Saturday, December 7, 2019

Comments by Nick Putman

Showing 2 of 2 comments.

  • Having been immersed in Open Dialogue for the past five years I have to say that my overriding impression has been that it is far from a quasi medical model approach. Yes, similar language to the medical model is used in some of the research/literature, but this is not a reflection of the daily work, where ordinary language is used and the emphasis is on connection and meaning, a far cry from the culture that the medical model tends to engender. Based on a number of conversations I have had with the founders of the Open Dialogue approach, I think that where similar language to the medical model is used, there are a number of reasons for this – to some extent I think that something has been lost in translation, but probably more pertinent is that there has been a deliberate attempt to speak the language of psychiatry in order to connect, and in the hope that interest in more dialogical approaches will develop within this field. In Open Dialogue network meetings you stay close to the language of the family/network, in order to further connection and understanding, and so it is only natural for those involved in Open Dialogue research to use a similar approach in attempting to connect with those using more conventional approaches. We can reason as to whether this is the best way of proceeding, and I myself have mixed feelings about this, but there can be no question that Open Dialogue is starting to make a difference to a good number of psychiatric services around the world, and most probably the language used has been significant in this regard.

    In addition to this it is important to remember that the Finns are passionate about public services and democracy – about the availability of high quality services to all. This is why Jaakko Seikkula speaks of the value of public services, and even of a ‘medical’ treatment system. I have never got a sense of ‘them’ and ‘us’ from the Finns who work in this way. Rather they would say that any of us could experience ‘psychosis’ given enough stresses/trauma in our lives. They want to be of service to others in a time of crisis, but right from the start they are seeking to empower the other, not themselves. They are not the experts, but rather the facilitators of a process, and if only a light touch is needed, this is all that will be offered. Having said this, I think that there is a good deal of skill/experience involved in such facilitation, so cannot agree that what we are seeing/involved in is a corporate stamping of “basic human characteristics or capacities” (though humanity is indeed at the heart of the approach).

    As the interest in Open Dialogue develops around the world it naturally engages those in grass roots movements, activists, peers, etc., who will have their own views about the relative benefit of a system of care over more informal networks of people coming together in the service of healing and growth. I have been inspired by many such networks, but I do also think that there is a place for a properly funded public services run along Open Dialogue lines. Put more simply, there is a role for healers in society, so I don’t think we should apologise for this – this is not necessarily a violation of the other. One of the reasons why Jaakko Seikkula and his colleagues advocate for public services is that, in responding to the other, to the needs of the family/network, it is important that we have a comprehensive range of practices, so that our response can be swift, flexible and sufficient. There is great responsibility in our responding, and we need to ensure that we have adequate resources. As someone working independently (with others) in the UK (whilst also working with those within the National Health Service), I am all too aware of the importance of this.

    With regard to the TM (or SM, ‘Service Mark’), the only place where this has been used is the US, and my understanding is that there are particular reasons for doing so in this context, which I am not party to, so can’t comment – it is not a feature of the development in any other country. Whenever an approach is being developed in a new context, I think there is a need to be protective of it, otherwise it can all too readily be eroded by the forces that be (I have seen this happen too often). Such protectiveness does of course need to be balanced out with an openness to local/cultural factors, but as I believe that Open Dialogue is at heart a cross-cultural approach (the affinity with many indigenous community based practices has already been mentioned), the emphasis for me will I think always be on trying to protect the integrity of an approach which makes so much sense to me. Having said this, Open Dialogue is a living organism, rooted in a wide range of practices. It has evolved over 30+ years in Western Lapland, and continues to do so, and as it starts to develop internationally this evolution will take many forms. I for one am excited to both witness and participate in the unfolding.

  • Whilst no formal cost-benefit analysis of Open Dialogue has been published, there is some national Finnish data which shows that it costs less to provide services in Western Lapland than in the rest of Finland. And this is just when you look at the data for the mental health service offered. When you take into consideration the data from the research published to date from Western Lapland, such as lower relapse rates, higher employment, far lower use of long-term medication, lower use of disability benefits, etc., it is, for me, clear that, when you look at the bigger picture, the cost savings will be considerable.