Open Dialogue in the NHS and the Voluntary Sector

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After attending the first Open Dialogue training run by NELFT in Birmingham I left excited and eager to utilise my new skills and then came the frustrations. I found myself in a position that prevented me from utilising them as Early Intervention Services adopted the CBTp model. I felt increasingly estranged from the service and its enforced pathway guided by commissioners with little clinical experience and no understanding of therapeutic work, outcome measures being the sole criteria.

Kent was fortunate enough to set up the first Open Dialogue service in the country and this was a huge learning curve, unfortunately my role as Operational Lead for EIS prevented me from joining the team. Unaccountably the original plans for the OD team to sit within Psychosis services did not come to fruition. The whole Open Dialogue journey has been a series of frustrations for me and I have found it quite difficult to accrue the necessary clinical hours. I have also because of NHS politics always appeared to be in the wrong role in the wrong Trust and unable to pursue my ideal…..the Helsinki International 2 year training resulting in me being an over qualified person unable to pursue my Open Dialogue ambitions.

My way forward with Open Dialogue and my training can only be through writing about it unless I attempt to set up a local Open Dialogue based family service. There is certainly in my area a need for such a service as the statutory sector no longer provides family therapy and the only family interventions are provided by Early Intervention Services in the form of Behavioural Gamily Therapy which is a 10 session model based on a behavioural framework with homework, exercises and a formulaic structure. B.F.T. is a useful intervention for some families who find it useful when considering ways of managing a mental health diagnosis, the behaviour surrounding it and the future prognosis. It is however at the opposite end of the therapeutic spectrum to Open Dialogue and as such has a restrictive remit.