BMC Psychiatry explores service user outcomes for a small-scale Peer Supported Open Dialogue program implemented within the UK’s National Health Service (NHS). The measures taken, including self-report questionnaires and questionnaires completed by social support system members and clinicians, found improvement across the board in the areas of wellbeing, social functioning, service satisfaction, and more.
“POD [Peer Supported Open Dialogue] is empowering of the service user and embraces a social network approach which brings together the social and professional network. This creates a space where service users and their network find words for their experiences. The aim of dialogic practice in Open Dialogue is to actively listen and respond, generating dialogue between all participants. This is unlike traditional treatments where methods or interventions are planned for a specific diagnosis to reduce symptoms or change thinking.
In the network meetings, clinicians reflect between themselves in the presence of the service user and their network, usually family members, with the aim of making sense of the crisis. Treatment decisions are made by all participants with the expressed aim of avoiding hasty treatment planning. POD is integrative and inherently democratic with transparent decision making,” the authors explain.
Open Dialogue (OD) as an alternative approach to treating mental health distress, particularly first-episode psychosis, has been suggested as a promising alternative to medication heavy care. For the uninitiated, OD is a practice model originating in Finland that emphasizes dignity for the person, a holistic community orientation, and shared dialogue and decision-making between service users, community members such as family/friends, and mental health professionals.
The current article provides an overview of a replication of the Open Dialogue program within England’s National Health Service, called “Peer Supported Open Dialogue” or “POD.” Though adhering to the core principles of Open Dialogue, POD also includes trained peer support staff.
The authors note that existing research on Open Dialogue outcomes is largely qualitative, with only six quantitative studies being performed over the years. Four of these were done by the creators of OD. In addition, many of the studies on OD do not adhere strictly to the original protocol and have variable inclusion criteria, making an overall assessment difficult. They state that more rigorous research into OD’s effectiveness is needed.
The objective of the current study was to examine the effectiveness of POD outcomes over the course of six months for service users as well as family and social networks. Measures in the form of questionnaires were collected relating to clinical outcomes, wellbeing, impact on daily routine, and family/social support network.
Fifty individuals participated in the study—a mix of service users, social network members, and clinicians. They were asked to complete outcome-based questionnaires before beginning POD treatment, at the three-month mark of treatment, and finally at the six-month mark of treatment.
54% of participants were male, and 94% were white British. The treatment program took place in the rural area of Kent in South East England.
All staff involved in POD underwent a one-year training course in the modality.
All participants completed the initial baseline measures, 80% completed the three-month measures, and 74% completed the six-month measures.
A measure of mental wellbeing found an improvement from baseline at the three-month mark, with a slight reduction at the six-month mark, but still higher than baseline.
Self-reported functionality related to work and social activities continued to improve throughout the treatment program. In addition, a measure that examines “health and social functioning” found significant improvement between baseline and the six-month point.
In terms of employment and education, at baseline, 22% of participants were employed full-time, and 12% were full-time students. After six months, 30% were employed, and 18% were in school.
Another measure found that there was reduced “clinician-reported symptom severity” from baseline to the six-month point, indicating improvement in mental distress over the course of the treatment.
One measure that assessed satisfaction with care received by the NHS program found that those associated with POD indicated a mean score of 9.19, while the mean 2017 national score for the NHS was 7.03. There was a reported increase in this satisfaction between the baseline and six-month points.
As another point of interest, over half of the network meetings, where service users met with POD staff to dialogue about their experience and mutually decide on future actions, were attended by carers from their community—spouses, parents, friends, adult children, other relatives, siblings, and more.
To summarize, all of the measures taken showed significant improvement throughout the POD program, and service users who took part expressed higher than average satisfaction with the care they received:
“National Health Service user experiences are measured each year using the CQC Community Mental Health Survey. Our observations of the scores show that service users rated the POD service more highly than other local and national data and suggests this approach may address some outstanding issues with mental health services around service user satisfaction.”
The authors did note challenges around implementing the POD program within the larger NHS system, which does not operate according to Open Dialogue principles or practices.
“A flexible, social network response to crisis care that includes peer support workers as a key component of the care, POD, with the continuity of the same POD clinicians building a shared memory of a family’s distress throughout care, represents a significantly different approach to mental health care in the UK.
Clinical outcomes were consistent across mental wellbeing and work/social adjustment (self-reported) and HoNOS scores (clinician-reported) and showed that this approach is clinically effective with significant improvements across all measures. As such, this study evidencing clinical outcomes and satisfaction for service users and their families supports the need for a full-scale randomized control trial research at a national level and augurs well for its findings.”
Kinane, C., Osborne, J., Ishaq, Y., Colman, M., & MacInnes, D. (2022). Peer supported Open Dialogue in the National Health Service: Implementing and evaluating a new approach to mental health care. BMC Psychiatry, 22(1), 138. (Link)