Dr Russell Razzaque, Consultant Psychiatrist and Associate Medical Director, North East London NHS Foundation Trust, will give a presentation on the Open Dialogue method of treatment.
Minutes:
The Associate Medical Director at NELFT explained that the cost of mental ill health to society was likely to double over the next 10 years. Funding for services was also reducing so it was necessary to look at more cost effective ways of providing services.
NELFT managed most people in the community and hence had the second lowest bed base in the UK. Studies had shown that people who had better social and family networks had better mental health outcomes in the long run. The National Institute of Clinical Excellence had therefore recommended that more family therapy should be provided but there were cost implications to this. A survey by the Care Quality Commission had shown that only 58% of service users had family or friends involved in their care.
The Open Dialogue technique had started in Finland where staff had been trained in family therapy and related skills. A patient’s family was at the heart of the care provided and this led to better outcomes. 74% of people treated under Open Dialogue were discharged within two years. The system was now used throughout Scandinavia and also in Germany and the USA.
The core principles of Open Dialogue included the provision of immediate help and the involvement of social or family networks. It was also important to ensure psychological continuity with the same team responsible for a person’s treatment. Therapists were also trained to use the dialogism technique whereby everyone’s voice was able to be heard.
Open Dialogue also allowed the flexibility and mobility for a user to take charge of their own care. Clinicians were also trained in the Mindfulness technique and made use of peer support whereby people with experience of mental health issues joined the team.
A proportion of mental health teams in Havering and Waltham Forest had now been trained in Open Dialogue and it was proposed to roll out the service to the rest of the NELFT area over the next year. NELFT training in Open Dialogue comprised a four week residential course which trained its first cohort of students in October 2015. Approximately 90 further members of staff were due to be trained this year. A post-graduate diploma in this area was also being developed with London South Bank University.
Initial feedback from service users had been very positive with patients becoming advocates for the service and considerable positive press coverage being generated. Staff reaction had also been very positive. The Department of Health had also shown interest and full roll out of Open Dialogue in trial areas would take place by January 2017.
Referrals would be made to the Open Dialogue staff instead of to a mental health crisis team. It was noted that in other countries communities had successfully developed of people with similar mental health issues. Similar communities were also now seen in Nottingham and Somerset. The Open Dialogue Technique was supported by the Care Act and officers agreed that it was important that service users received continuity of care.
Costs of the Open dialogue technique would be monitored and it was accepted that costs at the outset may be higher than alternative treatments. The Associate Medical Director felt however that the technique would reduce the costs of services in the long term. It was emphasised that the same team would be able to continue to treat people as in-patients.
It was AGREED that open dialogue be scrutinised again by the Committee at its meeting in January 2017 in order to consider the results of the trial of the service.